Ligament Bone Research Articles

Serum Tumor Necrosis Factor Alpha and High Sensitive C-Reactive protein as Biomarkers in Periodontitis in Iraqi Patients with Osteoarthritis

Background: Periodontitis (PD) is well-known chronic disease affecting the periodontal ligament and alveolar bone, Osteoarthritis (OA) is a chronic joint disease with compound reasons characterized by synovial inflammation, subchondral bone remodeling, also the formation of osteophytes, that cause cartilage degradation. Chronic periodontitis and osteoarthritis are considered widely prevalent diseases and related to tissue destruction due to chronic inflammation in general health and oral health. The aim of this study is todetermine the association of chronic periodontitis and osteoarthritits in patients by analysing tumor necrosis factor alpha TNFα and high sensitive c-reactive protein (hsCRP) in the serum. Materials and Method: A total of 80 patients of both sexes aged 35-50 years ,30 patients with osteoarthritis and moderate chronic periodontitis (CP+OA), 30 patients of both sexes aged 35-50 years with moderate chronic periodontitis alone (CP). And control group (C) of 20 healthy patients with healthy periodontium participated in this cross sectional study. we excluded the postmenopausal and pregnant woman from female patient and smoker patient also. All patients are free of medication and have good general health with no history of systemic disease. Participants with OA have documentation or radiographic imaging, consistent with degenerative arthritis in the absence of an inflammatory condition. Venous blood samples were drawn from each subject using pyrogen-free heparinized collection tubes. Tubes were centrifuged according to the manufacturer’s guidelines, then stored at -15°C till analyse. serum TNFα and hs CRP were measured using an enzyme-linked immunosorbent assay (ELISA). Results: A non-significant differences between studied group regarding serum level of hsCRP and TNF-α, as well as, the result revealed that the median of serum levels of hsCRP were little higher in chronic periodontitis with osteoarthritis group than chronic periodontitis group and control groups represent as 0.31, 0.29, and 0.24. Similarly, the medium serum level of TNFα was higher in chronic periodontitis with OAthan in other two groups (10.615, 10.533, and 9.682 respectively). The age and gender showed a non-significant difference between the groups Conclusion: The present study revealed that there’s a strong positive correlation between serum levels of hsCRP and TNFα in patients of all groups but there is no correlation between Osteoarthritis and chronic periodontitis.

Biomechanical Analysis of the Canine Tuberculum Dentale

We evaluate the structural significance of the development of a canine tuberculum dentale by means of three-dimensional finite element analysis. Using a scanned human permanent canine, we construct a computer generated canine, together with alveolar bone and periodontal ligament onto which we morph two cingulum shapes, namely a flat palatal surface and a stylised tuberculum dentale. We then subject the three shapes (flat, normal cingulum, and pronounced tuberculum dentale) to a normal occlusal force and we record principal and von Mises stresses in the crowns. Our results show that stresses are concentrated at the cingulum and in the approximal areas, and that these do not differ between the three forms. We conclude that the development of a tuberculum dentale does not confer biomechanical advantage to the human canine.

Dental Follicle Stem Cells as a Biomaterial for Periodontal Regeneration A proof-of-concept study

The goal of periodontal therapy is to regenerate the periodontal structures: cement, periodontal ligament and alveolar bone. Stem cell-based tissue engineering raised novel therapeutic strategies for periodontal repair. In vivo dental follicle stem (DFSC) cells give rise to cementoblasts, osteoblasts and fibroblasts. Based on this idea, we have assessed DFSC potential to regenerate the periodontal structures, and by that to elaborate a new biomaterial. An experimental study was performed on male Wistar rats which were subjected to a procedure of periodontitis induction through placing silk thread ligatures around the lower incisors, under general anesthesia. Clinically, the changes of the periodontal tissue (bleeding on probing, dental mobility, dental plaque, presence of pus) induced by the periodontitis progression were daily assessed. The subjects were divided in two groups: a control and a study group. After 7 days from placing silk thread ligatures, subjects from the study group received an injection in the gingival sulcus. The injected biomaterial contained dental follicle stem cells seeded on fibrinogen. Bleeding on probing at the end of the treatment period was significantly reduced in the study group (study vs control group - 0% vs 100%, p=0.01.). In terms of dental mobility statistical significant results were obtained (p=0.04): for 20% from the subjects from the study group dental mobility was absent, while in the control group all subjects presented different degrees of mobility (33.3% degree II- v-o/m-d, 66.6% degree III-v-o/m-d/ax). In the control group pus was present in 66.7% from the subjects, and absent in the study group (p=0.10). Dental plaque was present in 40% of the subjects from the study group and in 100% in the control group. The clinical and histological results of our study demonstrate that dental follicle stem cells are a valuable cell source for tissue engineering the periodontal tissue.

Hook Plate for Volar Rim Fractures of the Distal Radius: Review of the First 23 Cases and Focus on Dorsal Radiocarpal Dislocation.

Background Fragment-specific fixation of the distal radius is born to fix each articular fragment with limited surgical approach and low-profile devices. Over time, many devices with different designs and characteristics have been developed. However, many of them have showed the inability to securely fix marginal, small, and comminuted fragments as bony ligament avulsions and bony compression injuries. Purpose The purpose of this study was to evaluate the clinical and radiological outcome of a new device born to treat marginal articular fractures of the distal radius. Patients and Methods A retrospective review was conducted on 23 patients with a mean follow-up of 21 months including postoperative clinical evaluation, grip strength, computed tomography scan, and X-ray control. Results All fragments healed and maintained reduced until the final follow-up. The carpus was aligned with the distal radius in all patients presenting with a radiocarpal dislocation. Conclusion The volar rim fragment is an attachment site for the short radiolunate and the volar distal radioulnar ligament. Its unstable fixation can lead to articular incongruity, volar or dorsal subluxation of the carpus, and distal radioulnar instability. The involvement of this fragment on distal radius fractures is relatively common and many studies of the literature have been focused on its treatment. The Hook Plate stabilizes distal fragments at their bone-ligament interface. In addition to bony reduction, the device permits to stabilize the capsule and ligaments, as volar bony ligament avulsions, in a picture of dorsal radiocarpal dislocation. Level of Evidence This is a Level IV, case series.

Bone Bruises in Children and Adolescents Not Associated With Ligament Ruptures [corrected

Background:Clinical characteristics of uncomplicated bone bruises (ie, not associated with a ligament rupture, meniscal tear, or fracture of the knee) in young athletes have scarcely been reported.Purpose:To identify mechanisms of injury, characterize bone bruise patterns, and identify clinical factors relating to recovery in young patients suffering uncomplicated bone bruises about the knee.Study Design:Case series; Level of evidence, 4.Methods:A review of clinical records and magnetic resonance imaging (MRI) findings of patients seen at a single institution was completed.Results:We identified 62 children and teenagers (mean age, 13.9 years; range, 8-18 years) who had a total of 101 bone bruises on MRI. The injuries occurred during a variety of organized and recreational sporting activities, the most common being football, basketball, and soccer. The majority (61.4%) of bone bruises occurred as a result of noncontact mechanisms. Patients reported a mean pain scale score of 6.3 of 10 (range, 2-10) on presentation. Frequent clinical findings included non–joint-line tenderness (64.5%), limited range of motion (58.1%), joint-line tenderness (54.8%), and positive meniscal signs (50.0%). The majority of bone bruises (61.4%) were located medially, and the most common bone bruise type was subcortical (58.4%), followed by medullary/reticular (35.6%) and articular impaction (5.9%). The only factor related to time to recovery was mechanism of injury; patients reporting a noncontact mechanism required significantly more time to recover than those reporting a contact mechanism (mean, 99.7 ± 74.8 vs 65.7 ± 38.8 days, respectively; F = 3.753, P = .049).Conclusion:In this case series of 62 pediatric patients with non–anterior cruciate ligament (ACL) bone bruises, the majority occurred in the medial compartment, suggesting that these bone bruises result from a mechanism distinct from the pivot-shift mechanism, classically thought to cause ACL injuries.

Periodontal Disease and COPD

Periodontal disease is an inflammatory disease caused predominantly by Gram-negative, anaerobic, and microaerophilic bacteria that colonise the subgingival area though modified by environment, physical, social and host stresses. It results in progressive destruction of the periodontal ligament and alveolar bone with increased probing depth, recession, or both [1]. Throughout the history of mankind, it has been believed that oral diseases and maladies including periodontal disease may have an effect on the rest of the body. Over the centuries, writings from the ancient Egyptians, Hebrews, Assyrians, Greeks and Romans, have all noted the importance of the mouth in overall health and well-being. Thus, the concept of linking periodontitis and systemic diseases could be traced back to the beginning of recorded history and medicine [2]. Periodontal disease has been linked to an increased risk of various systemic diseases, including the respiratory diseases e.g. pneumonia and chronic obstructive pulmonary disease (COPD) [3]. COPD is a generic term defined by the presence of airflow obstruction with excess production of sputum resulting from chronic bronchitis and/or emphysema. It has been recognized as one of the major causes of death and disability globally and is the fourth leading cause of death in United States [4]. The aetiology of COPD is complex and multifactorial, involving multiple genetic and environmental factors [5]. An enhanced or abnormal inflammatory response to inhaled particles or gases, beyond the normal protective inflammatory response in the lungs, is a characteristic feature of COPD and is potential to produce lung injury

The Effect of Enamel Matrix Derivate Proteins EMD on Ortodontically Induced Bone Resorption Based on Mini-implants

Amelogenine protein is the major component of the continuously secreted enamel extracellular matrix that controls the mineralization of enamel crystals. EmdogainTM is an extract of porcine fetal tooth material, a product based on the high degree of homology between porcine and human enamel proteins, composed primarily of amelogenine protein. It was created to promote the regeneration of periodontal tissues such as cementum, periodontal ligament and alveolar bone by stimulating normal development of these tissues, it is used to treat deep intraosseus defects.

Damping ratio analysis of tooth stability under various simulated degrees of vertical alveolar bone loss and different root types

BackgroundThe purpose of this study was to evaluate the feasibility of using damping ratio (DR) analysis combined with resonance frequency (RF) and periotest (PTV) analyses to provide additional information about natural tooth stability under various simulated degrees of alveolar vertical bone loss and various root types.MethodsThree experimental tooth models, including upper central incisor, upper first premolar, and upper first molar were fabricated using Ti6Al4V alloy. In the tooth models, the periodontal ligament and alveolar bone were simulated using a soft lining material and gypsum, respectively. Various degrees of vertical bone loss were simulated by decreasing the surrounding bone level apically from the cementoenamel junction in 2-mm steps incrementally downward for 10 mm. A commercially available RF analyzer was used to measure the RF and DR of impulse-forced vibrations on the tooth models.ResultsThe results showed that DRs increased as alveolar vertical bone height decreased and had high coefficients of determination in the linear regression analysis. The damping ratio of the central incisor model without a simulated periodontal ligament were 11.95 ± 1.92 and 27.50 ± 0.67% respectively when their bone levels were set at 2 and 10 mm apically from the cementoenamel junction. These values significantly changed to 28.85 ± 2.54% (p = 0.000) and 51.25 ± 4.78% (p = 0.003) when the tooth model was covered with simulated periodontal ligament. Moreover, teeth with different root types showed different DR and RF patterns. Teeth with multiple roots had lower DRs than teeth with single roots.ConclusionDamping ratio analysis combined with PTV and RF analysis provides more useful information on the assessment of changes in vertical alveolar bone loss than PTV or RF analysis alone.

Biofabrication of soft tissue templates for engineering the bone-ligament interface.

Regenerating damaged tissue interfaces remains a significant clinical challenge, requiring recapitulation of the structure, composition, and function of the native enthesis. In the ligament-to-bone interface, this region transitions from ligament to fibrocartilage, to calcified cartilage and then to bone. This gradation in tissue types facilitates the transfer of load between soft and hard structures while minimizing stress concentrations at the interface. Previous attempts to engineer the ligament-bone interface have utilized various scaffold materials with an array of various cell types and/or biological cues. The primary goal of this study was to engineer a multiphased construct mimicking the ligament-bone interface by driving differentiation of a single population of mesenchymal stem cells (MSCs), seeded within blended fibrin-alginate hydrogels, down an endochondral, fibrocartilaginous, or ligamentous pathway through spatial presentation of growth factors along the length of the construct within a custom-developed, dual-chamber culture system. MSCs within these engineered constructs demonstrated spatially distinct regions of differentiation, adopting either a cartilaginous or ligamentous phenotype depending on their local environment. Furthermore, there was also evidence of spatially defined progression toward an endochondral phenotype when chondrogenically primed MSCs within this construct were additionally exposed to hypertrophic cues. The study demonstrates the feasibility of engineering spatially complex soft tissues within a single MSC laden hydrogel through the defined presentation of biochemical cues. This novel approach represents a new strategy for engineering the ligament-bone interface. Biotechnol. Bioeng. 2017;114: 2400-2411. © 2017 Wiley Periodicals, Inc.

Biomechanical Properties of First Dorsal Extensor Compartment Regarding Adequacy as a Bone-Ligament-Bone Graft.

Background:Bone-ligament-bone grafts for reconstruction of the scapholunate ligament are a valuable tool to prevent disease progression to carpal collapse. Locally available grafts do not require an additional donor site. The first extensor compartment was evaluated biomechanically regarding its possible use as an autograft.Methods:Twelve native fresh-frozen, human cadaver specimens were tested by applying axial tension in a Zwick Roell machine. Load to failure, transplant elongation, and bony avulsion were recorded. The load to failure was quantitated in newtons (N) and the displacement in length (millimeters). Parameters were set at distinct points as start of tension, 1 mm stretch and 1.5 mm dissociation, failure and complete tear, and were evaluated under magnified visual control. Although actual failure occurred at higher tension, functional failure was defined at a stretch of 1.5 mm.Results:Mean load at 1 mm elongation was 44.1 ± 28 N and at 1.5 mm elongation 57.5 ± 42 N. Failure occurred at 111 ± 83.1 N. No avulsion of the bony insertion was observed. Half the transplants failed in the central part of the ligament, while the rest failed near the insertion but not at the insertion itself. Analysis of tension strength displayed a wide range from 3.8 to 83.7 N/mm at a mean of 33.4 ± 28.4 N/mm.Conclusions:The biomechanical tensile properties of the first dorsal extensor compartment are similar to those of the dorsal part of the scapholunate ligament. A transplant with a larger bone stock and a longer ligament may display an advantage, as insertion is possible in the dorsal, easily accessible part of the carpal bones rather than in the arête-like region adjacent to the insertion of the scapholunate ligament. In this study, 1.5 mm lengthening of the bone–ligament–bone transplant was defined as clinical failure, as such elongation will cause severe gapping and is considered as failure of the transplant.

Efficacy of transpalatal arch as an anchorage reinforcing unit during orthodontic space closure: A three-dimensional finite element study

Background and Objectives Connecting the contralateral upper molars by means of a transpalatal arch (TPA) is thought to decrease the tendency of the molars to move mesially in response to orthodontic force (i.e., provide orthodontic anchorage). This study was hence conducted to investigate the effects of the TPA on the displacement of the molars and stresses generated in the periodontium during orthodontic tooth movement using the finite element method (FEM). Materials and Methods A three-dimensional (3D) model was generated using medical modeling software (Mimics) using the computed tomography slice images of the skull which were obtained at a slice thickness of 1 mm. From this, the finite element model was built using HyperMesh and analysis was performed using PATRAN software (MSC Software Corporation, 4675 MacArthur Court, Newport Beach, California 92660). The 3D finite element models were fabricated in two versions such as maxillary first molars including their associated periodontal ligament and alveolar bone one with TPA and another without TPA. Both were subjected to orthodontic forces, and the resultant stress patterns and displacements between the models with and without TPA were determined. Results The stress and displacement plots in this study failed to show any significant differences in stress and displacement within the periodontium of molars, between the two models – one with TPA and the other without, in response to the orthodontic force. Interpretation and Conclusion The results of the current finite element analysis, therefore, suggest that the presence of a TPA brings about no change in the initial dental and periodontal stress distribution and displacement.

Photoactivated disinfection using indocyanine green photosensitizer as an adjunct to regenerative periodontal therapy

Regenerative periodontal surgical procedures attempt to restore lost periodontal structure and functional attachment through the regeneration of cementum, periodontal ligament, and alveolar bone. Although meticulous debridement using surgical instrumentation reduces the bacterial burden, it fails to kill the periopathogens. To overcome this shortcoming, the development of alternative adjunctive or exclusive antibacterial therapeutic strategies, therefore, becomes important in the evolution of methods to control microbial growth in the oral cavity. The following case report explores the use of antimicrobial photodynamic therapy as an adjunct to regenerative periodontal therapy for the management of intrabony defects which was evaluated over a period of 6 months.

Diabetes and Periodontal Disease: A Two-Way Relationship

Periodontitis is an inflammatory disease of the supporting tissues of the teeth caused by specific micro-organisms or group of specific micro-organisms, resulting in progressive destruction of the periodontal ligament and alveolar bone with pocket formation, recession or both.1 Periodontal infections can adversely affect the systemic health with manifestations such as coronary heart disease, stroke, diabetes, preterm labor, low-birth weight delivery, and respiratory disease.1 Severe periodontitis often coexists with diabetes and is considered to be the sixth complication of the disease, as both type 1 and type 2 diabetic patients show a three-to four fold increased risk of periodontitis. 2

The periodontal infection may be a contributing factor to the development of gastric cancer

Introduction: Self-reported tooth loss is highly prevalent in patients with gastric cancer, the second most common malignancy worldwide. Periodontal disease is characterized by loss of the periodontal ligament and alveolar bone, and is a major cause of tooth loss. The theories have been confirmed that chronic systemic inflammation and increased exposure to carcinogenic nitrosamines can increase the risk of cancer, and periodontal pathogens could induce the chronic inflammation. Poor oral hygiene and periodontal diseases may contribute to greater nitrosamine production. The Hypothesis: We hypothesize that periodontal diseases might be an important risk factor for gastric cancer. Major pathogens of periodontal diseases may play a more direct role through local inflammatory responses and carcinogenic transformations in the development of gastric cancer. Evaluation of the Hypothesis: It is possible that periodontal disease may be a marker of a type of immune function that has implications for tumor growth and progression in stomach. If periodontal bacteria indeed play an important role in the development of gastric cancer, the patients should be treated not only focused on the stomach disease itself but also the periodontal problems.

Periodontitis- A Review

The early form of periodontitis is gingivitis where inflammatory changes including bleeding and swelling are restricted to marginal gingiva and surrounding connective tissue, without the involvement of periodontal ligament. Periodontitis occurs when inflammatory changes reach the periodontal ligament and alveolar bone ultimately leading to tooth loss. The underlying cause of the disease is the presence of a polymicrobial biofilm that forms as plaque on the tooth surface and the resulting host response that this plaque induces. Inflammatory responses are initiated by a number of late stage colonizers and the virulence factors they produce. Among these late stage pathogens is P. gingivalis, a Gram negative, asacchrolytic bacterium with a large arsenal of virulence factors. P. gingivalis produces up to 13 virulence factors involved in host evasion and 21 virulence factors involved in tissue destruction. The presence of these virulence factors induces the production of proinflammatory chemokine and cytokine responses often seen in the saliva and gingival crevicular fluid of individuals with periodontitis.

Application of reverse anterolateral thigh flap with venous superdrainage

Objective To investigate the application effect of venous superdrainage to repair the wound around the knee joint with reverse anterolateral thigh flap. Methods From February, 2010 to August, 2015, 7 patients with wound around the knee joint were treated with reverse anterolateral thigh flap. The size of wound ranged from 15 cm × 6 cm to 20 cm × 10 cm..Which bone and joint ligament exposed to air..With outside pressure and venous superdrainage, it can effectively solve the problem of venous stagnation, anastomosing their veins accompanied with the lateral femoral circumflex artery descending branch with the veins in the neighborhood, when repaired the wound with reverse anterolateral thigh flap..The size of the flap ranged from 17 cm × 8 cm to 23 cm × 12 cm. The donor sites were sutured directly or covered with full-thickness skin graft. Results All the 7 flaps survived completely without vascular crisis and swelling. These flaps had abundant blood supply an good appearance, soft texture, normal skin color, no pigmentation. Conclusion With venous superdrainage, it can effectively solve the problem of venous stagnation of reverse anterolateral thigh flap, and improve the survival rate of flaps. Key words: Anterolateral thigh flap, reverse; External pressure; Superdrainage; Descending branch, lateral femoral circumflex artery; Wound repair

High-performance liquid chromatography analysis of chondroitin sulfate isomers in human periodontium.

We investigated the chondroitin sulfate in human periodontal samples (gingiva, periodontal ligament, cementum and alveolar bone) collected for orthodontic reasons. Glycosaminoglycans (GAGs) were extracted from the periodontium by enzyme digestion, and unsaturated disaccharide isomers of chondroitin sulfate were obtained by chondroitinase ACII and hyaluronidase digestion. The isomers were analyzed by high-performance liquid chromatography. Chondroitin sulfate was found in all four types of periodontal tissue; its unsaturated disaccharide isomers consisted in delta Di-0S, delta Di-6S, delta Di-4S, delta Di-diSE and delta Di-triS. These four types of periodontal tissue showed different molar ratios of the unsaturated disaccharides. The ratio of delta Di-4S to delta Di-6S was greater in the calcified than in the uncalcified tissue.

Herpes Virus Prevalence in Patients with Chronic Periodontal Disease and Aggressive Periodontal Disease

Periodontitis is defined as an inflammatory disease of the supporting tissues of teeth caused by microorganisms or groups of specific microorganisms, which result in progressive destruction of the periodontal ligament and alveolar bone, caused by multiple infectious agents and is interconnected with the humoral and cellular immune responses of the host. This study aimed to determine the prevalence of herpes simplex virus type 1 and 2 and cytomegalovirus in patients with chronic and aggressive periodontits and healthy subjects. Biopsies samples were taken from patients presenting to the clinic of the Universidad Autonoma de Nuevo Leon diagnosed with chronic periodontitis o aggressive periodontitis and control patients. The samples taken were submitted to polymerase chain reaction (PCR) to detect the presence of the virus. The presence of the different kinds of virus was negative in the evaluated subjects.

In vivo structural and cellular remodeling of engineered bone–ligament–bone constructs used for anterior cruciate ligament reconstruction in sheep

ABSTRACTAnterior cruciate ligament (ACL) ruptures rank among the most prevalent and costly sports-related injuries. Current tendon grafts used for ACL reconstruction are limited by suboptimal biomechanical properties. We have addressed these issues by engineering multiphasic bone–ligament–bone (BLB) constructs that develop structural and mechanical properties similar to native ACL. The purpose of this study was to examine the acute remodeling process that occurs as the BLB grafts advance toward the adult ligament phenotype in vivo. Thus, we implanted BLB constructs fabricated from male cells into female host sheep and allowed 3, 7, 14, or 28 days (n = 4 at each time point) for recovery. To address whether or not graft-derived cells were even necessary, a subset of BLB constructs (n = 3) were acellularized, implanted, and allowed 28 days for recovery. At each recovery time point, the following histological analyses were performed: picrosirius red staining to assess collagen alignment and immunohistochemistry to assess both graft development and host immune response. Polymerase chain reaction (PCR) analysis, performed on every explanted BLB, was used to detect the presence of graft-derived male cells remaining in the constructs and/or migration into surrounding host tissue. The analysis of the PCR and histology samples revealed a rapid migration of host-derived macrophages and neutrophils into the graft at 3 days, followed by increased collagen density and alignment, vascularization, innervation, and near complete repopulation of the graft with host cells within 28 days. This study provides a greater understanding of the processes of ligament regeneration in our BLB constructs as they remodel toward the adult ligament phenotype.

Fresh and Frozen Tissue-Engineered Three-Dimensional Bone-Ligament-Bone Constructs for Sheep Anterior Cruciate Ligament Repair Following a 2-Year Implantation.

Injuries to the anterior cruciate ligament (ACL) often require surgical reconstruction utilizing tendon grafts to restore knee function and stability. Some current graft options for ACL repair are associated with poor long-term outcomes. Our laboratory has fabricated tissue-engineered bone–ligament–bone (BLB) constructs that demonstrate native ligament regeneration and advancement toward native ACL mechanical properties in a sheep ACL reconstruction model. Prior work has shown that freezing BLBs as a method of preservation resulted in similar outcomes compared with fresh BLBs after 6-month implantation. The purpose of this study was to evaluate the long-term efficacy of fresh and frozen BLBs. We hypothesized that both fresh and frozen BLBs would show continued regeneration of structural and functional properties toward those of native ACL after a 2-year implantation. Following removal of the native ACL, fresh (n = 2) and frozen (n = 2) BLBs were implanted arthroscopically. After 2 years of recovery, sheep were euthanized and both the experimental and contralateral hindlimbs were removed and radiographs were performed. Explanted knees were initially evaluated for joint laxity and were then further dissected for uniaxial tensile testing of the isolated ACL or BLB. Following mechanical testing, explanted contralateral ACL (C-ACL) and BLBs were harvested for histology. Two years post-ACL reconstruction, fresh and frozen BLBs exhibited similar morphological and biomechanical properties as well as more advanced regeneration compared with our 6-month recovery study. These data indicate that an additional 1.5-year regeneration period allows the BLB to continue ligament regeneration in vivo. In addition, freezing the BLBs is a viable option for the preservation of the graft after fabrication.