Anterior cruciate ligament

NANOTECHNOLOGY USED TO ENGINEER ACL REPLACEMENTS

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Connecting the femur to the tibia, the anterior cruciate ligament (ACL) rupture is one of the most devastating injuries in sports. No other injury has sidelined more athletes for a season or even the rest of a career. And ACL sprains and tears affect more people than just the pros. According to the American Association of Orthopaedic Surgeons, more than 250,000 ACL surgeries are performed annually in the United States, totaling up to more than $500 million in health care costs each year.

Not only is the ACL inelastic and prone to popping, it is incapable of healing itself, causing surgeons to rely on autografts for reconstruction. Most common is the bone-patellar tendon-bone (BPTB) graft, in which the surgeon removes part of the patellar tendon to replace the damaged ACL.

“BPTB autografts have a high incidence of knee pain and discomfort that does not go away,” said Guillermo Ameer, professor of biomedical engineering at the McCormick School of Engineering and professor of surgery at the Feinberg School of Medicine. “By saving the patient’s patellar tendon and using an off-the-shelf product, one may have a better chance of preserving the natural biomechanics of the knee.”

Ameer and his research team are working to engineer such a product by combining three components: polyester fibers that are braided to increase strength and toughness, an inherently antioxidant and porous biomaterial previously created in Ameer’s lab, and calcium nanocrystals, a mineral naturally found in human teeth and bones. His work is described in the paper “A biodegradable tri-component graft for anterior cruciate ligament reconstruction,” which was published in the Nov. 21 issue of the Journal of Tissue Engineering and Regenerative Medicine.

During ACL reconstruction surgeries, tunnels are drilled into the femur and tibia bones to hold the new ligament in a fixed position. Ameer created a bone-like material by combining his antioxidant biomaterials with the calcium nanocrystals; he then embedded braided polyester fibers into it. The artificial ligament’s bone-like ends healed to the native bone in the drilled tunnels, anchoring the ligament into place.

By studying an animal model, Ameer and his team noticed that the animal’s natural bone and tissue cells migrated into the pores of the artificial ligament, populating it throughout and integrating with the bone tunnels. While longer-term studies are necessary to evaluate the potential use of the approach in humans, Ameer is optimistic about the results.

“The engineered ligament is biocompatible and can stabilize the knee, allowing the animal to function,” Ameer said. “Most importantly, we may have found a way to integrate an artificial ligament with native bone.”

Scientists have discovered a new body part.

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Scientists have discovered a new ligament in the human knee, which seems to play an important role in patients who suffer ligament injuries and their knees continue to ‘give way’ even after treatment.

The discovery was made by orthopaedic surgeons Dr Steven Claes and Professor Dr Johan Bellemans of the University Hospitals Leuven, who have been conducting research for the last four years into serious anterior cruciate ligament (ACL) injuries.

They studied 41 cadaveric knees using macroscopic dissection techniques to examine why some patients continue to suffer the pivot shift, where the knee gives way during physical activity.

ACL tears are common among athletes and those who play sports such as basketball and football.

Dr Claes and Dr Bellemans followed on from the work of French surgeon Paul Ferdinand Segon in 1879, who penned an article that suggested an additional ligament may exist on the anterior of the knee.

Orthopedic surgeons find a new ligament that may explain why knees ‘give

Their research, published in the Journal of Anatomy, shows the new ligament now known as the anterolateral ligament (ALL) was present in all but one of the 41 knees.

Subsequent research shows that pivot shift of the knee in patients with an ACL tear is caused by an injury in the ALL ligament.

The study concluded: “Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.”

Dr Claes and Professor Bellemans are currently working on a surgical technique to correct ALL injuries, which could be ready within the next seven years.

Google Glass Used To Livestream ACL Surgery.

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Google Glass is finding its way into operation rooms: A surgeon in Ohio recently became one of the first to livestream an operation and use the technology to consult with a colleague.

On Aug. 21, Dr. Christopher Kaeding, director of sports medicine at Ohio State University Wexner Medical Center, wore Google Glass — a wearable computer that has a frame similar to traditional eyeglasses — as he performed surgery on the anterior cruciate ligament (ACL) in the knee of a 47-year-old woman.

The procedure was livestreamed to a group of medical students, who watched on laptops, and to Dr. Robert Magnussen, an assistant professor of clinical orthopedics at Ohio State, who watched from his office.

During the operation, Kaeding consulted with Magnussen about what he was seeing during the surgery.

Kaeding said he did not find wearing the device to be a distraction.

“To be honest, once we got into the surgery, I often forgot the device was there. It just seemed very intuitive and fit seamlessly,” Kaeding said in a statement.

The device does not have lenses, but instead, has a small glass screen that sits above the right eye. Using voice commands, wearers of Google Glasscan pull up information on that screen like they would on a computer. The device also has a camera that can take photos and videos that show the viewpoint of the user. So far, a select group of about 1,000 people have had the opportunity to test Google Glass. One of Kaeding’s colleagues applied and was accepted as a tester, and the two partnered for the surgery.

One day, doctors may use the technology to view X-rays, MRI images or other medical information about their patient as they conduct surgeries, although this was not done in the current surgery.

“We just have to start using it. Like many technologies, it needs to be evaluated in different situations to find out where the greatest value is, and how it can impact the lives of our patients in a positive way,” said Dr. Clay Marsh, chief innovation officer at the medical center.

In June, a doctor in Maine used Google Glass to livestream a surgery on Google Hangout. The surgery was a gastrostomy, a relatively simple procedure that involves the placement of a feeding tube into a patient’s stomach.

Watch the video on Youtube. URL: http://www.youtube.com/watch?feature=player_embedded&v=DbQY1ay8Sew

Source: http://www.huffingtonpost.com