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Synovialization on second-look arthroscopy after anterior cruciate ligament reconstruction using Achilles allograft in active young men

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study is to assess the relationship between clinical outcomes and the extent of synovialization through second-look arthroscopy for anterior cruciate ligament (ACL) reconstruction using Achilles allograft in active young men.

Methods

Ninety-five subjects were diagnosed with ACL rupture and underwent reconstruction with Achilles allograft. Median age was 22 years old (range, 17–40). Mean period from injury to operation was 15.1 ± 18.2 weeks. Lysholm score, IKDC classification, range of motion (ROM) of knee, and side-to-side difference (SSD) in anterior instability were evaluated preoperatively and at the last follow-up. Tegner activity scale was evaluated before injury and at the final follow-up. The extent of synovialization of the graft was evaluated under second-look arthroscopy at least 1 year after surgery. Formation of the synovial membrane was divided into four groups—group 1 for 25% or less, group 2 for 25–50%, group 3 for 50–75%, and group 4 for more than 75%. Outcomes were compared between each group.

Results

Lysholm score and IKDC classification were improved after surgery (P < 0.05). Most subjects had full ROM at the final follow-up except three subjects that showed flexion deficit of 5 degrees or less. Mean SSD in anterior instability was 9.0 ± 2.1 mm preoperatively and 1.6 ± 2.0 mm at the final follow-up (P < 0.001). Median Tegner activity scale was 7 before injury and 7 at the final follow-up (P < 0.001). Twelve subjects were in group 1, 10 in group 2, 14 in group 3, and 59 in group 4. Clinical outcomes depending on the extent of synovialization of the grafts were different between each group (P < 0.05). The average period from injury to reconstruction in each group was significantly different (P < 0.001). Correlation coefficient between the period from injury to reconstruction and the extent of synovialization was −0.411 (P < 0.001).

Conclusion

The extent of the synovialization is positively correlated with clinical outcomes and is negatively correlated with the period from injury to reconstruction.

Level of evidence

Therapeutic study-investigating the results of treatment, Level III.

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References

  1. Adachi N, Ochi M, Uchio Y, Iwasa J, Ryoke K, Kuriwaka M (2002) Mechanoreceptors in the anterior cruciate ligament contribute to the joint position sense. Acta Orthop Scand 73:330–334

    Article  PubMed  Google Scholar 

  2. Ahn JH, Yoo JC, Yang HS, Kim JH, Wang JH (2007) Second-look arthroscopic findings of 208 patients after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 15:242–248

    Article  PubMed  Google Scholar 

  3. Almqvist KF, Willaert P, De Brabandere S, Criel K, Verdonk R (2009) A long-term study of anterior cruciate ligament allograft reconstruction. Knee Surg Sports Traumatol Arthrosc 17:818–822

    Article  PubMed  CAS  Google Scholar 

  4. Angoules AG, Mavrogenis AF, Dimitriou R, Karzis K, Drakoulakis E, Michos J et al (2011) Knee proprioception following ACL reconstruction; a prospective trial comparing hamstrings with bone-patellar tendon-bone autograft. Knee 18:76–82

    Article  PubMed  CAS  Google Scholar 

  5. 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 64:217–224

    PubMed  CAS  Google Scholar 

  6. Attia E, Brown H, Henshaw R, George S, Hannafin JA (2010) Patterns of gene expression in a rabbit partial anterior cruciate ligament transection model: the potential role of mechanical forces. Am J Sports Med 38:348–356

    Article  PubMed  Google Scholar 

  7. Bottoni CR, Liddell TR, Trainor TJ, Freccero DM, Lindell KK (2008) Postoperative range of motion following anterior cruciate ligament reconstruction using autograft hamstrings: a prospective, randomized clinical trial of early versus delayed reconstructions. Am J Sports Med 36:656–662

    Article  PubMed  Google Scholar 

  8. Denti M, Monteleone M, Berardi A, Panni AS (1994) Anterior cruciate ligament mechanoreceptors. Histologic studies on lesions and reconstruction. Clin Orthop Relat Res 308:29–32

    PubMed  Google Scholar 

  9. Dhaher YY, Tsoumanis AD, Houle TT, Rymer WZ (2005) Neuromuscular reflexes contribute to knee stiffness during valgus loading. J Neurophysiol 93:2698–2709

    Article  PubMed  CAS  Google Scholar 

  10. Dhaher YY, Tsoumanis AD, Rymer WZ (2003) Reflex muscle contractions can be elicited by valgus positional perturbations of the human knee. J Biomech 36:199–209

    Article  PubMed  CAS  Google Scholar 

  11. Dyhre-Poulsen P, Krogsgaard MR (2000) Muscular reflexes elicited by electrical stimulation of the anterior cruciate ligament in humans. J Appl Physiol 89:2191–2195

    PubMed  CAS  Google Scholar 

  12. Georgoulis AD, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou CO et al (2001) The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc 9:364–368

    Article  PubMed  CAS  Google Scholar 

  13. Hunt P, Scheffler SU, Unterhauser FN, Weiler A (2005) A model of soft-tissue graft anterior cruciate ligament reconstruction in sheep. Arch Orthop Trauma Surg 125:238–248

    Article  PubMed  Google Scholar 

  14. Karasel S, Akpinar B, Gulbahar S, Baydar M, El O, Pinar H et al (2010) Clinical and functional outcomes and proprioception after a modified accelerated rehabilitation program following anterior cruciate ligament reconstruction with patellar tendon autograft. Acta Orthop Traumatol Turc 44:220–228

    Article  PubMed  Google Scholar 

  15. Katayama M, Higuchi H, Kimura M, Kobayashi A, Hatayama K, Terauchi M et al (2004) Proprioception and performance after anterior cruciate ligament rupture. Int Orthop 28:278–281

    Article  PubMed  Google Scholar 

  16. Kondo E, Yasuda K (2007) Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability. Arthroscopy 23:1198–1209

    Article  PubMed  Google Scholar 

  17. Krogsgaard MR, Dyhre-Poulsen P, Fischer-Rasmussen T (2002) Cruciate ligament reflexes. J Electromyogr Kinesiol 12:177–182

    Article  PubMed  Google Scholar 

  18. Lee BI, Min KD, Choi HS, Kwon SW, Chun DI, Yun ES et al (2009) Immunohistochemical study of mechanoreceptors in the tibial remnant of the ruptured anterior cruciate ligament in human knees. Knee Surg Sports Traumatol Arthrosc 17:1095–1101

    Article  PubMed  Google Scholar 

  19. Lee JH, Bae DK, Song SJ, Cho SM, Yoon KH (2010) Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts. Arthroscopy 26:41–49

    Article  PubMed  Google Scholar 

  20. Lee JH, Bae DK, Song SJ, Kim JW, Park SY, Yoon KH (2008) Clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon-bone allografts, anteriro tibialis tendon allografts, and hamstring tendon autografts. J Korean Knee Soc 20:30–37

    Google Scholar 

  21. Malinin TI, Levitt RL, Bashore C, Temple HT, Mnaymneh W (2002) A study of retrieved allografts used to replace anterior cruciate ligaments. Arthroscopy 18:163–170

    Article  PubMed  Google Scholar 

  22. Menetrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16:224–231

    Article  PubMed  CAS  Google Scholar 

  23. Muaidi QI, Nicholson LL, Refshauge KM, Adams RD, Roe JP (2009) Effect of anterior cruciate ligament injury and reconstruction on proprioceptive acuity of knee rotation in the transverse plane. Am J Sports Med 37:1618–1626

    Article  PubMed  Google Scholar 

  24. Murray MM, Martin SD, Martin TL, Spector M (2000) Histological changes in the human anterior cruciate ligament after rupture. J Bone Joint Surg Am 82:1387–1397

    PubMed  Google Scholar 

  25. Ozenci AM, Inanmaz E, Ozcanli H, Soyuncu Y, Samanci N, Dagseven T et al (2007) Proprioceptive comparison of allograft and autograft anterior cruciate ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 15:1432–1437

    Article  PubMed  Google Scholar 

  26. Papageorgiou CD, Ma CB, Abramowitch SD, Clineff TD, Woo SL (2001) A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am J Sports Med 29:620–626

    PubMed  CAS  Google Scholar 

  27. Park MJ, Lee MC, Seong SC (2001) A comparative study of the healing of tendon autograft and tendon-bone autograft using patellar tendon in rabbits. Int Orthop 25:35–39

    Article  PubMed  CAS  Google Scholar 

  28. Reider B, Arcand MA, Diehl LH, Mroczek K, Abulencia A, Stroud CC et al (2003) Proprioception of the knee before and after anterior cruciate ligament reconstruction. Arthroscopy 19:2–12

    PubMed  Google Scholar 

  29. Roberts D, Friden T, Stomberg A, Lindstrand A, Moritz U (2000) Bilateral proprioceptive defects in patients with a unilateral anterior cruciate ligament reconstruction: a comparison between patients and healthy individuals. J Orthop Res 18:565–571

    Article  PubMed  CAS  Google Scholar 

  30. Smith TO, Davies L, Hing CB (2010) Early versus delayed surgery for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 18:304–311

    Article  PubMed  Google Scholar 

  31. Solomonow M, Krogsgaard M (2001) Sensorimotor control of knee stability. A review. Scand J Med Sci Sports 11:64–80

    Article  PubMed  CAS  Google Scholar 

  32. Stone KR, Walgenbach AW, Turek TJ, Somers DL, Wicomb W, Galili U (2007) Anterior cruciate ligament reconstruction with a porcine xenograft: a serologic, histologic, and biomechanical study in primates. Arthroscopy 23:411–419

    Article  PubMed  Google Scholar 

  33. Sun K, Tian S, Zhang J, Xia C, Zhang C, Yu T (2009) Anterior cruciate ligament reconstruction with BPTB autograft, irradiated versus non-irradiated allograft: a prospective randomized clinical study. Knee Surg Sports Traumatol Arthrosc 17:464–474

    Article  PubMed  Google Scholar 

  34. Tomita F, Yasuda K, Mikami S, Sakai T, Yamazaki S, Tohyama H (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 17:461–476

    Article  PubMed  CAS  Google Scholar 

  35. Wang J, Ao Y (2009) Analysis of different kinds of cyclops lesions with or without extension loss. Arthroscopy 25:626–631

    Article  PubMed  Google Scholar 

  36. Woo SL, Young EP, Ohland KJ, Marcin JP, Horibe S, Lin HC (1990) The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament. A biomechanical study of the knee in dogs. J Bone Joint Surg Am 72:382–392

    PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Ms. Wonjoo Jung for her English corrections and suggestions.

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Authors and Affiliations

  1. National Police Hospital, Seoul, Korea

    Jung Ho Noh, Bo Gyu Yang & Jun Suk Lee

  2. Department of Orthopaedic Surgery, National Police Hospital, 58 Garakbon-dong, Songpa-gu, Seoul, 138-708, Korea

    Young Hak Roh

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  1. Jung Ho Noh
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Correspondence to Young Hak Roh.

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Noh, J.H., Yang, B.G., Roh, Y.H. et al. Synovialization on second-look arthroscopy after anterior cruciate ligament reconstruction using Achilles allograft in active young men. Knee Surg Sports Traumatol Arthrosc 19, 1843–1850 (2011). https://doi.org/10.1007/s00167-011-1476-2

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