B. Oakes (Cheltenham, AU)
Presenter Of 1 Presentation
P023 - A Quantitative Collagen Fibril Population Analyses of 39 Jone’s Free ACL Autografts vs Time
Abstract
Purpose
Why do so many Anterior Cruciate Ligament Reconstructions (ACLR’) fail/rupture in the young athlete ?
In my country one Australian Rules Football (ARF) player had 5 ACLR’s in 5 years & ALL failed !
Uribe et al. CORR 325:91-99,1996 and others have noted from 3-22% recurrent patholaxity.
Also recently L.J.Salmon et al AJSM 2018;46(3):531 has reported recently the high graft overt rupture rate of ACLR in athletes < 20 yrs old of ~ 36% !!
In (2020) in Carlsbad, Bert Mandelbaum, an experienced ACLR surgeon displayed a failed ACLR in an NFL player.
Methods and Materials
Biopsies of human ACL autografts from 6 months implantation to 10 years post-implantation were obtained in patients with meniscal and or articular cartilage lesions.
Quantitative ultrastructural studies of collagen fibril populations using specific software were performed on human 39 ACL autografts using the PT, Hamstrings, IT band and were compared to the normal ACL and PT.
Results
The outstanding feature was the absence of large diameter collagen fibrils >100nm after 6 months post-surgery and the predominance of small diameter fibrils <100nm diameter which were not arranged in normal fasciculi. The ACL graft itself was usually lax, soft and easily probed compared to the robust and firm nature of the normal ACL when probed and defined as two distinct bundles.
Conclusion
All the ACL autografts except at 6 weeks contained predominantly small fibrils < 100nm diameter.
Large fibrils > 100nm were not replaced at 10 years post-implantation.
This is a ‘de-ligamentization’ of these autografts.
This tissue if of poor tensile quality and is doomed to failure either by creep elongation or complete grade 3 overt failure.
Presenter Of 1 Presentation
P023 - A Quantitative Collagen Fibril Population Analyses of 39 Jone’s Free ACL Autografts vs Time
Abstract
Purpose
Why do so many Anterior Cruciate Ligament Reconstructions (ACLR’) fail/rupture in the young athlete ?
In my country one Australian Rules Football (ARF) player had 5 ACLR’s in 5 years & ALL failed !
Uribe et al. CORR 325:91-99,1996 and others have noted from 3-22% recurrent patholaxity.
Also recently L.J.Salmon et al AJSM 2018;46(3):531 has reported recently the high graft overt rupture rate of ACLR in athletes < 20 yrs old of ~ 36% !!
In (2020) in Carlsbad, Bert Mandelbaum, an experienced ACLR surgeon displayed a failed ACLR in an NFL player.
Methods and Materials
Biopsies of human ACL autografts from 6 months implantation to 10 years post-implantation were obtained in patients with meniscal and or articular cartilage lesions.
Quantitative ultrastructural studies of collagen fibril populations using specific software were performed on human 39 ACL autografts using the PT, Hamstrings, IT band and were compared to the normal ACL and PT.
Results
The outstanding feature was the absence of large diameter collagen fibrils >100nm after 6 months post-surgery and the predominance of small diameter fibrils <100nm diameter which were not arranged in normal fasciculi. The ACL graft itself was usually lax, soft and easily probed compared to the robust and firm nature of the normal ACL when probed and defined as two distinct bundles.
Conclusion
All the ACL autografts except at 6 weeks contained predominantly small fibrils < 100nm diameter.
Large fibrils > 100nm were not replaced at 10 years post-implantation.
This is a ‘de-ligamentization’ of these autografts.
This tissue if of poor tensile quality and is doomed to failure either by creep elongation or complete grade 3 overt failure.