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Nanomedical Biological Device in Development for Torn ACL Replacement. Francine Goulet , Ph.D., pht. INTRODUCTION.

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slide1

NanomedicalBiologicalDevice in Development for Torn ACL Replacement.

Francine Goulet, Ph.D., pht

slide3

Ligaments, including ACL, extend between adjacent bone structures and serve a primary function of providing appropriate stability to the joints, especially when subjected to loads in tension or upon torsional movement.

Type I collagen can be regenerated after tissue injury.

However, the anterior cruciate ligament (ACL) has little ability to heal itself.

slide4

ACL REPLACEMENT

100, 000 total ruptures / yr (USA)

50,000 reconstructive surgeries / yr (USA)

slide8

Therapeutic options

  • Synthetic prostheses
  • Carbone
  • dacron
  • LAD
  • Allograft
  • Autograft
slide9

Option usedoften

1/3 patellar tendon + patella and tibia fragments

slide10

Clinical drawbacks

  • Knee joint fibrosis
  • Patellar impegement
  • Anterior knee pain
  • Patellar fracture
  • Patellar tendon’s rupture
  • Quads weaknesses
slide11

ACL : complex features

  • Ultrastructure:
  • Fibrocartilage
  • Sharpey’s fibers
  • Vascular network
  • Nervous receptors
  • Histological content:
  • Fibroblasts
  • Collagen fibers
  • Proteoglycans
  • Elastin…..
slide12

ACL: Knee stabilizer

  • Average length: 32 mm
  • Average diameter: 11 mm
  • Diam. at its insertions: 23 mm (femoral) and 30 mm (tibial)
  • Functional limits:
  • -Max. elongation: 6% (about 2 mm)
  • -Max. load: 1730 N (390 pds)
  • -Walking: 169 N
  • -Intensive sport: 400-500N
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« LIGAMENTISATION » POST-IMPLANTATION

6 weeks; Vascularisation of the implant

30 weeks: histological and functional recoveries

Questions:

Innervation:?

Mechanisms?

slide14

ACL tissue engineering

Tissue engineering seems to be a promising alternative to produce ACL/ligament models:

- for fundamentalstudies in vitro;

- to develop tissue-emgineeredhuman ACL substitutes

slide15

ACL tissue engineering

To understand ACL healing and to establish new options for torn ACL replacement, the potential of tissue-engineered collagen scaffolds has to be assessed in vitro and in vivo.

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Tissue-engineered ACL

Appropriate scaffold is needed to provide support and promote cell adhesion, migration and growth, leading to tissue regeneration.

The scaffold must be biocompatible, biodegradable, suitable for cell attachment, and have a three-dimensional, porous structure.

Since collagen is a major structural element in so many tissues and organs, collagen fibers are a logical choice for scaffolds.

slide17

Objective:

Develop a new alternative for torn ACL replacement through the tissue-engineering approach.

Hypothesis:

Based on our expertise with tissue-engineeredhumanepidermal substitutes, wepostulatedthat ACL regenerationcanbeachieved by providing a biocompatible scaffoldthatcanbecolonized, remodeled and renewed by living cells in situ post-grafting.

slide23

Collagenfibersalignment

Before grafting

Native ACL

Periodicity: 67 nm

© F.G./LOEX