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Comparative and morphological analysis of commonly used autografts for anterior cruciate ligament reconstruction with the native ACL: an electron, microscopic and morphologic study

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

Abstract

Ligaments and tendons are similar in composition but differ in proportion and arrangement. Tendons are being used as grafts for the ACL reconstruction. Their microscopic structure has not been sufficiently studied and compared to the native ACL. A null hypothesis was declared stating that the anterior cruciate ligament should be histological, morphologically and functionally different from the tendon grafts used for ACL reconstruction. We investigated similarities and differences of the structure of ACL and tendons used as a graft tissue for ACL reconstruction. In this study, standardized samples of quadriceps, hamstrings (semitendinosus and gracilis) and patellar tendons, and the ACL were harvested from 26 autopsies (average age 36.4) and were investigated using light and electron microscopy, immunohistochemistry and morphometry. The thickness of the collagen fibrils, collagen organization and diameter, the fibril/interstitium ratio, density of fibroblasts and blood vessels, and distribution of the collagen type I, III and V fibrils were analyzed. The semitendinosus showed the highest density of fibroblasts and blood vessels, while the gracilis the highest fibril/interstitium ratio. No differences regarding the thickness of collagen fibrils and distribution of fibrils were found. The ACL had the highest concentration of type III and V collagen fibrils as well as elastic fibers. The histological and ultrastructural appearance of the ACL differs from those of the tendons used as graft, for ACL reconstruction. Its ultrastructure is varied and complex, with its collagen fibers bundles lying in many directions.

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Conflict of interest statement

The authors report no conflict of interest for this manuscript.

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Authors and Affiliations

  1. Department of Trauma and Reconstructive Surgery, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany

    Panayiotis T. Hadjicostas

  2. First Department Orthopaedic Surgery, Athens University, Athens, Greece

    Panayotis N. Soucacos

  3. Department of Pathology, University of Heidelberg, Heidelberg, Germany

    Nadezda Koleganova & Irina Berger

  4. Department of Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany

    Gerhard Krohmer

  5. 22 Chrisostomou Smirnis, Melissia, 151 27, Athens, Greece

    Panayiotis T. Hadjicostas

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  1. Panayiotis T. Hadjicostas
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  2. Panayotis N. Soucacos
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Correspondence to Panayiotis T. Hadjicostas.

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Hadjicostas, P.T., Soucacos, P.N., Koleganova, N. et al. Comparative and morphological analysis of commonly used autografts for anterior cruciate ligament reconstruction with the native ACL: an electron, microscopic and morphologic study. Knee Surg Sports Traumatol Arthr 16, 1099–1107 (2008). https://doi.org/10.1007/s00167-008-0603-1

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  • DOI: https://doi.org/10.1007/s00167-008-0603-1

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