Scranton P E, Lanzer W L, Ferguson M S, Kirkman T R, Pflaster D S
University of Washington, Seattle, USA.
Arthroscopy. 1998 Oct;14(7):702-16. doi: 10.1016/s0749-8063(98)70097-0.
Columbia-Rambouillet cross-bred sheep were used to study the revascularization and ligamentization process of anterior cruciate ligament (ACL) reconstruction over a 6-month period using basic histology, immunohistochemistry, and electron microscopy. The reconstruction technique studied was a quadruple-hamstring, interference screw fixation technique. Further, these specimens, after retrieval at 6, 12, and 26 weeks, were compared with human arthroscopic 'second looks' and with 10 en bloc specimens obtained when a cruciate-sacrificing total knee replacement was performed. The study showed that, with this reconstruction technique, Sharpey's fibers were seen at 6 weeks in both sheep and human specimens. The intratunnel specimens showed proliferative chondrification, then ossification of the matrix. Intra-articular neovascularization, ligamentization, and junction ossification occurred. Myoblasts or smooth muscle cells appear to mediate the ligamentization as evidenced in electron microscopy by proliferate collagen manufacture. These myoblasts were seen in both the healing sheep and human second looks, but not seen in mature ACL grafts or in normal ACLs. At 6 months postoperatively, the sheep ACL reconstruction appeared clinically, histologically, and immunohistochemically indistinguishable from the normal sheep ACL. A correlation of this work with published animal studies in which biomechanical testing was performed and with human 'second looks' would imply that an ACL reconstruction may be vulnerable during this period of neovascularization and ligamentization.
采用哥伦比亚-朗布依埃杂交绵羊，运用基础组织学、免疫组织化学及电子显微镜技术，对前交叉韧带（ACL）重建术后6个月的血管再生和韧带化过程进行研究。所研究的重建技术为四股绳肌、干涉螺钉固定技术。此外，将在术后6周、12周和26周取出的这些标本，与人类关节镜“二次探查”标本以及在进行牺牲交叉韧带的全膝关节置换时获取的10个整块标本进行比较。研究表明，采用这种重建技术时，在绵羊和人类标本中均于6周时观察到了沙比纤维。隧道内标本显示出增殖性软骨化，随后基质发生骨化。关节内出现了新生血管形成、韧带化以及连接部骨化。成肌细胞或平滑肌细胞似乎介导了韧带化过程，电子显微镜下增殖的胶原合成可证明这一点。在愈合的绵羊和人类二次探查标本中均可见到这些成肌细胞，但在成熟的ACL移植物或正常ACL中未见。术后6个月时，绵羊ACL重建在临床、组织学及免疫组织化学方面与正常绵羊ACL难以区分。这项研究与已发表的进行了生物力学测试的动物研究以及人类“二次探查”结果之间的相关性表明。在血管再生和韧带化这段时期，ACL重建可能较为脆弱。
