Pathological changes of the anterior cruciate ligament autografts and some clinical-morphological correlations at the frontal-medial knee joint instability relapses

Cover Page


Cite item

Abstract

Purpose: on the basis of study of histologic changes characterizing the condition of tendinous autografts of the anterior cruciate ligament ^TACL) to establish dependencies between clinical and morphologic indicators in patients with signs of knee joint anteromedial instability relapse. Material and methods: 30 resected tendinous transplants have been used received from own patellar ligament (10 cases) and semitendinous and gracilis muscles of the femur (20 cases). After histologic study the parameters of some graduated morphologic indices that versatile characterize the basic processes condition in АТА^ tissues, frequency of their occurrence separately for femoral and tibial parts of the graft, have been determined. Results: АТАСЦ by the moment of their insufficiency with relapse of antero-medial instability, the complex of unevenly expressed pathologic changes has been observed: ischemic-necrotic, dystrophic, inflammatory, reparative-fibrosing and in rare cases metaplastic changes; their topographical combinations and quantitative expressiveness occasionally can vary. In different parts of ATACL the degree of expressiveness of certain morphologic indices of the graft condition varies and can not correspond to separate types of macroarthroscopic estimates. The correlation analysis of pairs relations for nonparametric clinical and morphologic indices separately in femoral and tibial loci has revealed that only some values of coefficient of association corresponding to an moderate range or close to it - both with positive, and negative signs, some values of the coefficient of association have appeared significant by a number of observed cases. Conclusions. The cause of small number of moderate force correlations and absence of close correlations in pairs of indicators «clinic-morphology» is supposed to be in considerable inequality, and probably in cyclic processes of reparation, dystrophy, inflammation and uncontrollable damage of an immature fibrous tissue in ATACL-regenerates, developing during adaptation of the transplant to physical activities and preparing development of its insufficiency.

About the authors

V. V. Grigorovskiy

Institute of traumatology and orthopaedics NAMS of Ukraine

Author for correspondence.
Email: val_grigorov@bigmir.net
Russian Federation

S. S. Strafun

Institute of traumatology and orthopaedics NAMS of Ukraine

Email: strafun@mail.ru
Russian Federation

S. V. Bogdan

Institute of traumatology and orthopaedics NAMS of Ukraine

Email: sergey-mena@ukr.net
Russian Federation

References

  1. Ахпашев А.А., Загородний Н.В., Щеголева Н.Н., Гнелица Н.Н., Королев А.В. Морфологические аспекты несостоятельности аутотрансплантата передней крестообразной связки. Вестник новых медицинских технологий. 2007;(4):47-49
  2. Котельников Г.П. Посттравматическая нестабильность коленного сустава. Самара: Дом печати; 1998. 184 с
  3. Лазишвили Г.Д., Шехтер А.Б., Лисицын М.П., Скороглядов П.А., Копылов А.А., Лисицына Е.М. Артроскопическая и гистологическая оценка характера ремоделирования трансплантата после аутопластического замещения передней крестообразной связки коленного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2007;(1):28-33
  4. Скороглядов П.А. Артроскопическое замещение передней крестообразной связки коленного сустава свободным аутотрансплантатом из сухожилия прямой головки четырехглавой мышцы бедра [автореф. дис. ... канд. мед. наук]. Москва: ГОУ ВПО РГМУ Росздрава; 2008
  5. Amiel D., Kleiner J.B., Akeson W H. The natural history of the anterior cruciate ligament autograft of patellar tendon origin. Am. J. Sports Med. 1986; 14(6): 449-462.
  6. Bencardino J.T., Beltian J., Feldman M.I., Rose D.J. MRImaging of Complications of Anterior Cruciate Ligament Graft Reconstruction. RadioGraphics. 2009; 29(7):2115-2126.
  7. Bicer E.K., Lustig S., Servien E., SiSelmi T.A., Neyret Ph. Current knowledge in the anatomy of the human anterior cruciate ligament. Knee Surg, Sports Traumatol, Arthrosc. 2010;18:1075-1084.
  8. Blickenstaff K.R., Grana W.A., Egle D. Analysis of semitendinosus autograft in a rabbit model. Am. J. Sports Med. 1997;25(4):554-559.
  9. Carmichael J.R., Cross M.J. Why bone - patella tendon - bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction. Brit. J. Sports Med. 2009;43(5):323-325.
  10. Claes S., Verdonk P., Forsyth R., Bellemans J. The "Ligamentization" Process in Anterior Cruciate Ligament Reconstruction. What happens to the Human graft? A systematic Review of the Literature. Am. J. Sports Med. 2011;39(11):2476-2483.
  11. Corry I.S., Webb J.M., Clingeleffer A.J., Pinczewski L. Arthroscopic reconstruction of the anterior Cruciate Ligament. A Comparison of Patellar Tendon Autograft and Four-Strand Hamstring Tendon Autograft. Am. Sports Med. 1999; 27(4):444-454.
  12. Falconiero R.P., Distefano V.J., Cook T.M. Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans. Arthroscopy. 1998;14(2):197-205.
  13. Ikema Y., Tohyama H., Nakamura H., Kanaya F., Yasuda K. Growth kinetics and integrin expression of fibroblasts infiltrating devitalized patellar tendons are different from those of intrinsic fibroblasts. J. Bone and Joint Surg. 2005; 87-B(12): 1689-1693.
  14. Kondo E., Yasuda K., Katsura T., Hayashi R., Kotani Y., Tohyama H. Biomechanical and Histological Evaluations of the Doubled Semitendinosus Tendon Autograft After Anterior Cruciate Ligament Reconstruction in Sheep. J. Sports Med. 2012;40(2): 315-324.
  15. Papageorgiou Ch.D., Ma C.B., Abramovitch S.D., Clineff Th.D., Woo S.L.-Y. A multidisciplinary study of the healing of an intraarticular anterior cruciate ligament graft in a goat model. Am. J. Sports Med. 2001; 29(5) 620-626.
  16. Rougraff B., Shelbourne K.D., Gerth P.K., Warner J. Arthroscopic and histologic analysis of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Am. J. Sports Med. 1993; 21(2):277-284.
  17. Spindler K.P., Kuhn J.E., Freedman K.B., Matthews Ch.E., Dittus R.S., Harrell F.E. Anterior Cruciate Ligament Reconstruction Autograft Choice: Bone -Tendon - Bone versus Hamstring. Does et really Matter? A systematic review. Am. J. Sports Med. 2004; 32(8): 1986-1995.
  18. Tohyama H., Yasuda K., Uchida H., Nishihira J. The responses of extrinsic fibroblasts infiltrating the devitalized patellar tendon to IL-1B are different from those of normal tendon fibroblasts. J. Bone and Joint Surg. 2007; 89-B(9): 1261-1267.

Copyright (c)



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies