Skip to main content
SpringerLink
Log in

The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon

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

Abstract

The current study was performed to understand the relationship between graft length placed within the bone tunnel and intraosseous graft healing in anterior cruciate ligament (ACL) reconstruction. Twenty-four adult beagle dogs were divided into two groups of 12 animals each. In each animal, ACL reconstruction using a 4-mm diameter autogenous flexor tendon graft was done in the left knee. In groups I and II, the graft having a length of 15 and 5 mm, respectively, was placed within the tibial tunnel. The proximal end of the graft was placed through the over-the-top route in all animals. In each group, five animals were sacrificed immediately after surgery, and the remaining seven were sacrificed at 6 weeks postoperatively. Biomechanical and histologic evaluations were performed. In pull out testing, the ultimate failure load and the linear stiffness of the graft-tibia complex harvested at 6 weeks were significantly greater than those harvested at the time-zero period. There were no significant differences in those parameters between groups I and II at 6 weeks. In each group, the perpendicular collagen fibers connecting the tendon to the bone tunnel wall were observed only in the narrow area located close to the intra-articular tunnel outlet. In conclusion, excessively long placement of the flexor graft within the bone tunnel does not result in an additional increase of anchoring strength and stiffness of the graft in ACL reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. 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 

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

    PubMed  CAS  Google Scholar 

  3. Chiroff RT (1975) Experimental replacement of the anterior cruciate ligament: A histological and microradiographic study. J Bone Joint Surg Am 57:1124–1127

    PubMed  CAS  Google Scholar 

  4. Danto MI, Woo SL (1993) The mechanical properties of skeletally mature rabbit anterior cruciate ligament and patellar tendon over a range of strain rates. J Orthop Res 11:58–67

    Article  PubMed  CAS  Google Scholar 

  5. Forward AD, Cowan RJ (1963) Tendon suture to bone. An experimental investigation in rabbits. J Bone Joint Surg Am 45:807–823

    Google Scholar 

  6. Grana WA, Egle DM, Mahnken R, Goodhart CW (1994) An analysis of autograft fixation after anterior cruciate ligament reconstruction in a rabbit model. Am J Sports Med 22:344–351

    PubMed  CAS  Google Scholar 

  7. Greis PE, Burks RT, Bachus K, Luker MG (2001) The influence of tendon length and fit on the strength of a tendon-bone tunnel complex: A biomechanical and histologic study in the dog. Am J Sports Med 29:493–497

    PubMed  CAS  Google Scholar 

  8. Katsuragi R, Yasuda K, Tsujino J, Keira M, Kaneda K (2000) The effect of nonphysiologically high initial tension on the mechanical properties of in situ frozen anterior cruciate ligament in a canine model. Am J Sports Med 28:47–56

    PubMed  CAS  Google Scholar 

  9. Keira M, Yasuda K, Kaneda K, Yamamoto N, Hayashi K (1996) Mechanical properties of the anterior cruciate ligament chronically relaxed by elevation of the tibial insertion. J Orthop Res 14:157–166

    Article  PubMed  CAS  Google Scholar 

  10. Kernwein G, Fahey J, Garrison M (1938) The fate of tendon, fascia and elastic connective tissue transplanted into bone. Ann Surg 108:285–290

    Article  CAS  PubMed  Google Scholar 

  11. Kernwein GA (1942) A study of tendon implantations into bone. Gynecol Obstet 75:794–796

    Google Scholar 

  12. McFarland EG, Morrey BF, An KN, Wood MB (1986) The relationship of vascularity and water content to tensile strength in a patellar tendon replacement of the anterior cruciate in dogs. Am J Sports Med 14:436–448

    PubMed  CAS  Google Scholar 

  13. McPherson GK, Mendenhall HV, Gibbons DF, Plenk H, Rottmann W, Sanford JB, Kennedy JC, Roth JH (1985) Experimental, mechanical and histologic evaluation of the Kennedy ligament augmentation device. Clin Orthop 196:186–195

    PubMed  Google Scholar 

  14. Noyes FR, Delucas JL, Torvik PJ (1974) Biomechanics of anterior cruciate ligament failure. An analysis of strain-rate sensitivity and mechanism of failure in primates. J Bone Joint Surg Am 66:344–352

    Google Scholar 

  15. Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803

    PubMed  CAS  Google Scholar 

  16. Shoemaker SC, Rechl J, Campbell P, Kram HB, Sanchez M (1989) Effects of fibrin sealant on incorporation of autograft and xenograft tendons within bone tunnels. Am J Sports Med 17:318–324

    PubMed  CAS  Google Scholar 

  17. Tohyama H, Beynnen BD, Johnson RJ, Renstrom PA, Arms SW (1996) The effect of anterior cruciate ligament graft elongation at the time of implantation on the biomechanical behavior of the graft and knee. Am J Sports Med 24:608–614

    PubMed  CAS  Google Scholar 

  18. 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 

  19. Whiston TB, Walmsley R (1960) Some observations on the reaction of bone and tendon after tunneling of bone and insertion of tendon. J Bone Joint Surg Br 42:377–386

    PubMed  Google Scholar 

  20. Woo SL, Gomez MA, Seguchi Y, Endo CM, Akeson WH (1983) Measurement of mechanical properties of ligament substance from a bone-ligament-bone preparation. J Orthop Res 1:22–29

    Article  PubMed  CAS  Google Scholar 

  21. Woo SL, Peterson RH, Ohland KJ, Sites TJ, Danto MI (1990) The effects of strain rate on the properties of the medial collateral ligament in skeletally immature and mature rabbits: a biomechanical and histological study. J Orthop Res 8:712–721

    Article  PubMed  CAS  Google Scholar 

  22. Yamazaki S, Yasuda K, Tomita F, Minami A, Tohyama H (2002) The effect of graft-tunnel diameter disparity on intraosseous healing of the flexor tendon graft in anterior cruciate ligament reconstruction. Am J Sports Med 30:498–505

    PubMed  Google Scholar 

  23. Yoshiya S, Andrish JT, Manley MT, Bauer TW (1987) Graft tension in anterior cruciate ligament reconstruction. An in vivo study in dogs. Am J Sports Med 15:464–470

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This work was supported by Grants-in-Aid (Nos.16390425 and 14GS0301) for Scientific Research from the Ministry of Education Culture, Sports, Science, and Technology, Japan.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Shuji Yamazaki, Fumihisa Tomita & Akio Minami

  2. Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan

    Kazunori Yasuda & Harukazu Tohyama

Authors
  1. Shuji Yamazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazunori Yasuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumihisa Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akio Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Harukazu Tohyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazunori Yasuda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yamazaki, S., Yasuda, K., Tomita, F. et al. The effect of intraosseous graft length on tendon-bone healing in anterior cruciate ligament reconstruction using flexor tendon. Knee Surg Sports Traumatol Arthrosc 14, 1086–1093 (2006). https://doi.org/10.1007/s00167-006-0110-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-006-0110-1

Keywords

Search

Navigation