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He must have a doctor over there he really likes.
The Shop
Wonder how he went about it last time? Couldve change the method for this time
https://youtu.be/EZ36BPIoRF0
Hardcore!
Good luck Deano, your 150 ride in Premix made me a fan.
Well, they are definetly not wussies !!
Damned I was hoping it was less serious... I wish him a quick recovery, I really hope he gets a really good second half of the season.
http://m.youtube.com/watch?v=jdiB3cISeBk
Pit Row
Unfortunately, nothing yet beats natural tissue -- whether it be your own or a donor graft. Most Ortho surgeons would strongly advise against synthetic grafts... So I hope that's not what he's doing!
we give PRP (platelet rich plasma) injections in our office and in the Operating Room. They work really well in certain applications. Pretty cool stuff. Not covered by insurance for the most part (yet?), so guys charge whatever they can get for it (which is usually in the realm of $1,500-$3,000)
Works great in knees!
Lots of info on this subject of non tissue based ACL's..Some of that is below. Looks like the best bet is your own stuff. Keep it real! )
Artificial materials
The beginning: carbon fibres
The advent of artificial ligaments dates back to the beginning of the 20th century, when silver and stainless wires, nylon and silk strings and various synthetic fibres were used to create artificial grafts [10]. However, the unsatisfactory results and the high rate of early ruptures confined these initial attempts to the stage of animal experiments, and these materials were never adopted in clinical trials.
In the 1970s the interest for synthetic grafts led to their introduction as substitutes for biological human tissue. The increased appeal of these supports resulted in the commercialization of products such as Proplast ligaments (Vitex-Inc, Houston, TX, USA) made of Teflon and carbon and Polyflex (Richard, Memphis, TN, USA) made of polypropylene. Results were scarce for both methods which had to be withdrawn from the market due to their high rupture rate and inflammatory reaction in the surrounding tissues. Experimental studies conducted on these materials showed their unsuitable mechanical properties.
In 1977, Jenkins et al. [11] developed an artificial ligament made of carbon fibre (Intergraft, Osteonics Biomaterials, Livermore, CA, USA). After being initially employed for tendon sutures, its use was then extended to ligament reconstruction in the knee and other joints.
In 1981, Dandy et al. first implanted a carbon-fibre reinforced substitute for ACL with an arthroscopic procedure [12].
However, after preliminary encouraging results, serious sequelae were observed during clinical application. It has been demonstrated that the poor resistance to torsion forces caused an early rupture of the fibres leading to carbon deposits in the liver and inflammatory synovitis in the knee joint [13].
Neither the subsequent attempt to combine this material with autologous tissue nor the association with bio-adsorbable polymers on the ligament surface could prevent the significant side effects associated with these grafts. For this reason these materials were completely abandoned.
Gore-Tex
As carbon fibres were overtaken and surgeons increasingly performed ACL reconstruction arthroscopically, new materials came in.
In 1986, ligaments made by expanded polytetrafluorethylene (PTFE) (Gore-Tex, W.L.Gore, Flagstaff, AR, USA), a material already adopted in vascular surgery, were approved in the United States by the Food and Drug Administration (FDA) for the use in patients with previously failed autologous ACL reconstructions.
The Gore-Tex ligament is made by a single strand of PTFE wounded into multiple loops. It was designed as a true prosthesis and implanted to permanently replace the natural ACL [14]. It was supposed to promote immediate fixation and early load-bearing capacity. These grafts have an ultimate tensile strength of 5300 N, higher than any other commercial artificial ligament [15]. It should be noted that a natural ACL has a tensile strength of 630 N in adults [16] and 1730 N in the young population [17] (Table 1). In addition, its stiffness of 322 N/mm and its ultimate strain of 9% confer to the graft an excellent postoperative stability immediately and an early load-bearing capacity; thus explaining their initial spread as first reports in 1983 documented their encouraging short-term results.
Table 1
Table 1
Mechanical properties of synthetic grafts compared to natural ligaments
Ahlfeld et al. [18] followed 30 patients with a Gore-Tex ACL graft, and two years after the implant documented only one prosthetic breakage. Glousman et al. [19] reported a prospective study on the implant of 82 PTFE ligaments with an 18 month follow-up (range 12–30), noticing an immediate improvement of objective and subjective parameters. Complications included four ruptures, seven major complications (8%) and 14 revision operations (17%). Similar results were reported by Woods et al. [20] in a two-year follow-up on 33 patients. After preliminary good results, they observed a worsening in knee stability. Ahlfeld et al. [21] followed up 30 patients with a Gore-Tex ACL graft and two years after the implant observed only one prosthetic breakage. Similarly, Friedman [22] reported the results of 103 Gore-Tex ACL ligaments with a follow-up of 16 months documenting only three ruptures. Using the same graft material, Ferkel et al. [23] performed 21 second look arthroscopies 11 months after surgery and found the ligament partially damaged in six knees and completely ruptured in four cases.
Soon, mechanical properties of these grafts were recognised as unsuitable, as failures were related to mechanical fatigue due to the lack of tissue ingrowth and to the presence of wear debris.
With a two-year follow-up after the implantation of 41 Gore-Tex ligaments, Indelicato et al. [24] stressed the possibility that these devices were susceptible to breakage and correlated the findings of synovial reaction found in nine patients to the presence of PTFE particles. Paulos et al. [25] noted an improvement of subjective and objective criteria in less then 50% of the 188 patients followed-up for four years, reporting a total complication rate of 76% in patients that had already previously undergone ACL reconstruction. Sledge et al. [26] reported a rupture rate of 29% in their five-year follow-up and discouraged future implantation of these devices. Two cases of tunnel osteolysis were described by Seemann and Steadman [27] with the finding of a progressive tunnel enlargement leading to late failure. Wilson et al. [28] described an inguinal limphoadenopathy in two patients after Gore-Tex ligament implantation in the knee joint. Microbiological and hystological examinations demonstrated the presence of PTFE particles in the lymphonode, proving the occurrence of complications in sites distant from the knee.
The Gore-Tex graft was withdrawn from the market in 1993 as well as the Gore-Tex CD, the second-generation ligament. Since then the use of this material has been completely abandoned in knee instability surgery.
Dacron
A different approach in the development was adopted for the Dacron ligament (Meadox Medicals, Oakland, NJ, USA; Stryker Corp., Kalamazoo, MI, USA), initially employed in acromio-clavicular joint injuries and in tendon reconstructions. This ligament, approved in 1989 in the United States by the FDA, is made of polyester and is designed to replace the ACL permanently. The graft is composed of an 8-mm diameter sleeve of loosely woven velour with a central core made of four tightly woven tapes. It has a mean ultimate tensile strength of 3,631 N and a mean ultimate elongation of 18.7% [15, 29] (Table 1).
Initial reports have shown encouraging results in the short term. A study by Lukianov et al. [29] reported the results at a mean follow-up of 28 months in 41 patients who underwent ACL reconstruction with a Stryker Dacron ligament prosthesis. In 75% of the patients Lachman, anterior drawer, and pivot shift tests were found negative.
However, in 1991, Arnauw et al. [30] studied 57 patients with an ACL Dacron prosthesis and observed a rupture rate of 40% 18 months after surgery.
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