Substitution of the anterior cruciate ligament: A long-term histologic and biomechanical study with autogenous pedicled grafts of the iliotibial band in dogs

This paper reports the experience with anterior cruciate ligament (ACL) substitution by standardized pedicled strips of the iliotibial band, fixed to the tibia and femur with a bone-peg fixation technique. Thirty-two young adult (± one year old) Labrador dogs were used for the experiments (58 transplant knees and six controls). The posttransplantation period ranged from day zero to three years postoperatively. Of the transplants, there were five failures. Forty-seven knees served for gross, photographic, and histologic examination. In 17 knees, the transplants were submitted to tensile testing in an Instron testing machine. The behavior of the ACL transplants was as follows: the transplants became necrotic in a short period of time, but after day four, a process of creeping substitution took place. At 12–16 weeks, a newly formed ligament was seen with a striking macroscopic resemblance to the normal ACL. However, its collagen fibers were coarser and more undulant, and they were fixed to the bony interfaces with Sharpey-like fibers. When these rather good-looking ACLs were subjected to mechanical testing and compared with normal ACLs, the results were less satisfactory. Mechanically, the substituted ACLs were 45% less stiff than normal ligaments, the yield point was at one-third, and the ultimate load was 40% of that of a normal ACL (deformation rate, 5 mm/min). Normal ACLs rupture at their tibial insertion. The transplants ruptured intraligamentarily. A striking finding was that the substituted ligament did not derotate when all the other ligamentous and capsular structures were cut. There was no torsional arrangement of their component bundles. Although the substituted ACL has an excellent histological and macroscopic appearance, its mechanical properties are inferior.