Abstract Presented at the 29th Annual Meeting of the Arthroscopy Association of North America| Volume 26, ISSUE 6, SUPPLEMENT , e20-e21, June 2010

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The Evaluation of Revascularization Following Arthroscopic Anterior Cruciate Ligament Reconstruction Using Vascular Angiography Imaging and Serum Vascular Markers (SS-40)


      To investigate the relationship between the vascular markers expression, the variables of vascularity at the tendon-bone interface and the functional outcome in the early phase after the arthroscopic anterior cruciate ligament reconstruction (ACLR): the temporal changes of angiogenesis status.


      Between July 2007 and October 2008 25 patients with arthroscopic ACLR were chosen from those admitted at the Department of Sports Medicine & Arthroscopy. Mean follow-up was 12 months. Control data was collected from 25 subjects by Blood Bank. The ANG were measured by ELISA kit from R&D Systems. Express ELISA techniques have been developed to quantify immune marker of angiogenesis (anti-ANG IgG) in INR. Digital angiography imaging was used to evaluate the revascularization following arthroscopic ACLR. Functional outcome was evaluated using the International Knee Documentation Committee (IKDC) scoring. Before surgery, and at 1, 2, 3, 4, 5, 8, and 12 weeks after it, a control IKDC assessment, serological vascular markers, and vascular imaging measurements were completed.


      Neovascularization was confirmed by the angiogenic markers including ANG and anti-ANG IgG. Mean serum ANG levels in patients after ACLR were significantly higher at all time points, except on day 17 (m±SD, ng/mL: 334.9±93.9 versus 443.6±91.1; P≤0.005). Levels were found equal after day 17 in both donors and ACLR patients. Digital angiography imaging research of ACLR blood supply and blood vessel indicated a significant difference between the revascularization of the normal and the pathological ACLR (P≤0.0089). The vascularity at the tendon-bone interface was present as early as 3 weeks after surgery and increased over next 5 weeks. For patients with ACLR ANG expression was directly associated with levels of secretory anti-ANG IgG of this patients (r=0.93; P≤0.0001). Serum anti-ANG IgG levels in ACLR patients were significantly correlated with the vascular state, i.e., patients after surgery with higher serum anti-ANG IgG levels (m±SD, ODx1000: 499±163 versus 625±118; P≤0.005) had hypervascularity. Postoperative IKDC score was positively correlated with expression of ANG and anti-ANG IgG. Additionally, a significant association was seen between intensity of revascularization and functional outcome: IKDC score (r=0.93; P≤0.0001).


      A significant relationship was found between the examined variables of vascularity at the tendon-bone interface, IKDC score, and the dynamic change of serum levels of vascular markers after ACLR. ANG and anti-ANG IgG concentrations are elevated in the sera of patients after ACLR and correlate with individual and composite measures of the revascularization activity. Sensitive methods for visualizing revascularization following ACLR, such as digital angiography, are emerging as clinically important tools in the assessment of revascularization activity. Imaging technologies capable of evaluating vascularity at the tendon-bone will have a practical value in assessment of functional outcome following ACLR. Measurement of serologic vascular markers and angiography vascular imaging can be used to identify early revascularization following ACLR and show promise for functional outcome. Serological vascular markers and vascular imaging after ACLR will become useful tools in the assessment of revascularization activity and immune response to surgical intervention.