Electron microscopic evaluation of the effects of stress-shielding on maturation of the mid-substance and ligament-bone junction of the reconstructed anterior cruciate ligament in rabbits.

To analyze the effects of stress-shielding on graft maturation after the anterior cruciate ligament (ACL) reconstruction, autogenous ACL reconstruction using Achilles tendon was performed in rabbits. Two-end fixation with a ligament augmentation device (LAD), as a stress-shielding model (SS group), and pull-out fixation with Leeds-Keio artificial ligaments (L-K ligament), as a non-stress-shielding model (non-SS group), were investigated. Intact ACL was used as the control. Specimens were harvested 6 mon postoperatively, and the analysis was focused on collagen fibril maturation in the mid-substance and bone-anchoring pattern in the bone tunnel, under light and transmission electron microscopy. The density of collagen fibrils in the control was lower than that in both experimental groups (p<0.01). The per cent collagen area in the control was higher than that in the SS (p<0.01) and the non-SS group (p< 0.05). The per cent collagen area in the non-SS group was higher than that in the SS group (p<0.05). At the ligament-bone interface, intracellular calcification of the degenerated chondrocytes occurred in the non-SS group, while in the SS group hydroxyapatite deposits were observed only in the extracellular matrix. These results show unfavorable influence of stress-shielding on graft maturation not only in the mid-substance but also at the ligament-bone junction. Copyright 1999 Kluwer Academic Publishers