Mesenchymal stromal cells and platelet-rich plasma promote tendon allograft healing in ovine anterior cruciate ligament
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Mesenchymal stromal cells and platelet‑rich plasma promote tendon allograft healing in ovine anterior cruciate ligament reconstruction Adam T. Hexter1,6 · Anita Sanghani‑Kerai1 · Nima Heidari2 · Deepak M. Kalaskar1 · Ashleigh Boyd1 · Catherine Pendegrass1 · Scott A. Rodeo3 · Fares S. Haddad4 · Gordon W. Blunn5 Received: 3 September 2020 / Accepted: 24 November 2020 © The Author(s) 2020
Abstract Purpose The effect of bone marrow mesenchymal stromal cells (BMSCs) and platelet-rich plasma (PRP) on tendon allograft maturation in a large animal anterior cruciate ligament (ACL) reconstruction model was reported for the first time. It was hypothesised that compared with non-augmented ACL reconstruction, BMSCs and PRP would enhance graft maturation after 12 weeks and this would be detected using magnetic resonance imaging (MRI). Methods Fifteen sheep underwent unilateral tendon allograft ACL reconstruction using aperture fixation and were randomised into three groups (n = 5). Group 1 received 10 million allogeneic BMSCs in 2 ml fibrin sealant; Group 2 received 12 ml PRP in a plasma clot injected into the graft and bone tunnels; and Group 3 (control) received no adjunctive treatment. At autopsy at 12 weeks, a graft maturation score was determined by the sum for graft integrity, synovial coverage and vascularisation, graft thickness and apparent tension, and synovial sealing at tunnel apertures. MRI analysis (n = 2 animals per group) of the signal–noise quotient (SNQ) and fibrous interzone (FIZ) was used to evaluate intra-articular graft maturation and tendon–bone healing, respectively. Spearman’s rank correlation coefficient (r) of SNQ, autopsy graft maturation score and bone tunnel diameter were analysed. Results The BMSC group (p = 0.01) and PRP group (p = 0.03) had a significantly higher graft maturation score compared with the control group. The BMSC group scored significantly higher for synovial sealing at tunnel apertures (p = 0.03) compared with the control group. The graft maturation score at autopsy significantly correlated with the SNQ (r = − 0.83, p 75%)
1.0
Partial rupture
25–74%
0
Complete rupture ≤ 25%
– No elongation of a sufficiently thick graft Partial elongation of a sufficiently thick graft or no elongation of a relatively thin graft Obvious elongation of a thin graft
Moderate synovial sealing (25–75%) Low synovial sealing ( 75% circumference), the second highest mark was for a partial sealing (25–75% circumference) and the lowest mark was for low sealing (
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