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First published on November 7, 2006, doi:10.1177/0363546506294469
This version was published on December 1, 2006
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The American Journal of Sports Medicine 34:1918-1925 (2006)
© 2006 American Orthopaedic Society for Sports Medicine

Effects of Local Administration of Vascular Endothelial Growth Factor on Mechanical Characteristics of the Semitendinosus Tendon Graft After Anterior Cruciate Ligament Reconstruction in Sheep

Toshikazu Yoshikawa, MD*,{dagger}, Harukazu Tohyama, MD, PhD*,{ddagger}, Taro Katsura, DVM, PhD*, Eiji Kondo, MD, PhD*, Yoshihisa Kotani, MD, PhD§, Hideo Matsumoto, MD, PhD{dagger}, Yoshiaki Toyama, MD, PhD{dagger} and Kazunori Yasuda, MD, PhD*

From the * From the Department of Sports Medicine, Hokkaido University School of Medicine, Sapporo, Japan, the {dagger} Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan, and the § Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Sapporo, Japan

{ddagger} Address correspondence to Harukazu Tohyama, MD, PhD, Department of Sports Medicine and Joint Reconstruction Surgery, Hokkaido University School of Medicine, Kita-15 Nishi-7 Kita-ku, Sapporo, 060-8638, Japan (e-mail: tohyama{at}med.hokudai.ac.jp).

Background: Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis.

Hypothesis: An application of VEGF may enhance angiogenesis in the grafted tendon in anterior cruciate ligament (ACL) reconstruction, and the application may affect mechanical characteristics of the ACL graft.

Study Design: Controlled laboratory study.

Methods: Eighteen sheep were divided into groups I and II. In group I, the harvested semitendinosus tendon was soaked in VEGF solution, and the right knee then underwent ACL reconstruction using this tendon. In group II, the right knee underwent identical procedures to those of group I except that the harvested tendon was soaked in phosphate-buffered saline. All animals were sacrificed 12 weeks after ACL reconstruction.

Results: Histologic findings showed that newly formed vessels and infiltrative fibroblasts were more abundant in group I than in group II. The anterior-posterior translation of the knee during an anterior-posterior force of ± 100 N was significantly larger in group I than in group II by 2.58 mm (95% confidence interval, –1.76 mm to 1.76 mm) (P = .002). The linear stiffness of the femur-graft-tibia complex in group I was significantly lower than that in group II by 41.5 N/mm (95% confidence interval, –32.2 N/mm to 32.2 N/mm) (P = .017).

Conclusion: This study has revealed that VEGF as administered in this study promotes angiogenesis in the ACL graft and significantly reduces the stiffness of the ACL graft with increased knee laxity at 12 weeks after ACL reconstruction.

Clinical Relevance: Exogenous VEGF application for ACL reconstruction can induce an increase in knee laxity and a decrease in the stiffness of the grafted tendon at least temporarily after ACL reconstruction. These potentially negative mechanical effects need to be taken into account when considering clinical use of VEGF.

Key Words: angiogenesis • anterior cruciate ligament • biomechanical properties • vascular endothelial growth factor (VEGF)




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