Travmatologiâ i Ortopediâ Rossii (Dec 2013)
Pathological changes of the anterior cruciate ligament autografts and some clinical-morphological correlations at the frontal-medial knee joint instability relapses
Abstract
Purpose: on the basis of study of histologic changes characterizing the condition of tendinous autografts of the anterior cruciate ligament ^TACL) to establish dependencies between clinical and morphologic indicators in patients with signs of knee joint anteromedial instability relapse. Material and methods: 30 resected tendinous transplants have been used received from own patellar ligament (10 cases) and semitendinous and gracilis muscles of the femur (20 cases). After histologic study the parameters of some graduated morphologic indices that versatile characterize the basic processes condition in АТА^ tissues, frequency of their occurrence separately for femoral and tibial parts of the graft, have been determined. Results: АТАСЦ by the moment of their insufficiency with relapse of antero-medial instability, the complex of unevenly expressed pathologic changes has been observed: ischemic-necrotic, dystrophic, inflammatory, reparative-fibrosing and in rare cases metaplastic changes; their topographical combinations and quantitative expressiveness occasionally can vary. In different parts of ATACL the degree of expressiveness of certain morphologic indices of the graft condition varies and can not correspond to separate types of macroarthroscopic estimates. The correlation analysis of pairs relations for nonparametric clinical and morphologic indices separately in femoral and tibial loci has revealed that only some values of coefficient of association corresponding to an moderate range or close to it - both with positive, and negative signs, some values of the coefficient of association have appeared significant by a number of observed cases. Conclusions. The cause of small number of moderate force correlations and absence of close correlations in pairs of indicators «clinic-morphology» is supposed to be in considerable inequality, and probably in cyclic processes of reparation, dystrophy, inflammation and uncontrollable damage of an immature fibrous tissue in ATACL-regenerates, developing during adaptation of the transplant to physical activities and preparing development of its insufficiency.
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