ISAKOS Congress 2021

2021 ISAKOS Biennial Congress ePoster


Biologically Augmented Suture for Ligament Bracing Positively Effects Human Ligamentocytes and Osteoblasts in vitro

Alexander Otto, MD, Neufahrn, Bavaria GERMANY
Mary Beth McCarthy, BA, Farmington, United States of Ame UNITED STATES
Joshua B. Baldino, PharmD, Newington, CT UNITED STATES
Julian Mehl, MD, Munich, Bavaria GERMANY
Lukas Nawid Muench, MD, Munich GERMANY
Robert A. Arciero, MD, Farmington, CT UNITED STATES
Augustus D. Mazzocca, MS, MD, Farmington, CT UNITED STATES

Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, UNITED STATES

FDA Status Cleared


This study provides in vitro data on a new treatment concept of biologic augmentation for acute ligamentous lesions treated with ligament bracing.

ePosters will be available shortly before Congress



Recently, ligament bracing as a treatment for acute ligament tears in multiple joints has emerged. An outstanding advantage is that the applied suture material is in close proximity to the injured ligaments. The purpose was to evaluate the response of human ligamentocytes (HLs) and osteoblasts (HOBs) after biological augmentation with thrombin, concentrated bone marrow aspirate (cBMA), or platelet rich plasma (PRP) on two different types of suture material used for ligament bracing.


Uncoated (U) and collagen-coated (C) suture tapes were augmented with either thrombin (T), cBMA (B), PRP (P), or a combination of these three (A), while platelet poor plasma was used as a source for fibrin (F) in each assay. Previously cultured HLs and HOBs were added with a defined density and assayed after the required time period for adhesion, proliferation, and alkaline phosphatase activity, respectively.


Biological augmentation of uncoated [(UFT, UFBT, UFA: p<0.001), (UFPT: p=0.017)] and collagen coated suture (CFT, CFPT, CFBT, CFA: p<0.001) lead to a significantly higher HLs adhesion. Significantly higher adhesion (UFT, UFPT, UFBT, UFA: p<0.001; CFT, CFPT, CFBT, CFA: p<0.001) was also observed for HOBs. Similarly, HLs proliferation [(UFT, UFPT, UFA: p=0.009), (UFBT: p=0.001); (CFT: p=0.009), (CFBT: p=0.001), (CFA: p=0.01)] was significantly higher. HOBs showed significantly higher proliferation [(UFT, UFPT, UFA: p=0.002), (UFBT: p=0.001); CFT: p=0.003), (CFPT, CFBT, CFA: p=0.001)] as well. Augmentation with thrombin, PRP, and BMA for uncoated (UFT: p=0.006, UFPT: p=0.035, UFBT: p=0.001) and BMA (CFBT: p=0.027) for coated suture tape led to significantly higher alkaline phosphatase activity.


Biological enhancement of suture material used for ligament bracing leads to a significant increase in HLs as well as HOBs adhesion, proliferation, and alkaline phosphatase activity. Furthermore, no overall superiority between uncoated or collagen-coated suture material was observed. The biological augmentation of suture material used for ligament bracing may improve the healing of injured ligaments in addition to providing immediate biomechanical stabilization.

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