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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2015 | Knee

Peri-tunnel bone loss: does it affect early tendon graft to bone tunnel healing after ACL reconstruction?

Authors: Pauline Po Yee Lui, Yuk Wa Lee, Tsui Yu Mok, Yau Chuk Cheuk

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2015

Abstract

Purpose

The clinical relevance and mechanisms of local bone loss early post-anterior cruciate ligament (ACL) reconstruction remain unclear. The early spatial and temporal changes of peri-tunnel bone, its molecular mechanisms and its relationships with graft–bone tunnel healing were investigated in a 12-week-old rat model.

Methods

At various times, the reconstructed ACL complex was harvested for vivaCT imaging, biomechanical test, histology and immunohistochemical staining of CD68+ cells (a monocyte–macrophage lineage marker), MMP1 and MMP13.

Results

The peri-tunnel bone resorbed simultaneously with improvement of graft–bone tunnel healing. There were 30.1 ± 17.4, 46.8 ± 10.5 and 81.5 ± 12.3 % loss of peri-tunnel BMD as well as 43.2 ± 21.7, 78.7 ± 8.5 and 92.4 ± 17.7 % loss of peri-tunnel bone volume/total volume (BV/TV) at week 6 at the distal femur, epiphysis and metaphysis of tibia, respectively. MMP1, MMP13 and CD68+ cells were expressed at the graft–bone tunnel interface and peri-tunnel bone and increased with time post-reconstruction at the tibia. The ultimate load and stiffness of the healing complex positively correlated with tibial tunnel bone formation and negatively correlated with tibial peri-tunnel bone. Tunnel BV/TV at the tibial metaphysis and epiphysis showed the highest correlation with ultimate load (ρ = 0.591; p = 0.001) and stiffness (ρ = 0.427; p = 0.026) of the complex, respectively.

Conclusion

There was time-dependent loss of peri-tunnel bone early post-reconstruction, with the greatest loss occurring at the tibial metaphysis. This was consistent with high expression of MMP1, MMP13 and CD68+ cells at the graft–bone tunnel interface and the peri-tunnel region. The significant loss of peri-tunnel bone, though not critically affecting early tunnel healing, suggested the need to protect the knee joint early post-reconstruction.

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Title: Peri-tunnel bone loss: does it affect early tendon graft to bone tunnel healing after ACL reconstruction?
Authors: Pauline Po Yee Lui
Yuk Wa Lee
Tsui Yu Mok
Yau Chuk Cheuk
Publication date: 01-03-2015
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2697-3

At a glance: The STEP trials

Springer Medicine

Peri-tunnel bone loss: does it affect early tendon graft to bone tunnel healing after ACL reconstruction?

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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