Atkinson T S, Atkinson P J, Mendenhall H V, Haut R C
Department of Osteopathic Surgical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan 48824, USA.
J Surg Res. 1998 Sep;79(1):25-30. doi: 10.1006/jsre.1998.5387.
Clinical studies have documented proliferation of the host patellar tendon and fibrosis extending into adjacent tissues after reconstruction of the injured anterior cruciate ligament (ACL) using the central one-third of the patellar tendon (PT) as the graft. Such generalized arthrofibrosis has been implicated in knee locking and as possible source of anterior knee pain. However, it is not clinically feasible to measure changes in tendon morphology and mechanical properties and degeneration of peripheral tissues over time following graft harvest. In a rabbit experimental model proliferative changes in the tendon and the infrapatellar fat pad have been documented following harvest of a central third tendon graft without ACL reconstruction. Studies in larger animals have shown significant reductions in the strength and stiffness of the healing patellar tendon, but without assessment of the peripheral tissue response. In the current study an ACL reconstruction was performed in a goat model using an autogenous patellar tendon graft. Extensive tendon and fat pad proliferation were observed along with significant reductions in the biomechanical properties of the host tendon. Significant fat pad fibrosis was documented using biochemical methods. The current data confirm that harvest of an autogenous PT graft for reconstruction of the ACL results in significant changes in the PT and adjacent tissues. These data may help explain some of the clinical complications documented in the reconstructed joint.
临床研究表明，在使用髌腱（PT）中三分之一作为移植物重建受损前交叉韧带（ACL）后，宿主髌腱会增生，且纤维化会延伸至相邻组织。这种广泛性关节纤维化与膝关节绞锁有关，也可能是膝前疼痛的原因。然而，在移植物取材后，测量肌腱形态和力学性能的变化以及周围组织随时间的退变在临床上并不可行。在一个兔实验模型中，记录了在未进行ACL重建的情况下取材中央三分之一肌腱移植物后，肌腱和髌下脂肪垫的增殖性变化。对大型动物的研究表明，愈合中的髌腱强度和刚度显著降低，但未评估周围组织的反应。在当前研究中，使用自体髌腱移植物在山羊模型中进行了ACL重建。观察到广泛的肌腱和脂肪垫增生，同时宿主肌腱的生物力学性能显著降低。使用生化方法记录了显著的脂肪垫纤维化。当前数据证实，取材自体PT移植物用于ACL重建会导致PT和相邻组织发生显著变化。这些数据可能有助于解释重建关节中记录的一些临床并发症。
