Quantification and comparison of tenocyte distribution and collagen content in the commonly used autografts for anterior cruciate ligament reconstruction

Abstract

Anterior cruciate ligament is a commonly damaged ligament of the knee. Reconstruction of this ligament usually entails the use of graft harvested from the same subject (i.e., autografts). Several tendons, for example quadriceps, patellar or semitendinosus tendon can be used as an autograft. The composition of the tendons is similar to the anterior cruciate ligament but there is no data that directly compares the compositions of the quadriceps, patellar and semitendinosus tendons. This study quantified and compared the tenocyte distribution and collagen content of these tendons from cadavers of South Africans of European Ancestry. The tenocyte distribution and collagen content were assessed using the ImageJ software. The results showed similarities in the collagen content across the tendons in both sexes (P>0.05). The tenocyte distribution was significantly higher in the quadriceps (P=0.019) or semitendinosus (P=0.016) tendon than in the patellar tendon in the female but no difference was seen in the male (P=0.872). This shows that a large harvestable area may not be directly associated with a more abundant collagen content or tenocyte distribution in the tendon. However, sex-specific tenocyte distribution is an important observation that underpins the possible influence of underlying biological factors on the composition of each tendon and this requires further investigations. In all, this study will contribute to knowledge and assist orthopaedic surgeons in making an informed decision on the choice of graft.

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“…Unfortunately, there is no report in the literature to compare with the present findings, so it is not discussed further. The data on the surface area of the QT may be of benefit to the rate of recovery at the harvest site, since the QT has been shown to have more collagen content (Hadjicostas et al, 2007) which contributes to its tensile strength (Shani et al, 2016;Krebs et al, 2019;Latiff and Olateju, 2022). The implication of this is that the remaining collagen content after the harvesting of a graft should be sufficient for the QT to recover quicker and function more satisfactorily than the patellar tendon, which has a lesser collagen content (Hadjicostas et al, 2007) and a smaller surface area than the QT (unpublished report).…”

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“…Collagen distribution on each image was quantified using the ImageJ software’s threshold tool, which was adjusted until all the collagen (i.e. green) stains had been highlighted [ 30 , 31 ]. The percentage collagen distribution per image was calculated as the threshold area divided by the area of the image.…”

Morphometry of the patellar tendon using a simple tracing method: a gold standard for anterior cruciate ligament reconstruction

“…Similar dissection described by Latiff and Olateju [ 28 , 29 ] was utilized, the PT on the lower limb was exposed by making a midline longitudinal incision on the anterior surface of the lower limb from midway of the thigh to midway of the leg. Transverse incisions perpendicular to the midline incisions were made proximally in the thigh and distally in the leg to expose the PT and allow for adequate space for observation and morphometric measurements.…”