Akhil Jakkula, Sontakke Yogesh, Balaji Gopisankar
Anatomy, Pondicherry Institute of Medical Sciences (PIMS), Puducherry, IND.
Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.
Cureus. 2024 Sep 9;16(9):e68989. doi: 10.7759/cureus.68989. eCollection 2024 Sep.
Anterior cruciate ligament (ACL) rupture is a commonly encountered sports injury worldwide. ACL rupture is known to have poor healing capacity, hypothesized to be due to low vascularity. ACL reconstruction surgery with ligament removal and tendon graft became essential for the higher grades of ACL tears. However, ACL-reconstructed patients faced post-traumatic osteoarthritis 10-15 years after surgery. In the recent past, the tibial remnant of ACL was shown to have intrinsic healing potential. Blood vessel density and the location of blood vessels of ACL remnants have critical implications in the newly upcoming remnant-preservation ACL reconstruction surgeries that showed better healing response. This study was performed to characterize the histological features of ruptured ACL remnants in terms of blood vessels to assess the healing potential and their utility in novel surgical techniques.
This was a descriptive cross-sectional study in which the tibial remnant of 24 ruptured ACL samples was evaluated for blood vessel density (per sq. mm), luminal area (sq. µm), and location of blood vessels using hematoxylin and eosin (H&E) staining with ImageJ software (U. S. National Institutes of Health, Bethesda, Maryland, USA). The blood vessel density and location of blood vessels were compared among various groups based on the duration of injury and number of injuries.
Twenty-three male and one female adult patients with a mean duration of injury of 7.54 ± 5.63 months (range: 2-24 months) were included in the study. They were divided into three groups based on duration of injury: group I (2-5 months; n = 10), group II (6-8 months; n = 8), and group III (9-24 months; n = 6). The median blood vessel density (blood vessels per sq. mm) was 5.50 (3.30, 10.23) per sq. mm. There was no correlation of blood vessel density observed with duration of injury. All groups showed similar results statistically. More patients in earlier duration of injury showed very high range (10.1-40 per sq. mm) of blood vessels compared to the patients of later duration. Immature and intermediary blood vessels were identified denoting angiogenesis. Location of blood vessels varied in the groups based on duration of injury. There was no significant difference in blood vessel density and location of blood vessels between patients with single injury and those with multiple injuries.
The present study demonstrates the presence of healing potential of ruptured anterior cruciate ligaments in terms of blood vessel density, luminal area, and location of blood vessels. Future studies looking into the functional outcome would enhance the understanding of utility of novel remnant-preservation surgeries in place of standard graft reconstruction surgeries.
前交叉韧带（ACL）断裂是全球常见的运动损伤。已知ACL断裂后愈合能力较差，据推测这是由于血管分布较少所致。对于较严重的ACL撕裂，去除韧带并进行肌腱移植的ACL重建手术成为必要手段。然而，接受ACL重建手术的患者在术后10 - 15年会面临创伤后骨关节炎问题。最近研究表明，ACL的胫骨残端具有内在愈合潜力。ACL残端的血管密度和血管位置对于新出现的残端保留型ACL重建手术具有关键意义，该手术显示出更好的愈合反应。本研究旨在通过评估血管情况来描述断裂的ACL残端的组织学特征，以评估其愈合潜力及其在新型手术技术中的应用价值。
这是一项描述性横断面研究，使用苏木精和伊红（H&E）染色及ImageJ软件（美国国立卫生研究院，马里兰州贝塞斯达）对24个ACL断裂样本的胫骨残端进行血管密度（每平方毫米）、管腔面积（平方微米）及血管位置的评估。根据损伤持续时间和损伤次数将各亚组的血管密度和血管位置进行比较。
本研究纳入了23名男性和1名女性成年患者，平均损伤持续时间为7.54 ± 5.63个月（范围：2 - 24个月）。根据损伤持续时间将他们分为三组：第一组（2 - 5个月；n = 10），第二组（6 - 8个月；n = 8），第三组（9 - 24个月；n = 6）。血管密度中位数（每平方毫米血管数）为5.50（3.30，10.23）每平方毫米。未观察到血管密度与损伤持续时间之间存在相关性。所有组在统计学上显示出相似的结果。与损伤持续时间较长的患者相比，损伤持续时间较短的患者中更多患者的血管范围非常高（每平方毫米10.1 - 40个）。识别出不成熟和中间阶段的血管，表明存在血管生成。血管位置在不同组中因损伤持续时间而异。单次损伤患者与多次损伤患者之间的血管密度和血管位置无显著差异。
本研究表明，断裂的前交叉韧带在血管密度、管腔面积和血管位置方面具有愈合潜力。未来关于功能结果的研究将加深对新型残端保留手术替代标准移植物重建手术应用价值的理解。
