Abstract
Introduction: To our knowledge, no studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction. The purpose of this study was to histologically clarify the differences between ACL remnant tissue, reconstructed graft after anatomic double-bundle ACL reconstruction, and reconstructed graft after non-anatomic single-bundle ACL reconstruction.Methods: This histological study included five patients after anatomic double-bundle ACL reconstruction, three patients after non-anatomic single-bundle ACL reconstruction performed who injured their operated knees again, and five patients who injured their ACL for the first time and agreed to participate. All of the grafts and ACL remnant tissue were harvested, stained with hematoxylin and eosin, S-100, and alpha smooth muscle actin and evaluated using light microscopy.Results: There was no area of necrosis in the reconstructed graft after an anatomic double-bundle ACL reconstruction. However, there were obvious areas of necrosis in the reconstructed graft after non-anatomic single-bundle ACL reconstruction. Additionally, the collagen fibers were more longitudinally oriented, and most cells were spindle shaped like those in ACL remnant tissue after an anatomic double-bundle ACL reconstruction in contrast with the finding of the grafts after non-anatomic single-bundle ACL reconstruction.Conclusion: Initially reconstructed graft after an anatomic double-bundle ACL reconstruction may be beneficial if preserved at the time of the revision surgery.
Highlights
To our knowledge, no studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction
After anatomic double-bundle ACL reconstruction performed at our institution, who injured their operated knees again (Group A-DB); three patients, after non-anatomic single-bundle ACL reconstruction performed at another institution, who injured their operated knees again (Group NA-SB); and five patients, who injured ACL for the first time from April 2016 to Match 2017 and agreed to participate in this histological study (Group R), were included
The ACL remnant tissue was covered by thin synovial tissue
Summary
No studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction. Persistent areas of necrosis and acellularity within the graft may indicate insufficient remodeling and recovery of a functionally normal ACL. Gender, reason for re-injury (contact/non-contact), graft source at the time of primary ACL reconstruction (hamstring/BTB), time from initial reconstruction to histological evaluation, and time from re-injury to revision surgery were compared between the groups. All of the injured graft in Group A-DB and Group NA-SB, and ACL remnant tissue in Group R exhibited weak tension when probed during routine arthroscopic evaluation. The entire injured graft in Group A-DB and Group NA-SB and ACL remnant tissue in Group R were harvested using a sharp scalpel. The sections were evaluated using light microscopy (BioRevo BZ-9000; Keyence Corp., Itasca, IL) [7]
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