Immunohistological analysis of extracted anterior cruciate ligament graft impinged against posterior cruciate ligament

So Kato,Kozo Nakamura,Jinso Hirota,Kohei Nakajima,Shuichi Nakayama,Atsushi Fukai,Takumi Nakagawa,Shuji Taketomi,Hideki Takeda

doi:10.1186/1758-2555-3-26

Abstract

A young female athlete suffered from the residual instability of the knee after anterior cruciate ligament (ACL) reconstruction with hamstring autograft. The 3-dimensional (3-D) CT scan showed the "high noon" positioning of the primary femoral bone tunnel. The revision surgery with anatomic double-bundle technique was performed two years after the primary surgery and the femoral tunnels were created with the assistance of the 3-D fluoroscopy-based navigation. An arthroscopic examination confirmed the ACL graft impingement against posterior cruciate ligament (PCL) when the knee was deeply flexed. The histological analysis of the resected primary ACL graft showed local inflammatory infiltration, enhanced synovial coverage and vascularization at the impinged site. The enhanced expression of vascular endothelial growth factor (VEGF) at the impinged area when compared with non-impinged area was observed on immunohistochemical analysis. Abnormal mechanical stress by the impingement against PCL might have induced chronic inflammation and VEGF overexpression.

Highlights

It is well known that roof impingement or posterior cruciate ligament (PCL) impingement of anterior cruciate ligament (ACL) graft can adversely affect the postoperative result, including range of motion (ROM) and knee stability [1]
We experienced a case in which malpositioning of femoral tunnel in primary ACL reconstruction caused PCL impingement and graft loosening as a
At the revision ACL surgery, the stretched-out graft was extracted and immunohistological analysis was performed both at the impinged site and non-impinged site to clarify possible molecular changes induced by increased strain

Summary

Introduction

It is well known that roof impingement or posterior cruciate ligament (PCL) impingement of anterior cruciate ligament (ACL) graft can adversely affect the postoperative result, including range of motion (ROM) and knee stability [1]. We experienced a case in which malpositioning of femoral tunnel in primary ACL reconstruction caused PCL impingement and graft loosening as a At the revision ACL surgery, the stretched-out graft was extracted and immunohistological analysis was performed both at the impinged site and non-impinged site to clarify possible molecular changes induced by increased strain.

Results

Conclusion