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Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts

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Abstract

Background

The purpose of the study was the histological examination of tendon-bone healing of hamstring grafts after anterior cruciate ligament (ACL) reconstruction.

Methods

During five arthroscopies done 6–14 months after ACL reconstructions, biopsies of the wall of the former drilled femoral canal were obtained. Four patients were primarily operated on using a suspending device (Endobutton, Acufex Microsurgical, Mansfield, MA, USA, and Transfix, Arthrex, Naples, FL, USA) for femoral fixation, one patient was reconstructed with a biodegradable interference screw directly inserted between the tendon and the wall of the canal. Biopsies were obtained using a tube harvester during re-arthroscopy. Three grafts were stable, two grafts were unstable, and revision of the ACL was performed.

Results

Histologically, in the four cases of reconstruction with a button or a rectangular pin, biopsies resembled granulation tissue without insertion of fibers between the tendon tissue and the bony wall. A wide area of woven bone was noted adjacent to the pre-existing lamellar bone. In contrast, the tendon-bone junction in the knee reconstructed with a biodegradable interference screw resembled a zone of metaplastic fibrous cartilage between the tendon graft and the lamellar bone. Collagen fibers connecting the tendon-bone interface occurred under polarized light microscopy.

Conclusion

We conclude that the use of hamstring grafts for ACL reconstruction can lead to different histological pattern of tendon-bone healing. Micromotion of the hamstring graft inside the drilled canal can be play a role in tendon-bone healing.

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Authors and Affiliations

  1. Marienkrankenhaus Düsseldorf-Kaiserswerth, An St. Swidbert 17, 40489, Düsseldorf, Germany

    W. Nebelung

  2. Department of Orthopedic Surgery, Otto von Guericke University Magdeburg, 39120, Magdeburg, Germany

    R. Becker, D. Urbach & M. Röpke

  3. Institute of Pathology, Otto von Guericke University Magdeburg, 39120, Magdeburg, Germany

    A. Roessner

Authors
  1. W. Nebelung
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  2. R. Becker
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  3. D. Urbach
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  4. M. Röpke
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  5. A. Roessner
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Corresponding author

Correspondence to W. Nebelung.

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Nebelung, W., Becker, R., Urbach, D. et al. Histological findings of tendon-bone healing following anterior cruciate ligament reconstruction with hamstring grafts. Arch Orthop Trauma Surg 123, 158–163 (2003). https://doi.org/10.1007/s00402-002-0463-y

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  • DOI: https://doi.org/10.1007/s00402-002-0463-y

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