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The Journal of Bone and Joint Surgery, Vol 64, Issue 2 217-224, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog
SP Arnoczky, GB Tarvin and JL Marshall
We investigated the revascularization pattern of patellar tendon grafts
used to replace the anterior cruciate ligament in thirty-six dogs by
histological and tissue-clearing (Spalteholz) techniques. Initially the
grafts were avascular, but by six weeks they were completely ensheathed in
a vascular synovial envelope. The soft tissues of the infrapatellar fat
pad, the tibial remnant of the anterior cruciate ligament, and the
posterior synovial tissues contributed to this synovial vasculature.
Intrinsic revascularization of the patellar tendon graft progressed from
the proximal and distal portions of the graft centrally and was complete by
twenty weeks. The tibial attachment of the patellar tendon graft did not
contribute any vessels to the revascularization process. At one year, the
vascular and histological appearance of the patellar tendon graft resembled
that of a normal anterior cruciate ligament. Clinical Relevance: The
absence of perfused vessels within the patellar tendon graft immediately
after transplantation within the knee joint and the failure of the osseous
insertion of the graft to contribute vessels to the revascularization
process suggest that although it is left attached at the tibia, the
patellar tendon graft is essentially an avascular free graft at
transplantation. The contribution of the soft tissues of the knee to the
revascularization process of the graft suggests preservation and
utilization of the infrapatellar fat pad and synovial tissue to optimize
the graft's revascularization and ultimate viability.
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