Abstract
BackgroundTendon-bone interface healing and ligamentization of the graft in anterior cruciate ligament (ACL) reconstruction with autografts are important factors affecting treatment outcome. This study aimed to investigate the effectiveness of a cylindrical titanium-web (TW) in tendon-bone interface healing and graft maturation in ACL reconstruction.MethodsFourteen mature female CLAWN miniature swine underwent bilateral ACL reconstructions with patellar tendon (PT) autografts. In one limb, the TW/tendon complex was placed into the proximal side of the tibial tunnel. Only the graft was transplanted into the tunnel in the control limb. The proximal side of the graft was sutured into the stump of the native ACL and the distal end was stapled to the tibia. The animals were euthanized at 4 and 15 weeks postoperatively, for histological and biochemical analyses.ResultsMicroscopic images in TW limbs showed that ingrowth of tendon-like tissue and mineralized bone tissue into the TW connected the bone and the tendon directly. In contrast, fibrous tissue intervened between the bone and tendon in the control limbs. The total amount of collagen cross-links (which defines the strength of collagen fibers) and the maturation of collagen cross-links in TW tendons were significantly higher (p < 0.05) than those of control limbs. There was no significant difference in the ratio of dihydroxy-lysinonorleucine to hydroxy-lysinonorleucine (an indicator of tissue specific collagen maturation) between TW tendons and that of the native PT.ConclusionsTW promoted the maturation and formation of collagen cross-links in the grafted tendon while maintaining the cross-links pattern of native tendon collagen, and enabled direct binding of tendon to bone.
Highlights
Tendon-bone interface healing and ligamentization of the graft in anterior cruciate ligament (ACL) reconstruction with autografts are important factors affecting treatment outcome
Histological findings 4 weeks after surgery (n = 4) In the control limbs the interface between the tendon and the anterior side bone was filled fibrous tissue and inflammatory cells
The present study demonstrated that the use of TW in ACL reconstruction surgery promoted formation and maturation of collagen cross-links in the grafted tendon, and directly binding the bone and tendon tissue through the TW
Summary
Tendon-bone interface healing and ligamentization of the graft in anterior cruciate ligament (ACL) reconstruction with autografts are important factors affecting treatment outcome. Tendonbone interface healing and ligamentization of the graft in ACL reconstruction with autografts are important factors affecting treatment outcome after surgery [3, 4]. After ACL reconstruction with a free-tendon graft, collagen fibers are first formed at the tendon-bone interface, and collagen fibers perpendicular to the interface called the Sharpey-like fibers form to connect the tendon and bone tunnel [5, 6] This so-called indirect insertion is different from the direct insertion found in the normal ACL tendon–bone interface or tendon–bone late healing phase at the exit of the bone tunnel [5, 7]. Most researchers believe that indirect insertions are less effective than direct insertions and this slow and incomplete healing of the tendon-bone interface may result in inferior functional recovery and even worse osteoarthritic changes [8]
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