Wu Bing, Qiu Zhihe, Li Sheng, Liang Daqiang, Xu Jian, Zhong Mingjin, Lu Wei, Wang Daping, Liu Haifeng, Zhu Weimin, Ouyang Kan, Li Hao
Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People's Hospital), Shenzhen Guangdong, 518000, P.R.China;Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061, P.R.China.
Department of Medicine, Shenzhen University, Shenzhen Guangdong, 518061,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Jul 15;32(7):873-879. doi: 10.7507/1002-1892.201802001.
To investigate the histological characteristics of autogenous hamstring grafts after anterior cruciate ligament (ACL) reconstruction.
The patients who underwent arthroscopic single-bundle ACL reconstruction with autogenous hamstring tendons and were followed up at least 4 years and also underwent second-look arthroscopy between March 2017 and December 2017 and met the selection criteria were considered for enrollment. Graft quality under arthroscopy was evaluated as good remodeling group (GRG, the total scores were 4-6) and poor remodeling group (PRG, the total scores were 1-3) according to synovial and vascular coverage, the apparent tension of the grafts, the thickness and retear of the grafts. During the second-look arthroscopic procedures, ACL graft biopsies were performed. Normal ACL tissues harvested from the patients under 60 years old who underwent total knee arthroplasty were designated as normal controls. Graft vascularity, cellular morphology, cellular metabolism, and collagen fibril distribution were analyzed.
The 18 specimens (11 cases of GRG group and 7 cases of PRG group) and 9 native ACL biopsied tissue sample were enrolled into the study. Arthroscopy scores were 2-6 (mean, 4.7). The biology under light microscopy of GRG group was similar to that of native ACL in control group. There was no significant difference in the scores of graft vascularity and cellular morphology between GRG group and control group ( >0.05), while PRG group was significantly lower than the other two groups ( <0.05). Transmission electron microscope evaluation showed that GRG group and control group had better collagen fibril distribution and lower levels of cellular metabolism than PRG group ( <0.05). There was no significant difference in cellular metabolism between GRG and control groups ( >0.05), while collagen fibril distribution score of GRG group was significantly lower than that of control group ( <0.05).
While good remodeling grafts under arthroscopy in histological maturation period was proved to be more similar to normal ACL on ultrastructure properties under light and electron microscope, ultra structural differences regarding collagen fibril distribution still persist.
研究前交叉韧带（ACL）重建术后自体腘绳肌移植物的组织学特征。
选取2017年3月至2017年12月期间接受关节镜下单束ACL重建术且使用自体腘绳肌腱、至少随访4年并接受二次关节镜检查且符合入选标准的患者。根据滑膜和血管覆盖情况、移植物的表观张力、移植物的厚度和再撕裂情况，将关节镜下的移植物质量评估为良好重塑组（GRG，总分4 - 6分）和不良重塑组（PRG，总分1 - 3分）。在二次关节镜手术过程中，取ACL移植物进行活检。从接受全膝关节置换术的60岁以下患者中获取的正常ACL组织作为正常对照。分析移植物的血管情况、细胞形态、细胞代谢和胶原纤维分布。
18个标本（GRG组11例，PRG组7例）和9个自体ACL活检组织样本纳入研究。关节镜评分2 - 6分（平均4.7分）。GRG组光镜下生物学表现与对照组正常ACL相似。GRG组与对照组在移植物血管评分和细胞形态评分上无显著差异（P>0.05），而PRG组显著低于其他两组（P<0.05）。透射电子显微镜评估显示，GRG组和对照组的胶原纤维分布优于PRG组，细胞代谢水平低于PRG组（P<0.05）。GRG组与对照组在细胞代谢方面无显著差异（P>0.05），而GRG组的胶原纤维分布评分显著低于对照组（P<0.05）。
虽然在组织学成熟期关节镜下良好重塑的移植物在光镜和电镜下的超微结构特性更接近正常ACL，但在胶原纤维分布方面仍存在超微结构差异。
