Skip to main content
Log in

Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography

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

Abstract

The purpose of this study is to evaluate the vascular status of autogenous semitendinosus grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Twelve patients (mean age, 24.3 years) who underwent anterior cruciate ligament reconstruction with the 4-strand semitendinosus tendon were studied. All patients underwent contrast-enhanced magnetic resonance angiography and second-look arthroscopy in their reconstructed knees on an average of 15.8 months (range 9–22 months) after surgery. Blood vessels to the graft were visualised and contrast medium enhancement for visualising the femoral tunnel, graft, and tibial tunnel was evaluated. Magnetic resonance angiography showed that a branch of the middle genicular artery extended to the upper side of the graft through the posterior capsule and that branches of the inferior genicular artery ended at the lower side of the graft in all patients. These were consistent with the actual findings of the second-look arthroscopy. We found contrast medium enhancement in the femoral and tibial tunnels in all patients. The effect of enhancement at 9 months after ACL reconstruction was higher than that at 22 months. The graft showed enhancement patterns in the posterior portion of the femoral side and the anterior portion of the tibial side. This study demonstrated that the branches of the middle and inferior genicular arteries provide blood supply to the graft, which may influence the maturation of the graft. The revascularisation of the bone tunnels could play an important role in the healing of the ligament–bone tunnel junction.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Finsterbush A, Frankl U, Matan Y et al (1990) Secondary damage to the knee after isolated injury of the anterior cruciate ligament. Am J Sports Med 18:475–479

    Article  PubMed  CAS  Google Scholar 

  2. Fujikawa K, Seedhom BB, Matsumoto H, Kawakubo M, Otani T (1993) The Leeds–Keio ligament. In: Stover AE (ed) Intraarticular reconstruction of the anterior cruciate ligament. Butterworth-Heinemann, Oxford, pp 173–207

    Google Scholar 

  3. Hara K, Kubo T, Shimizu C, Suginoshita T, Minami G, Hirasawa Y (1999) A new arthroscopic method for reconstructing the anterior and posterior cruciate ligaments using a single-incision technique: simultaneous grafting of the autogenous semitendinosus and patellar tendons. Arthroscopy 15:871–876

    Article  PubMed  CAS  Google Scholar 

  4. Kannus P, Jarvinen M (1987) Conservatively treated tears of the anterior cruciate ligament. J Bone Joint Surg Am 69:1007–1012

    PubMed  CAS  Google Scholar 

  5. Kohn D (1986) Arthroscopy in acute injuries of anterior cruciate-deficient knees: fresh and old intraarticular lesions. Arthroscopy 2:98–102

    Article  PubMed  CAS  Google Scholar 

  6. Noyes FR, Barber-Westin SD (1996) Reconstruction of the anterior cruciate ligament with human allograft. Comparison of early and later results. J Bone Joint Surg Am 78(4):524–537

    PubMed  CAS  Google Scholar 

  7. Rosenberg TD, Deffner KT (1997) ACL reconstruction: semitendinosus tendon is the graft of choice. Orthopaedics 20:396–398

    CAS  Google Scholar 

  8. Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18(3):292–299

    Article  PubMed  CAS  Google Scholar 

  9. Arnoczky SP, Warren RF, Minei JP (1986) Replacement of the anterior cruciate ligament using a synthetic prosthesis. An evaluation of graft biology in the dog. Am J Sports Med 14(1):1–6

    Article  PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  11. Clancy WG Jr, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg Am 64(3):352–359

    PubMed  Google Scholar 

  12. Clancy WG Jr, Narechania RG, Rosenberg TD, Gmeiner JG, Wisnefske DD, Lange TA (1981) Anterior and posterior cruciate ligament reconstruction in rhesus monkeys. J Bone Joint Surg Am 63(8):1270–1284

    PubMed  Google Scholar 

  13. Unterhauser FN, Bail HJ, Hoher J, Haas NP, Weiler A (2003) Endoligamentous revascularisation of an anterior cruciate ligament graft. Clin Orthop Relat Res 414:276–288

    Article  PubMed  Google Scholar 

  14. Robert H, Es-Sayeh J, Heymann D, Passuti N, Eloit S, Vaneenoge E (2003) Hamstring insertion site healing after anterior cruciate ligament reconstruction in patients with symptomatic hardware or repeat rupture: a histologic study in 12 patients. Arthroscopy 19(9):948–954

    Article  PubMed  Google Scholar 

  15. Kawamura S, Ying L, Kim HJ, Dynybil C, Rodeo SA (2005) Macrophages accumulate in the early phase of tendon-bone healing. J Orthop Res 23(6):1425–1432

    PubMed  CAS  Google Scholar 

  16. Dovan TT, Ritty T, Ditsios K, Silva MJ, Kusano N, Gelberman RH (2005) Flexor digitorum profundus tendon to bone tunnel repair: a vascularization and histologic study in canines. J Hand Surg [Am] 30(2):246–257

    Article  Google Scholar 

  17. Kreitner KF, Kalden P, Neufang A, Duber C, Krummenauer F, Kustner E, Laub G, Thelen M (2000) Diabetes and peripheral arterial occlusive disease: prospective comparison of contrast-enhanced three-dimensional MR angiography with conventional digital subtraction angiography. Am J Roentgenol 174(1):171–179

    CAS  Google Scholar 

  18. Ho KY, Leiner T, de Haan MW, Kessels AG, Kitslaar PJ, van Engelshoven JM (1998) Peripheral vascular tree stenoses: evaluation with moving-bed infusion-tracking MR angiography. Radiology 206(3):683–692

    PubMed  CAS  Google Scholar 

  19. Scapinelli R (1968) Studies on the vasculature of the human knee joint. Acta Anat 70:305–331

    Article  PubMed  CAS  Google Scholar 

  20. Nakajima H, Kondo M, Kurosawa H, Fukubayashi T (1979) Insufficiency of the anterior cruciate ligament. Review of our 118 cases. Arch Orthop Trauma Surg 95(4):233–40

    Article  PubMed  CAS  Google Scholar 

  21. Goradia VK, Rochat MC, Kida M, Grana WA (2000) Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med 28(1):40–46

    PubMed  CAS  Google Scholar 

  22. Gaffney K, Cookson J, Blades S, Coumbe A, Blake D (1998) Quantitative assessment of the rheumatoid synovial microvascular bed by gadolinium-DTPA enhanced magnetic resonance imaging. Ann Rheum Dis 57(3):152–157

    PubMed  CAS  Google Scholar 

  23. Howell SM, Knox KE, Farley TE, Taylor MA (1995) Revascularisation of a human anterior cruciate ligament graft during the first two years of implantation. Am J Sports Med 23(1):42–49

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yuji Arai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arai, Y., Hara, K., Takahashi, T. et al. Evaluation of the vascular status of autogenous hamstring tendon grafts after anterior cruciate ligament reconstruction in humans using magnetic resonance angiography. Knee Surg Sports Traumatol Arthr 16, 342–347 (2008). https://doi.org/10.1007/s00167-007-0478-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-007-0478-6

Keywords

Navigation