ACL reconstruction with semitendinosus tendon autograft without detachment of its tibial insertion: a histologic study in a rabbit model

Abstract

The purpose of this study was to evaluate the histologic changes that occur between 3 and 12 weeks in an intra-articular, semitendinosus autograft, which was harvested without detachment of its tibial insertion and was placed through tibial and femoral drill holes, in a rabbit model. About 30 New Zealand white rabbits underwent ACL replacement using a semitendinosus tendon autograft. The normal ACL was transected at its femoral and tibial insertions. The tendon graft was harvested without detachment of its tibial insertion and its free end was secured with sutures. The graft was then passed through one tibial and one femoral tunnel and secured at the lateral femoral condyle. All animals were divided into three groups and were killed at 3, 6 and 12 weeks after surgery. Nine more animals underwent ACL reconstruction using a free semitendinosus tendon autograft. These animals were used as controls. The intra-articular portion of the graft and the interface between the bone tunnel and the graft was evaluated postoperatively for gross morphology and histological appearance. Results of this study showed that in a rabbit model the semitendinosus tendon autograft retained its viability when harvested without detachment of its peripheral insertion. On contrary, at the control group, necrosis of the graft was observed 3 weeks after surgery and progressively revascularization and maturation occurred 6 and 12 weeks after surgery. Retaining the tibial insertion of the semitendinosus autograft seems to preserves its viability and bypasses the stages of avascular necrosis and revascularization that occurs with the use of a free tendon autograft.

Anterior Cruciate Ligament Reconstruction and Preservation: The Single–Anteromedial Bundle Biological Augmentation (SAMBBA) Technique

“…4 In our opinion, retaining the tibial insertion of the ST autograft preserves its viability and bypasses the stages of avascular necrosis and revascularization that occur with the use of a free tendon autograft. To preserve the tibial insertion of the ST, use of an open-ended tendon stripper is mandatory.…”

“…The graft is harvested with an open-ended tendon stripper, allowing the tibial insertion to be preserved, thereby improving fixation and vascularity of the graft. 4 Once harvested, the graft is evaluated to determine whether an 8-to 10-mm graft diameter with a 12-cm length can be obtained. This evaluation is performed by tripling or quadrupling the graft over 2 suture loops to determine the drill diameter for the bony tunnel.…”

“…The tibial attachment of the semitendinosus (ST) graft is kept attached to the tibia to prevent avascular necrosis and is passed through the ACL remnant from the tibia to the femur. 4 This technique is performed through standard portals without the need for any special equipment.…”

Arthroscopic ACL reconstruction with Δ plasty: an innovative approach with hamstrings’ transfer and double tibial tunnel

“…Average age = 23.7 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) years. The left knee was involved 6 times and the right knee 12 times.…”

Development of a Surgically Optimized Graft Insertion Suture Technique to Accommodate a Tissue-Engineered TendonIn Vivo

“…4 Additionally, tendons are usually under physiological tension, and following rupture the ends of the tendon retract, leaving a gap either between the torn tendon ends or its bony insertion. Various graft materials have been used to fill this deficit including allografts, 5–7 autografts, 8–10 xenografts, 11,12 and synthetic grafts. 13–16 These strategies have inherent weaknesses such as autografts leading to donor site morbidity and having limited availability, 17–19 while allografts are expensive, require storage, and may elicit an immune response leading to rejection.…”