An Analysis of Autograft Fixation After Anterior Cruciate Ligament Reconstruction in a Rabbit Model

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Fixation and incorporation of a tendon implanted within the bone pose theoretical as well as practical concerns for the surgeon who treats instability problems of the knee. Understanding the physiology involved in graft-bone incorporation is necessary for the appropriate rehabilitation of patients who undergo anterior cruciate ligament surgery. The purpose of the study was to examine the histologic and biomechanical changes of a semitendinosus autograft reconstruction of the anterior cruciate ligament in a rabbit model at the graft-bone tunnel interface in the femur. The results indicate that by 3 weeks, failure of the bone-graft-bone or construction is through the intraarticular portion of the graft, not as a result of pullout from the bone tunnel. Graft fixation of the bone tunnel occurs by an intertwining of graft and connective tissue and anchoring of connective tissue to bone by collagenous fibers and bone formation in the tunnels. The collagenous fibers have the appearance of the Sharpey's fibers seen in an indirect tendon insertion.

Related collections

Most cited references 14

Record: found
Abstract: found
Article: not found

Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.

E Grood, Aodhán Butler, Frank R. Noyes … (1984)

Virtually all types of collagenous tissues have been transferred in and around the knee joint for intra-articular and extra-articular ligament reconstructions. However, the mechanical properties (in particular, strength) of such grafts have not been determined in tissues from young adult donors, where age and disuse-related effects have been excluded. To provide this information, we subjected ligament graft tissues to high-strain-rate failure tests to determine their strength and elongation properties. The results were compared with the mechanical properties of anterior cruciate ligaments from a similar young-adult donor population. The study indicated that some graft tissues used in ligament reconstructions are markedly weak and therefore are at risk for elongation and failure at low forces. Grafts utilizing prepatellar retinacular tissues (as in certain anterior-cruciate reconstructions) and others in which a somewhat narrow width of fascia lata or distal iliotibial tract is utilized are included in this at-risk group. Wider grafts from the iliotibial tract or fascia lata would of course proportionally increase ultimate strength. The semitendinosus and gracilis tendons are stronger, having 70 and 49 per cent, respectively, of the initial strength of anterior cruciate ligaments. The bone-patellar tendon-bone graft (fourteen to fifteen millimeters wide, medial or central portion) was the strongest, with a mean strength of 159 to 168 per cent of that of anterior cruciate ligaments. Patellar tendon-bone units, based on grip-to-grip motions, were found to be three to four times stiffer than similarly gripped anterior cruciate ligaments, while gracilis and semitendinosus tendon preparations had values that were nearly identical to those of anterior cruciate ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)

0 comments Cited 112 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog.

S Arnoczky, Christopher J. Marshall, G B Tarvin (1982)

We investigated the revascularization pattern of patellar tendon grafts used to replace the anterior cruciate ligament in thirty-six dogs by histological and tissue-clearing (Spalteholz) techniques. Initially the grafts were avascular, but by six weeks they were completely ensheathed in a vascular synovial envelope. The soft tissues of the infrapatellar fat pad, the tibial remnant of the anterior cruciate ligament, and the posterior synovial tissues contributed to this synovial vasculature. Intrinsic revascularization of the patellar tendon graft progressed from the proximal and distal portions of the graft centrally and was complete by twenty weeks. The tibial attachment of the patellar tendon graft did not contribute any vessels to the revascularization process. At one year, the vascular and histological appearance of the patellar tendon graft resembled that of a normal anterior cruciate ligament. The absence of perfused vessels within the patellar tendon graft immediately after transplantation within the knee joint and the failure of the osseous insertion of the graft to contribute vessels to the revascularization process suggest that although it is left attached at the tibia, the patellar tendon graft is essentially an avascular free graft at transplantation. The contribution of the soft tissues of the knee to the revascularization process of the graft suggests preservation and utilization of the infrapatellar fat pad and synovial tissue to optimize the graft's revascularization and ultimate viability.