Clin Orthop Surg.  2018 Dec;10(4):413-419. 10.4055/cios.2018.10.4.413.

Factors Affecting the Extent of Graft Tendon Synovialization after Double-Bundle Anterior Cruciate Ligament Reconstruction: Based on Second-Look Arthroscopic Findings

• Ahn GY
• Nam IH
• Lee YH
• Lee YS
• Choi YD
• Lee HH
• Hwang SH

• KMID: 2426525
• DOI: http://doi.org/10.4055/cios.2018.10.4.413

Abstract

BACKGROUND
We aimed to examine the factors that influence synovialization of the grafted tendon after double-bundle anterior cruciate ligament (ACL) reconstruction based on second-look arthroscopic findings.
METHODS
Out of 205 knees that were treated between August 2008 and May 2016 with double-bundle ACL reconstruction using bio-absorbable cross-pins and Endobuttons for femoral tunnel fixation, we enrolled 65 knees (64 patients) that underwent second-look arthroscopy with hardware removal at 1 year postoperatively. Measured clinical outcomes included the Lysholm score and Tegner activity score that were evaluated preoperatively and during the final follow-up. We analyzed the relationship between synovial coverage and patient age, length of the preserved remnant tissue on the tibial side, type of bundle (anteromedial or posterolateral), type of graft (autograft or allograft), and time from injury to surgery.
RESULTS
The area of synovial coverage showed a significant statistical correlation with patient age and the length of the preserved remnant tissue on the tibial side. The average synovial coverage was significantly better for the anteromedial bundle than for the posterolateral bundle, better for the autograft than for the allograft reconstruction, and better when treated in the acute stage than in the chronic stage. However, synovialization of grafted tendon did not correlate to clinical outcomes.
CONCLUSIONS
While we were able to identify several factors influencing synovialization of the grafted tendon after double-bundle ACL reconstruction, including patient age, length of preserved remnant tissue of the torn ACL, type of bundle, type of graft, and time from injury to surgery, we found no evidence that increased synovialization improves clinical outcomes at 1 year postoperatively.

Keyword

Anterior cruciate ligament; Double-bundle reconstruction; Second-look arthroscopy; Synovialization

MeSH Terms

Allografts
Anterior Cruciate Ligament Reconstruction*
Anterior Cruciate Ligament*
Arthroscopy
Autografts
Follow-Up Studies
Humans
Knee
Lysholm Knee Score
Tendons*
Transplants*

Figure

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  Fig. 1 Representative second-look arthroscopic image showing synovialization at 1 year after double-bundle reconstruction of a torn anterior cruciate ligament. Compared to the posterolateral (PL) bundle, the anteromedial (AM) bundle appears enveloped with abundant synovium.

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  Fig. 2 Graft tendon synovialization at 1 year after double-bundle reconstruction of a torn anterior cruciate ligament. Compared to the allograft (Allo), the autograft (Auto) appears thicker and curved with more abundant capillary infiltration by the synovium.

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  Fig. 3 Second-look arthroscopic images showing synovialization of tendons treated at different times after injury. Reconstruction in the acute stage (A) provides superior outcomes compared to those obtained after reconstruction in the chronic stage (B).

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  Fig. 4 Suturing along the remnant tissue of the anterior cruciate tendon at the tibial side. The remnant tendon was sutured with absorbable 2-0 polydioxanone, and the sutures cover the grafted ligament.

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  Fig. 5 Histology of synovium samples from grafted tendons at 1 year after double-bundle reconstruction of a torn anterior cruciate ligament. Synovial lining cells (arrows) are much more abundant in the autograft specimen (A) than in the allograft specimen (B) (H&E, magnification ×40).

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