Takahashi Tsuneari, Kimura Masashi, Higuchi Hiroshi, Suzuki Kosuke, Yamada Yuichiro, Takeshita Katsushi
Orthopaedic Surgery, Jichi Medical University, Shimotsuke, JPN.
Orthopaedic Surgery, Zenshukai Hospital, Maebashi, JPN.
Cureus. 2021 Jan 30;13(1):e13016. doi: 10.7759/cureus.13016.
To our knowledge, no studies have investigated the histological comparison between primary injured anterior cruciate ligament (ACL), initially anatomically reconstructed grafts and non-anatomically reconstructed grafts at the time of revision ACL reconstruction. The purpose of this study was to histologically clarify the differences between ACL remnant tissue, reconstructed graft after anatomic double-bundle ACL reconstruction, and reconstructed graft after non-anatomic single-bundle ACL reconstruction.
This histological study included five patients after anatomic double-bundle ACL reconstruction, three patients after non-anatomic single-bundle ACL reconstruction performed who injured their operated knees again, and five patients who injured their ACL for the first time and agreed to participate. All of the grafts and ACL remnant tissue were harvested, stained with hematoxylin and eosin, S-100, and alpha smooth muscle actin and evaluated using light microscopy.
There was no area of necrosis in the reconstructed graft after an anatomic double-bundle ACL reconstruction. However, there were obvious areas of necrosis in the reconstructed graft after non-anatomic single-bundle ACL reconstruction. Additionally, the collagen fibers were more longitudinally oriented, and most cells were spindle shaped like those in ACL remnant tissue after an anatomic double-bundle ACL reconstruction in contrast with the finding of the grafts after non-anatomic single-bundle ACL reconstruction.
Initially reconstructed graft after an anatomic double-bundle ACL reconstruction may be beneficial if preserved at the time of the revision surgery.
据我们所知，尚无研究对初次损伤的前交叉韧带（ACL）、初次解剖重建移植物与翻修ACL重建时非解剖重建移植物之间进行组织学比较。本研究的目的是从组织学上阐明ACL残余组织、解剖双束ACL重建后的重建移植物以及非解剖单束ACL重建后的重建移植物之间的差异。
这项组织学研究纳入了5例接受解剖双束ACL重建的患者、3例接受非解剖单束ACL重建后再次损伤患膝的患者以及5例初次ACL损伤且同意参与的患者。所有移植物和ACL残余组织均被采集，用苏木精-伊红、S-100和α平滑肌肌动蛋白染色，并使用光学显微镜进行评估。
解剖双束ACL重建后的重建移植物中没有坏死区域。然而，非解剖单束ACL重建后的重建移植物中有明显的坏死区域。此外，与非解剖单束ACL重建后的移植物相比，解剖双束ACL重建后的胶原纤维更呈纵向排列，且大多数细胞呈梭形，类似于ACL残余组织中的细胞。
如果在翻修手术时保留，解剖双束ACL重建后的初次重建移植物可能是有益的。
