The bone microstructure from anterior cruciate ligament footprints is similar after ligament reconstruction and does not affect long-term outcomes

Mateusz Stolarz,Małgorzata Janik,Zbigniew Kwiatkowski,Jacek Karpe,Zygmunt Wrobel,Krzysztof Ficek,Damian Czyzewski,Jolanta Rajca,Marcin Binkowski,Filip Humpa,Paulina Cyganik

doi:10.1007/s00167-021-06493-z

Abstract

PurposeThe purpose of this study was to assess the quality of the bone tissue microstructure from the footprints of the anterior cruciate ligament (ACL) and its impact on late follow-up outcomes in patients who undergo anterior cruciate ligament reconstruction (ACLR).MethodsThe records of 26 patients diagnosed with a completely torn ACL who underwent ACLR were collected. During the surgery performed using the Felmet method, bone blocks from the native ACL footprints were collected. The primary measurements of the bone microstructure were made using a microtomographic scanner. In late follow-up examinations, a GNRB arthrometer was used.ResultsThere was no significant difference in the bone microstructure assessed using micro-CT histomorphometric data according to the blood test results, plain radiographs, age or anthropometric data. There was no difference in the bone volume/total volume ratio or trabecular thickness in the area of the native ACL footprints. Routine preoperative examinations were not relevant to the quality of the bone microstructure. The elapsed time from an ACL injury to surgery had no relevance to the results of arthrometry.ConclusionThe similarities in the microstructure of bone blocks from ACL footprints from the femur and tibia allow the variable use of these blocks to stabilize grafts in the Felmet method. The bone microstructure is not dependent on the time from injury to surgery. Histomorphometric values of the structure of the femoral and tibial ACL footprints have no impact on the long-term stability of the operated knee joint.Trial registrationThe approval of the Bioethics Committee of the Silesian Medical Chamber in Katowice, Poland (resolution 16/2014) was given for this research.Level of evidenceII.

Highlights

The healing process after anterior cruciate ligament reconstruction (ACLR) and the quality of the new connection between the bone and the ACL graft are not fully understood [8, 9]
ACLR contributed to a reduction in knee joint instability in each patient
The most important finding of the present study was the lack of a difference in bone microstructure between the tibial and femoral bone blocks, which suggests the possibility of using bone blocks interchangeably during ACL graft fixation in the Felmet method

Summary

Introduction

The healing process after anterior cruciate ligament reconstruction (ACLR) and the quality of the new connection between the bone and the ACL graft are not fully understood [8, 9] These characteristics are usually described based on animal models without considering many external factors, e.g., rehabilitation and chronic diseases. The outer part includes the cortical bone of the diaphysis, the middle part consists of the trabecular bone, and the inner part consists of the cortex layer, which has direct contact with the joint cavity [1] This heterogeneity has a biological effect on the speed of osseointegration of the graft [1] and the type of connection formed in different parts of the tunnel [26]. Lui et al [14] noted that different parts of the bone tunnel exhibited significantly different environments, both biologically and mechanically, but the authors did not describe the structures

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