Abstract
Purpose: The purpose of this study was to compare intraosseous graft healing between the doubled
flexor tendon (FT) graft and the bone–patellar tendon–bone (BPTB) graft in anterior
cruciate ligament (ACL) reconstruction. Type of Study: Randomized trial. Methods: A biomechanical and histologic study was conducted with 24 adult beagle dogs. Bilateral
ACL reconstructions were performed in each animal. Autogenous doubled FT and BPTB
grafts were used for the left and right knees, respectively. Each end of the 2 grafts
was tethered with a polyester suture to a screw post with a washer. The animals were
then allowed unrestricted activities in their cages. Eight animals were killed at
3, 6, and 12 weeks, respectively. Results: Histologically, the FT graft was anchored to the tunnel wall with newly formed collagen
fibers resembling Sharpey’s fibers by 12 weeks. These fibers were more abundant in
the anterior (ventral) gap than in the posterior (dorsal) gap. In the BPTB graft,
the bone plug was anchored with newly formed bone at 3 weeks, although osteocytes
in the plug trabeculae were necrotic for 12 weeks. Degeneration of the tendon-bone
junction in the plug progressed at 6 weeks. Tensile testing showed that the weakest
site was different not only between the 2 grafts but also between the observation
periods. In the FT graft, the weakest site was the graft-wall interface at 3 weeks
and the intraosseously grafted tendon at 6 weeks. In the BPTB graft, the weakest site
was the graft-wall interface at 3 weeks and the proximal site in the bone plug at
6 weeks. The ultimate failure load of the FT graft was significantly inferior (45.8%)
to that of the BPTB graft at 3 weeks (P =.021). At 6 weeks, the load of the FT graft was 85% that of the BPTB graft without
a significant difference (P =.395). Conclusions: As to the clinical relevance, the fixation device chosen for soft-tissue fixation
appears to be more important than comparing it to the BPTB graft, although this has
yet to be conclusively proven.
Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 5 (May-June),
2001: pp 461–476
Keywords
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References
- Analysis of a semitendinosus autograft in a rabbit model.Am J Sports Med. 1997; 25: 554-559
- Anterior and posterior cruciate ligament reconstruction in Rhesus monkeys.J Bone Joint Surg Am. 1981; 63: 1270-1284
- Tendon suture to bone. An experimental investigation in rabbits.J Bone Joint Surg Am. 1963; 45: 807-823
- An analysis of autograft fixation after anterior cruciate ligament reconstruction in a rabbit model.Am J Sports Med. 1994; 22: 344-351
- Reluctance of metaphyseal bone to heal to tendon: Histologic evidence for poor mechanical strength.Trans Orthop Res Soc. 1989; 14: 277
- The fate of tendon, fascia and elastic connective tissue transplanted into bone.Ann Surg. 1938; 108: 285-290
- A study of tendon implantations into bone.Gynecol Obstet. 1942; 75: 794-796
- Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog.J Bone Joint Surg Am. 1993; 75: 1795-1803
- Effects of fibrin sealant on incorporation of autograft and xenograft tendons within bone tunnels: A preliminary study.Am J Sports Med. 1989; 17: 318-324
- Some observations on the reaction of bone and tendon after tunneling of bone and insertion of tendon.J Bone Joint Surg Br. 1960; 42: 377-386
- Experimental replacement of the anterior cruciate ligament: A histological and microradiographic study.J Bone Joint Surg Am. 1975; 57: 1124-1127
- Remodeling and healing process of bone patellar tendon-bone graft in a bone tunnel: A histological study in dogs.Trans Orthop Res Soc. 1997; 22: 78
- Effects of structure and strain measurement technique on the material properties of young human tendon and fascia.J Biomech. 1984; 17: 579-596
- Effects of stress shielding on the mechanical properties of rabbit patellar tendon.Trans ASME J Biomech Eng. 1993; 115: 23-28
- Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog.J Bone Joint Surg Am. 1982; 64: 217-224
- The relationship of vascularity and water content to tensile strength in a patellar tendon replacement of the anterior cruciate in dogs.Am J Sports Med. 1986; 14: 436-448
- Graft tension in anterior cruciate ligament reconstruction. An in vivo study in dogs.Am J Sports Med. 1987; 15: 464-470
- Experimental, mechanical and histologic evaluation of the Kennedy ligament augmentation device.Clin Orthop Rel Res. 1985; 196: 186-195
- The phenomenon of “ligamentization”: Anterior cruciate ligament reconstruction with autogenous patellar tendon.J Orthop Res. 1986; 4: 162-172
- Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: A long-term histological and biomechanical study.J Orthop Res. 1989; 7: 474-485
- The effect of anterior cruciate ligament graft elongation at the time of implantation on the biomechanical behavior of the graft and knee.Am J Sports Med. 1996; 24: 608-614
- The mechanical properties of skeletally mature rabbit anterior cruciate ligament and patellar tendon over a range of strain rates.J Orthop Res. 1993; 11: 58-67
- The effects of strain rate on the properties of the medial collateral ligament in skeletally immature and mature rabbits: A biomechanical and histological study.J Orthop Res. 1990; 8: 712-721
- Biomechanics of anterior cruciate ligament failure: An analysis of strain-rate sensitivity and mechanisms of failure in primates.J Bone Joint Surg Am. 1974; 66: 344-352
- The effect of graft-tunnel diameter disparity on healing of the doubled flexor tendon graft within the bone tunnel in anterior cruciate reconstruction.Trans Orthop Res Soc. 1999; 24: 932
- Meniscal repair using an exogenous fibrin clot. An experimental study in dogs.J Bone Joint Surg. 1988; 70: 1209-1217
- Replacement of the anterior cruciate ligament by allogenic tendon graft: An experimental study in the dog.J Bone Joint Surg Br. 1984; 66: 672-681
- Cyclic strain stimulates DNA and collagen synthesis in fibroblasts cultured from rat medial collateral ligaments.Trans Orthop Res Soc. 1990; 15: 130
- The biomechanical and morphological changes in the medical collateral ligament of the rabbit after immobilization and remobilization.J Bone Joint Surg Am. 1987; 69: 1200-1211
- Effects of complete stress-shielding on the mechanical properties and histology of in situ frozen patellar tendon.J Orthop Res. 1993; 11: 592-602
- Treatment of the medial collateral ligament injury of the knee—Structure and function of canine knees in response to differing treatment regimens.Am J Sports Med. 1987; 15: 22-29
- Interference screw fixation of doubled flexor tendon graft in anterior cruciate ligament reconstruction—Biomechanical evaluation with cyclic elongation.Clin Biomech. 2000; 15: 188-195
- Different hamstring tendon graft fixation techniques under incremental cyclic loading conditions.Arthroscopy. 1998; 14: 425-426
- The effect of cyclic displacement on the biomechanical characteristics of anterior cruciate ligament reconstructions.Am J Sports Med. 1999; 27: 772-777
Article info
Footnotes
*Supported in part by Grants-in-Aid for Scientific Research (Nos. 10558124 and 12470299) from the Ministry of Education, Science and Culture, Japan.
**Address correspondence and reprint requests to Kazunori Yasuda, M.D., Ph.D., Department of Medical Bioengineering, Hokkaido University School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan. E-mail: [email protected]
Identification
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© 2001 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
