Abstract
BackgroundWe developed a novel technique to improve tendon-bone attachment by hybridizing calcium phosphate (CaP) with a tendon graft using an alternate soaking process. However, the long-term result with regard to the interface between the tendon graft and the bone is unclear.MethodsWe analyzed bone tunnel enlargement by computed tomography and histological observation of the interface and the tendon graft with and without the CaP hybridization 2 years after anterior cruciate ligament (ACL) reconstruction in goats using EndoButton and the postscrew technique (CaP, n = 4; control, n = 4).ResultsThe tibial bone tunnel enlargement rates in the CaP group were lower than those in the control group (p < 0.05). In the CaP group, in the femoral and tibial bone tunnels at the anterior and posterior of the joint aperture site, direct insertion-like formation that contained a cartilage layer without tidemarks was more observed at the tendon-bone interface than in the control group (p < 0.05). Moreover, the gap area between the tendon graft and the bone was more observed at the femoral bone tunnel of the joint aperture site in the control group than in the CaP group (p < 0.05). The maturation of the tendon grafts determined using the ligament tissue maturation index was similar in both groups.ConclusionsThe CaP-hybridized tendon graft enhanced the tendon-bone healing 2 years after ACL reconstruction in goats. The use of CaP-hybridized tendon grafts can reduce the bone tunnel enlargement and gap area associated with the direct insertion-like formation in the interface near the joint.
Highlights
The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee
We developed a novel technique to improve tendon-bone attachment by hybridizing calcium phosphate (CaP) with tendons using an alternate soaking process [12]
We used a goat model of ACL reconstruction, because long-term studies of goat knees have shown the effective restoration of knee stability after ACL reconstruction [18,19]
Summary
The anterior cruciate ligament (ACL) is the most frequently injured ligament in the knee. The CaP-hybridized tendon graft reduced bone tunnel enlargement in the femoral side 6 months after ACL reconstruction in goats [16]. The new bone formation at the bone tunnel and cartilage layer formation at the tendon-bone interface near the joint in the CaP group were more observed than those in the control group [17]. The longterm effect of the CaP-hybridized tendon after ACL reconstruction in animal experiments is unclear. To clarify this issue, we used a goat model of ACL reconstruction, because long-term studies of goat knees have shown the effective restoration of knee stability after ACL reconstruction [18,19]. The long-term result with regard to the interface between the tendon graft and the bone is unclear
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