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Collagen Fibril Organization in the Patellar Tendon Autograft After Posterior Cruciate Ligament Reconstruction

A Quantitative Evaluation in a Sheep Model

Department of Traumasurgery, Hannover Medical School, Hannover

Brigitte Decker, PhD

Laboratory of Cell Biology and Electron Microscopy, Hannover Medical School, Hannover

Hans D. Möller, MD

Department of Traumasurgery, Hannover Medical School, Hannover

Werner J. Kasperczyk, MD

Department of Traumasurgery, Hannover Medical School, Hannover

Hans J. Oestern, MD

Department of Traumasurgery, Celle General Hospital, Celle, Germany

We replaced the posterior cruciate ligament in 30 skel etally mature sheep with a patellar tendon autograft using the central third of the ipsilateral patellar tendon. The healing autograft was compared with the contralat eral posterior cruciate ligament and the patellar tendons and posterior cruciate ligaments of nonoperated ani mals. The collagen fibril diameters were analyzed using transmission electron photomicrographs of fibril cross sections taken at six periods during the 2 years after surgery. The patellar tendon and posterior cruciate liga ment were characterized by a broad, nongaussian dis tribution of collagen fibril diameters. The autografts shifted to a unimodal distribution by an increase of small-diameter collagen fibrils. The frequency of small- diameter fibrils measuring up to 100 nm was 99% after 2 years. At that time, these small-diameter fibrils rep resented 91.6% of the area covered by collagen fibrils. The mean diameter of the collagen fibrils in the au tografts significantly decreased to 45% of the controls at Week 26 and remained at this level until the end of this study. The percentage of area covered by collagen fibrils per 1 µm² was 78% of the controls 2 years post operatively. This study suggests that the patellar tendon autograft could not reproduce the collagen fibril orga nization of the posterior cruciate ligament. This may be a biologic factor responsible for inconsistent results in posterior cruciate ligament replacement.

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