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Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

A 49-year-old woman underwent anatomic double-bundle anterior cruciate ligament reconstruction using a hamstring tendon. Due to knee osteoarthritis progression, total knee arthroplasty was performed 13 years after the surgery. The anteromedial (AM) bundle was composed partly of tendon-like tissue and partly of scar-like tissue. In the tendon-like part of the AM bundle, the collagen fibers were slightly loose and showed a low-frequency crimp structure with an ovoid cell shape. In contrast, the collagen arrangement in the scar-like part was irregular, edematous, and sparsely cell-dense, with an ovoid cell shape. The posterolateral bundles were generally composed of spindle-shaped cells, and the collagen was arranged in tight cohesion and had well-demarcated bundles with normal crimping. Within the tibial tunnel, the graft was mainly connected to the surrounding lamellar bone on the posterior sides, with sparser connections on the anterior and medial/lateral side. The findings of this long-term case provide valuable information to enable understanding of multiple-folded hamstring tendons.

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Abbreviations

ACL:

Anterior cruciate ligament

BPTB:

Bone–patellar tendon–bone

TKA:

Total knee arthroplasty

AM:

Anteromedial

PL:

Posterolateral

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Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Daiki Kumaki, Keiji Tensho, Tomoya Iwaasa, Kazushige Yoshida, Suguru Koyama, Hiroki Shimodaira & Jun Takahashi

  2. Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Mai Iwaya

  3. Department of Rehabilitation, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan

    Hiroshi Horiuchi

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  1. Daiki Kumaki
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  2. Keiji Tensho
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  4. Tomoya Iwaasa
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Contributions

DK, KT, TI, and KY were involved with drafting and revising the manuscript, as well as creation of the figures. MI was involved with the assessment of pathological findings. SK and HS were involved with the filming of the specimens. HH and JT were involved with revision of the manuscript. KT was involved in the surgical management of the patient. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Keiji Tensho.

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We declare that we have no conflicts of interest in the authorship or publication of this contribution.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Shinshu University.

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In preparing the content of this article, we obtained informed consent from the patient.

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Kumaki, D., Tensho, K., Iwaya, M. et al. Macroscopic and microscopic findings of multi-folded hamstring grafts of anatomical double-bundle ACL reconstruction 13 years after surgery. Knee Surg Sports Traumatol Arthrosc 31, 2406–2411 (2023). https://doi.org/10.1007/s00167-022-07185-y

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