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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-09-2008 | Knee

Graft remodeling and ligamentization after cruciate ligament reconstruction

Authors: S. U. Scheffler, F. N. Unterhauser, A. Weiler

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2008

Abstract

After reconstruction of the cruciate ligaments, replacement grafts have to undergo several phases of healing in the intra-articular graft region and at the site of graft-to-bone incorporation. The changes in the biological and mechanical properties of the healing graft in its intra-articular region are described as the ligamentization process. Significant knowledge has been added in the understanding of the several processes during the course of graft healing and is summarized in this article. The understanding of the spatial and time-dependent changes as well as the differences between the different models of graft healing are of significant importance to develop strategies of improved treatment options in cruciate ligament surgery, so that full restoration of function and mechanical strength of the intact cruciate ligaments will be achieved.

Abe S et al (1993) Light and electron microscopic study of remodeling and maturation process in autogenous graft for anterior cruciate ligament reconstruction. Arthroscopy 9(4):394–405PubMed

Amiel D et al (1984) Tendons and ligaments: a morphological and biochemical comparison. J Orthop Res 1(3):257–265PubMedCrossRef

Amiel D et al (1986) The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4(2):162–172PubMedCrossRef

Arnoczky SP, Tarvin GB, Marshall JL (1982) Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg Am 64(2):217–224PubMed

Ballock RT et al (1989) Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: a long-term histologic and biomechanical study. J Orthop Res 7(4):474–485PubMedCrossRef

Blickenstaff KR, Grana WA, Egle D (1997) Analysis of a semitendinosus autograft in a rabbit model. Am J Sports Med 25(4):554–559PubMedCrossRef

Bosch U, Kasperczyk WJ (1992) Healing of the patellar tendon autograft after posterior cruciate ligament reconstruction—a process of ligamentization? An experimental study in a sheep model. Am J Sports Med 20(5):558–566PubMedCrossRef

Bosch U et al (1994) The patellar tendon graft for PCL reconstruction. Morphological aspects in a sheep model. Acta Orthop Belg 60(Suppl 1):57–61PubMed

Cho S et al (2004) Electron microscopic evaluation of two-bundle anatomically reconstructed anterior cruciate ligament graft. J Orthop Sci 9(3):296–301PubMedCrossRef

10.

Clancy WG Jr et al (1981) Anterior and posterior cruciate ligament reconstruction in rhesus monkeys. J Bone Joint Surg Am 63(8):1270–1284PubMed

11.

Falconiero RP, DiStefano VJ, Cook TM (1998) Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans. Arthroscopy 14(2):197–205PubMedCrossRef

12.

Flint MH et al (1984) Collagen fibril diameters and glycosaminoglycan content of skins—indices of tissue maturity and function. Connect Tissue Res 13(1):69–81PubMedCrossRef

13.

Goradia VK et al (2000) Tendon-to-bone healing of a semitendinosus tendon autograft used for ACL reconstruction in a sheep model. Am J Knee Surg 13(3):143–151PubMed

14.

Goradia VK et al (2000) Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med 28(1):40–46PubMed

15.

Grana WA et al (1994) An analysis of autograft fixation after anterior cruciate ligament reconstruction in a rabbit model. Am J Sports Med 22(3):344–351PubMedCrossRef

16.

Howell SM et al (1995) Revascularization of a human anterior cruciate ligament graft during the first two years of implantation. Am J Sports Med 23(1):42–49PubMedCrossRef

17.

Jackson DW et al (1991) The effects of in situ freezing on the anterior cruciate ligament. An experimental study in goats. J Bone Joint Surg Am 73(2):201–213PubMed

18.

Jackson DW et al (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21(2):176–185PubMedCrossRef

19.

Jackson JR et al (1997) Expression of vascular endothelial growth factor in synovial fibroblasts is induced by hypoxia and interleukin 1beta. J Rheumatol 24(7):1253–1259PubMed

20.

Johnson LL (1993) The outcome of a free autogenous semitendinosus tendon graft in human anterior cruciate reconstructive surgery: a histological study. Arthroscopy 9(2):131–142PubMed

21.

Kawamura S et al (2005) Macrophages accumulate in the early phase of tendon-bone healing. J Orthop Res 23(6):1425–1432PubMed

22.

Kleiner JB et al (1986) Origin of replacement cells for the anterior cruciate ligament autograft. J Orthop Res 4(4):466–474PubMedCrossRef

23.

Kleiner JB et al (1989) Early histologic, metabolic, and vascular assessment of anterior cruciate ligament autografts. J Orthop Res 7(2):235–242PubMedCrossRef

24.

Kuroda R et al (2000) Localization of growth factors in the reconstructed anterior cruciate ligament: immunohistological study in dogs. Knee Surg Sports Traumatol Arthrosc 8(2):120–126PubMedCrossRef

25.

Liu SH et al (1995) Collagen in tendon, ligament, and bone healing. A current review. Clin Orthop Relat Res 318:265–278PubMed

26.

Majima T et al (2003) Stress shielding of patellar tendon: effect on small-diameter collagen fibrils in a rabbit model. J Orthop Sci 8(6):836–841PubMedCrossRef

27.

Marumo K et al (2005) The “ligamentization” process in human anterior cruciate ligament reconstruction with autogenous patellar and hamstring tendons: a biochemical study. Am J Sports Med 33(8):1166–1173PubMedCrossRef

28.

Murray MM et al (2000) Histological changes in the human anterior cruciate ligament after rupture. J Bone Joint Surg Am 82-A(10):1387–1397PubMed

29.

Ng GY et al (1995) Biomechanics of patellar tendon autograft for reconstruction of the anterior cruciate ligament in the goat: three-year study. J Orthop Res 13(4):602–608PubMedCrossRef

30.

Ng GY et al (1996) Long-term study of the biochemistry and biomechanics of anterior cruciate ligament-patellar tendon autografts in goats. J Orthop Res 14(6):851–856PubMedCrossRef

31.

Ohno K et al (1993) Effects of complete stress-shielding on the mechanical properties and histology of in situ frozen patellar tendon. J Orthop Res 11(4):592–602PubMedCrossRef

32.

Papageorgiou CD et al (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med 29(5):620–626PubMed

33.

Parry DA, Barnes GR, Craig AS (1978) A comparison of the size distribution of collagen fibrils in connective tissues as a function of age and a possible relation between fibril size distribution and mechanical properties. Proc R Soc Lond B Biol Sci 203(1152):305–321PubMed

34.

Petersen W, Laprell H (2000) Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 8(1):26–31PubMedCrossRef

35.

Petersen W et al (2003) The angiogenic peptide vascular endothelial growth factor (VEGF) is expressed during the remodeling of free tendon grafts in sheep. Arch Orthop Trauma Surg 123(4):168–174PubMed

36.

Rodeo SA et al (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75(12):1795–1803PubMed

37.

Rougraff BT, Shelbourne KD (1999) Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 7(1):9–14PubMedCrossRef

38.

Rougraff B et al (1993) Arthroscopic and histologic analysis of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Am J Sports Med 21(2):277–284PubMedCrossRef

39.

Roux W (1905) Die Entwicklungsmechanik; ein neuer Zweig der biologischen Wissenschaft, vols I & II. Wilhelm Engelmann, Leipzig

40.

Scheffler SU et al (2005) The biological healing and restoration of the mechanical properties of free soft-tissue allografts lag behind autologous ACL reconstruction in the sheep model. Trans Orthop Res

41.

Shino K, Horibe S (1991) Experimental ligament reconstruction by allogeneic tendon graft in a canine model. Acta Orthop Belg 57(Suppl 2):44–53PubMed

42.

Shino K et al (1984) Replacement of the anterior cruciate ligament by an allogeneic tendon graft. An experimental study in the dog. J Bone Joint Surg Br 66(5):672–681PubMed

43.

Spindler KP et al (1996) Distribution of cellular repopulation and collagen synthesis in a canine anterior cruciate ligament autograft. J Orthop Res 14(3):384–389PubMedCrossRef

44.

Tohyama H, Yasuda K (1998) Significance of graft tension in anterior cruciate ligament reconstruction. Basic background and clinical outcome. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S30–S37PubMedCrossRef

45.

Tohyama H, Yasuda K (2000) Extrinsic cell infiltration and revascularization accelerate mechanical deterioration of the patellar tendon after fibroblast necrosis. J Biomech Eng 122(6):594–599PubMedCrossRef

46.

Tohyama H, Yasuda K (2002) The effect of increased stress on the patellar tendon. J Bone Joint Surg Br 84(3):440–446PubMedCrossRef

47.

Tomita F et al (2001) Comparisons of intraosseous graft healing between the doubled flexor tendon graft and the bone-patellar tendon-bone graft in anterior cruciate ligament reconstruction. Arthroscopy 17(5):461–476PubMed

48.

Tsuchida T et al (1997) Effects of in situ freezing and stress-shielding on the ultrastructure of rabbit patellar tendons. J Orthop Res 15(6):904–910PubMedCrossRef

49.

Unterhauser FN et al (2003) Endoligamentous revascularization of an anterior cruciate ligament graft. Clin Orthop Relat Res (414):276–288

50.

Unterhauser FN et al (2004) Alpha-smooth muscle actin containing contractile fibroblastic cells in human knee arthrofibrosis tissue. Winner of the AGA-DonJoy Award 2003. Arch Orthop Trauma Surg 124(9):585–591PubMedCrossRef

51.

Weiler A et al (2001) Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging. A two-year study in sheep. Am J Sports Med 29(6):751–761PubMed

52.

Weiler A et al (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):124–135PubMed

53.

Weiler A et al (2002) Tendon healing in a bone tunnel. Part I: biomechanical results after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):113–123PubMed

54.

Weiler A et al (2002) Alpha-smooth muscle actin is expressed by fibroblastic cells of the ovine anterior cruciate ligament and its free tendon graft during remodeling. J Orthop Res 20(2):310–317PubMedCrossRef

55.

Weiler A et al (2004) The influence of locally applied platelet-derived growth factor-BB on free tendon graft remodeling after anterior cruciate ligament reconstruction. Am J Sports Med 32(4):881–891PubMedCrossRef

56.

Yoshikawa T et al (2006) Expression of vascular endothelial growth factor and angiogenesis in patellar tendon grafts in the early phase after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14(9):804–810 PubMedCrossRef

57.

Yoshikawa T et al (2006) Effects of local administration of vascular endothelial growth factor on mechanical characteristics of the semitendinosus tendon graft after anterior cruciate ligament reconstruction in sheep. Am J Sports Med 34(12):1918–1925PubMedCrossRef

58.

Zaffagnini S et al (2007) Neoligamentization process of BTPB used for ACL graft: histological evaluation from 6 months to 10 years. Knee 14(2):87–93PubMedCrossRef

Title: Graft remodeling and ligamentization after cruciate ligament reconstruction
Authors: S. U. Scheffler
F. N. Unterhauser
A. Weiler
Publication date: 01-09-2008
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2008
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-008-0560-8

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Graft remodeling and ligamentization after cruciate ligament reconstruction

Abstract

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