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Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Tunnel widening after anterior cruciate ligament (ACL) reconstruction (ACLR) is commonly reported without a clear understanding of the mechanism. This study aimed to quantify the spatiotemporal change of the newly formed bone mass, bone tunnel diameter, and area along both bone tunnels using micro-computed tomography (μCT) and correlated the result with histology.

Methods

ACLR was performed in 24 rabbits. At baseline and weeks 2, 6, and 12, the juxta-articular, middle, and exit segments of both tunnels were harvested for μCT and histological evaluation.

Results

μCT and histology revealed significant bone tunnel and graft-bone tunnel healing, respectively, only at week 6 after reconstruction. Despite this, the mean tunnel diameter and area remained relatively unchanged with time. The newly formed bone mass [new bone volume/total bone volume (BV/TV) ratio] and its bone mineral density (BMD) were both higher, whereas the mean tunnel diameter and area were significantly smaller at the femoral tunnel compared to those at the tibial tunnel at weeks 6 and 12 and at week 12, respectively. These were consistent with histological findings, which showed inferior graft remodeling and integration at the tibial tunnel at weeks 6 and 12. The BV/TV increased, whereas the mean tunnel diameter and area decreased toward the exit segment of both tunnels. However, whereas better histological healing occurred at the femoral exit segment, poorer graft remodeling and Sharpey’s fiber formation occurred at the tibial exit segment.

Conclusions

Poor healing was observed during the initial 6 weeks, particularly that of the tibia, after ACLR. Bone resorption was rapid during healing, resulting in unchanged tunnel diameter and area with time.

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Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China

    Pauline Po Yee Lui, Grace Ho, Wai Ting Shum, Yuk Wa Lee, Po Yan Ho & Wing Nin Lo

  2. The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Pauline Po Yee Lui, Grace Ho, Wai Ting Shum, Yuk Wa Lee, Po Yan Ho & Wing Nin Lo

  3. Program of Stem Cell and Regeneration, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China

    Pauline Po Yee Lui

  4. Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China

    Chun Kwong Lo

  5. Prince of Wales Hospital, Room 74025, 5/F, Clinical Sciences Building, Shatin, Hong Kong Special Administrative Region, China

    Pauline Po Yee Lui

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  1. Pauline Po Yee Lui
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Lui, P.P.Y., Ho, G., Shum, W.T. et al. Inferior tendon graft to bone tunnel healing at the tibia compared to that at the femur after anterior cruciate ligament reconstruction. J Orthop Sci 15, 389–401 (2010). https://doi.org/10.1007/s00776-010-1460-6

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  • DOI: https://doi.org/10.1007/s00776-010-1460-6

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