The Journal of Bone and Joint Surgery, Vol 75, Issue 12 1795-1803, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog

SA Rodeo, SP Arnoczky, PA Torzilli, C Hidaka and RF Warren
Laboratory for Comparative Orthopaedic Research, Hospital for Special Surgery, New York, N.Y. 10021.

Our study evaluated tendon-to-bone healing in a dog model. Twenty adult mongrel dogs had a transplantation of the long digital extensor tendon into a 4.8-millimeter drill-hole in the proximal tibial metaphysis. Four dogs were killed at each of five time-periods (two, four, eight, twelve, and twenty-six weeks after the transplantation), and the histological and biomechanical characteristics of the tendon-bone interface were evaluated. Serial histological analysis revealed progressive reestablishment of collagen-fiber continuity between the bone and the tendon. A layer of cellular, fibrous tissue was noted between the tendon and the bone, along the length of the bone tunnel; this layer progressively matured and reorganized during the healing process. The collagen fibers that attached the tendon to the bone resembled Sharpey fibers. High-resolution radiographs showed remodeling of the trabecular bone that surrounded the tendon. At the two, four, and eight-week time-periods, all specimens had failed by pull-out of the tendon from the bone tunnel. The strength of the interface was noted to have significantly and progressively increased between the second and the twelfth week after the transplantation. At the twelve and twenty-six-week time-periods, all specimens had failed by pull-out of the tendon from the clamp or by mid-substance rupture of the tendon. The progressive increase in strength was correlated with the degree of bone ingrowth, mineralization, and maturation of the healing tissue, noted histologically.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				K. Sasaki, R. Kuroda, K. Ishida, S. Kubo, T. Matsumoto, Y. Mifune, K. Kinoshita, K. Tei, T. Akisue, Y. Tabata, et al. Enhancement of Tendon-Bone Osteointegration of Anterior Cruciate Ligament Graft Using Granulocyte Colony-Stimulating Factor Am. J. Sports Med., August 1, 2008; 36(8): 1519 - 1527. [Abstract] [Full Text] [PDF]

				L. V. Gulotta, D. Kovacevic, L. Ying, J. R. Ehteshami, S. Montgomery, and S. A. Rodeo Augmentation of Tendon-to-Bone Healing With a Magnesium-Based Bone Adhesive Am. J. Sports Med., July 1, 2008; 36(7): 1290 - 1297. [Abstract] [Full Text] [PDF]

				K. L. Moffat, W.-H. S. Sun, P. E. Pena, N. O. Chahine, S. B. Doty, G. A. Ateshian, C. T. Hung, and H. H. Lu From the Cover: Characterization of the structure-function relationship at the ligament-to-bone interface PNAS, June 10, 2008; 105(23): 7947 - 7952. [Abstract] [Full Text] [PDF]

				F. R.T. Nelson, M. Bey, D. P. Fyhrie, and P. E. Di Cesare On the Horizon From the ORS J. Am. Acad. Ortho. Surg., April 1, 2008; 16(4): 237 - 240. [Full Text] [PDF]

				S.-J. Kim, T.-E. Kim, D.-H. Lee, and K.-S. Oh Anterior Cruciate Ligament Reconstruction in Patients Who Have Excessive Joint Laxity J. Bone Joint Surg. Am., April 1, 2008; 90(4): 735 - 741. [Abstract] [Full Text] [PDF]

				P. L. Hays, S. Kawamura, X.-H. Deng, E. Dagher, K. Mithoefer, L. Ying, and S. A. Rodeo The Role of Macrophages in Early Healing of a Tendon Graft in a Bone Tunnel J. Bone Joint Surg. Am., March 1, 2008; 90(3): 565 - 579. [Abstract] [Full Text] [PDF]

				C.-H. Chen, H.-W. Liu, C.-L. Tsai, C.-M. Yu, I-H. Lin, and G.-H. Hsiue Photoencapsulation of Bone Morphogenetic Protein-2 and Periosteal Progenitor Cells Improve Tendon Graft Healing in a Bone Tunnel Am. J. Sports Med., March 1, 2008; 36(3): 461 - 473. [Abstract] [Full Text] [PDF]

				M. E. Steiner, M. M. Murray, and S. A. Rodeo Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement Am. J. Sports Med., January 1, 2008; 36(1): 176 - 189. [Abstract] [Full Text] [PDF]

				S. A. Rodeo, S. Kawamura, C. B. Ma, X.-h. Deng, P. S. Sussman, P. Hays, and L. Ying The Effect of Osteoclastic Activity on Tendon-to-Bone Healing: An Experimental Study in Rabbits J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2250 - 2259. [Abstract] [Full Text] [PDF]

				M. Y. H. Soon, A. Hassan, J. H. P. Hui, J. C. H. Goh, and E. H. Lee An Analysis of Soft Tissue Allograft Anterior Cruciate Ligament Reconstruction in a Rabbit Model: A Short-Term Study of the Use of Mesenchymal Stem Cells to Enhance Tendon Osteointegration Am. J. Sports Med., June 1, 2007; 35(6): 962 - 971. [Abstract] [Full Text] [PDF]

				C. B. Ma, S. Kawamura, X.-H. Deng, L. Ying, J. Schneidkraut, P. Hays, and S. A. Rodeo Bone Morphogenetic Proteins-Signaling Plays a Role in Tendon-to-Bone Healing: A Study of rhBMP-2 and Noggin Am. J. Sports Med., April 1, 2007; 35(4): 597 - 604. [Abstract] [Full Text] [PDF]

				F. R. Noyes and S. D. Barber-Westin Posterolateral Knee Reconstruction With an Anatomical Bone-Patellar Tendon-Bone Reconstruction of the Fibular Collateral Ligament Am. J. Sports Med., February 1, 2007; 35(2): 259 - 273. [Abstract] [Full Text] [PDF]

				A. D. Mazzocca, K. J. Burton, A. A. Romeo, S. Santangelo, D. A. Adams, and R. A. Arciero Biomechanical Evaluation of 4 Techniques of Distal Biceps Brachii Tendon Repair Am. J. Sports Med., February 1, 2007; 35(2): 252 - 258. [Abstract] [Full Text] [PDF]

				M. S. George, W. R. Dunn, and K. P. Spindler Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., December 1, 2006; 34(12): 2026 - 2037. [Abstract] [Full Text] [PDF]

				S. A. Rodeo, S. Kawamura, H.-J. Kim, C. Dynybil, and L. Ying Tendon Healing in a Bone Tunnel Differs at the Tunnel Entrance Versus the Tunnel Exit: An Effect of Graft-Tunnel Motion? Am. J. Sports Med., November 1, 2006; 34(11): 1790 - 1800. [Abstract] [Full Text] [PDF]

				T. Kanazawa, T. Soejima, H. Murakami, T. Inoue, M. Katouda, and K. Nagata An immunohistological study of the integration at the bone-tendon interface after reconstruction of the anterior cruciate ligament in rabbits J Bone Joint Surg Br, May 1, 2006; 88-B(5): 682 - 687. [Abstract] [Full Text] [PDF]

				D. B. Cohen, S. Kawamura, J. R. Ehteshami, and S. A. Rodeo Indomethacin and Celecoxib Impair Rotator Cuff Tendon-to-Bone Healing Am. J. Sports Med., March 1, 2006; 34(3): 362 - 369. [Abstract] [Full Text] [PDF]

				J. H. Ahn, H. S. Yang, W. K. Jeong, and K. H. Koh Arthroscopic Transtibial Posterior Cruciate Ligament Reconstruction With Preservation of Posterior Cruciate Ligament Fibers: Clinical Results of Minimum 2-Year Follow-up Am. J. Sports Med., February 1, 2006; 34(2): 194 - 204. [Abstract] [Full Text] [PDF]

				E. G. McFarland, H. B. Park, E. Keyurapan, H. S. Gill, and H. S. Selhi Suture Anchors and Tacks for Shoulder Surgery, Part 1: Biology and Biomechanics Am. J. Sports Med., December 1, 2005; 33(12): 1918 - 1923. [Abstract] [Full Text] [PDF]

				M. Kobayashi, N. Watanabe, Y. Oshima, Y. Kajikawa, M. Kawata, and T. Kubo The Fate of Host and Graft Cells in Early Healing of Bone Tunnel After Tendon Graft Am. J. Sports Med., December 1, 2005; 33(12): 1892 - 1897. [Abstract] [Full Text] [PDF]

				B. Demirag, B. Sarisozen, O. Ozer, T. Kaplan, and C. Ozturk Enhancement of Tendon-Bone Healing of Anterior Cruciate Ligament Grafts by Blockage of Matrix Metalloproteinases J. Bone Joint Surg. Am., November 1, 2005; 87(11): 2401 - 2410. [Abstract] [Full Text] [PDF]

				B. D. Beynnon, R. J. Johnson, J. A. Abate, B. C. Fleming, and C. E. Nichols Treatment of Anterior Cruciate Ligament Injuries, Part 2 Am. J. Sports Med., November 1, 2005; 33(11): 1751 - 1767. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, A. M. Stewart, R. Izquierdo, and L. U. Bigliani Tendon-Bone Interface Motion in Transosseous Suture and Suture Anchor Rotator Cuff Repair Techniques Am. J. Sports Med., November 1, 2005; 33(11): 1667 - 1671. [Abstract] [Full Text] [PDF]

				N. P. Thomas, R. Kankate, F. Wandless, and H. Pandit Revision Anterior Cruciate Ligament Reconstruction Using a 2-Stage Technique With Bone Grafting of the Tibial Tunnel Am. J. Sports Med., November 1, 2005; 33(11): 1701 - 1709. [Abstract] [Full Text] [PDF]

				O. Kilicoglu, O. Koyuncu, M. Demirhan, C. Z. Esenyel, A. C. Atalar, S. Ozsoy, E. Bozdag, E. Sunbuloglu, and B. Bilgic Time-Dependent Changes in Failure Loads of 3 Biceps Tenodesis Techniques: In Vivo Study in a Sheep Model Am. J. Sports Med., October 1, 2005; 33(10): 1536 - 1544. [Abstract] [Full Text] [PDF]

				M. C. Park, E. R. Cadet, W. N. Levine, L. U. Bigliani, and C. S. Ahmad Tendon-to-Bone Pressure Distributions at a Repaired Rotator Cuff Footprint Using Transosseous Suture and Suture Anchor Fixation Techniques Am. J. Sports Med., August 1, 2005; 33(8): 1154 - 1159. [Abstract] [Full Text] [PDF]

				M. J. Oddy, C. J. Pendegrass, A. E. Goodship, S. R. Cannon, T. W. R. Briggs, and G. W. Blunn Extensor mechanism reconstruction after proximal tibial replacement J Bone Joint Surg Br, June 1, 2005; 87-B(6): 873 - 878. [Abstract] [Full Text] [PDF]

				R. V. West and C. D. Harner Graft Selection in Anterior Cruciate Ligament Reconstruction J. Am. Acad. Ortho. Surg., May 1, 2005; 13(3): 197 - 207. [Abstract] [Full Text] [PDF]

				A. Harvey, N. P. Thomas, and A. A. Amis Fixation of the graft in reconstruction of the anterior cruciate ligament J Bone Joint Surg Br, May 1, 2005; 87-B(5): 593 - 603. [Full Text] [PDF]

				D. M. Grover, S. M. Howell, and M. L. Hull Early Tension Loss in an Anterior Cruciate Ligament Graft. A Cadaver Study of Four Tibial Fixation Devices J. Bone Joint Surg. Am., February 1, 2005; 87(2): 381 - 390. [Abstract] [Full Text] [PDF]

				P. Aglietti, F. Giron, R. Buzzi, F. Biddau, and F. Sasso Anterior Cruciate Ligament Reconstruction: Bone-Patellar Tendon-Bone Compared with Double Semitendinosus and Gracilis Tendon Grafts. A Prospective, Randomized Clinical Trial J. Bone Joint Surg. Am., October 1, 2004; 86(10): 2143 - 2155. [Abstract] [Full Text] [PDF]

				R. Mihelic, M. Pecina, M. Jelic, S. Zoricic, V. Kusec, P. Simic, D. Bobinac, B. Lah, D. Legovic, and S. Vukicevic Bone Morphogenetic Protein-7 (Osteogenic Protein-1) Promotes Tendon Graft Integration in Anterior Cruciate Ligament Reconstruction in Sheep Am. J. Sports Med., October 1, 2004; 32(7): 1619 - 1625. [Abstract] [Full Text] [PDF]

				Y. Hata, S. Saitoh, N. Murakami, H. Kobayashi, and K. Takaoka Atrophy of the Deltoid Muscle Following Rotator Cuff Surgery J. Bone Joint Surg. Am., July 1, 2004; 86(7): 1414 - 1419. [Abstract] [Full Text] [PDF]

				F. Margheritini, C. S. Mauro, J. A. Rihn, K. J. Stabile, S. L-Y. Woo, and C. D. Harner Biomechanical Comparison of Tibial Inlay Versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction: Analysis of Knee Kinematics and Graft In Situ Forces Am. J. Sports Med., April 1, 2004; 32(3): 587 - 593. [Abstract] [Full Text] [PDF]

				C. S. Ahmad, T. R. Gardner, M. Groh, J. Arnouk, and W. N. Levine Mechanical Properties of Soft Tissue Femoral Fixation Devices for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., April 1, 2004; 32(3): 635 - 640. [Abstract] [Full Text] [PDF]

				J. T. Nurmi, H. Sievanen, P. Kannus, M. Jarvinen, and T. L. N. Jarvinen Porcine Tibia Is a Poor Substitute for Human Cadaver Tibia for Evaluating Interference Screw Fixation Am. J. Sports Med., April 1, 2004; 32(3): 765 - 771. [Abstract] [Full Text] [PDF]

				A. Krivic, P. Sikiric, and S. Rodeo Comment on "Use of recombinant human bone morphogenetic protein-2 to enhance tendon healing in a bone tunnel". Am. J. Sports Med., July 1, 2003; 31(4): 636 - 637. [Full Text] [PDF]

				D. W. Starch, J. W. Alexander, P. C. Noble, S. Reddy, and D. M. Lintner Multistranded Hamstring Tendon Graft Fixation with a Central Four-Quadrant or a Standard Tibial Interference Screw for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., May 1, 2003; 31(3): 338 - 344. [Abstract] [Full Text] [PDF]

				Y. Uchio, M. Ochi, N. Adachi, K. Kawasaki, and M. Kuriwaka Determination of Time of Biologic Fixation after Anterior Cruciate Ligament Reconstruction with Hamstring Tendons Am. J. Sports Med., May 1, 2003; 31(3): 345 - 352. [Abstract] [Full Text] [PDF]

				J. T. Nurmi, P. Kannus, H. Sievanen, M. Jarvinen, and T. L. N. Jarvinen Compaction Drilling Does Not Increase the Initial Fixation Strength of the Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction in a Cadaver Model Am. J. Sports Med., May 1, 2003; 31(3): 353 - 358. [Abstract] [Full Text] [PDF]

				H. Segawa, Y. Koga, G. Omori, M. Sakamoto, and T. Hara Influence of the Femoral Tunnel Location and Angle on the Contact Pressure in the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., May 1, 2003; 31(3): 444 - 448. [Abstract] [Full Text] [PDF]

				H. Otsuka, Y. Ishibashi, E. Tsuda, K. Sasaki, and S. Toh Comparison of Three Techniques of Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Graft: Differences in Anterior Tibial Translation and Tunnel Enlargement with Each Technique Am. J. Sports Med., March 1, 2003; 31(2): 282 - 288. [Abstract] [Full Text] [PDF]

				B. S. Delay, B. E. McGrath, and E. R. Mindell Observations on a Retrieved Patellar Tendon Autograft Used to Reconstruct the Anterior Cruciate Ligament : A Case Report J. Bone Joint Surg. Am., September 9, 2002; 84(8): 1433 - 1438. [Full Text] [PDF]

				B. D. Beynnon, R. J. Johnson, B. C. Fleming, P. Kannus, M. Kaplan, J. Samani, and P. Renström Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts : A Prospective, Randomized Study J. Bone Joint Surg. Am., September 3, 2002; 84(9): 1503 - 1513. [Abstract] [Full Text] [PDF]

				V. Martinek, C. Latterman, A. Usas, S. Abramowitch, S. L-Y. Woo, F. H. Fu, and J. Huard Enhancement of Tendon-Bone Integration of Anterior Cruciate Ligament Grafts with Bone Morphogenetic Protein-2 Gene Transfer : A Histological and Biomechanical Study J. Bone Joint Surg. Am., July 9, 2002; 84(7): 1123 - 1131. [Abstract] [Full Text] [PDF]

				S. Yamazaki, K. Yasuda, F. Tomita, A. Minami, and H. Tohyama The Effect of Graft-Tunnel Diameter Disparity on Intraosseous Healing of the Flexor Tendon Graft in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., July 1, 2002; 30(4): 498 - 505. [Abstract] [Full Text] [PDF]

				W. Singhatat, K. W. Lawhorn, S. M. Howell, and M. L. Hull How Four Weeks of Implantation Affect the Strength and Stiffness of a Tendon Graft in a Bone Tunnel: A Study of Two Fixation Devices in an Extraarticular Model in Ovine Am. J. Sports Med., July 1, 2002; 30(4): 506 - 513. [Abstract] [Full Text] [PDF]

				J. T. Nurmi, T. L. N. Jarvinen, P. Kannus, H. Sievanen, J. Toukosalo, and M. Jarvinen Compaction Versus Extraction Drilling for Fixation of the Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., March 1, 2002; 30(2): 167 - 173. [Abstract] [Full Text] [PDF]

				M. D. Shaieb, D. M. Kan, S. K. Chang, J. M. Marumoto, and A. B. Richardson A Prospective Randomized Comparison of Patellar Tendon Versus Semitendinosus and Gracilis Tendon Autografts for Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., March 1, 2002; 30(2): 214 - 220. [Abstract] [Full Text] [PDF]

				K. Anderson, A. M. Seneviratne, K. Izawa, B. L. Atkinson, H. G. Potter, and S. A. Rodeo Augmentation of Tendon Healing in an Intraarticular Bone Tunnel with Use of a Bone Growth Factor Am. J. Sports Med., November 1, 2001; 29(6): 689 - 698. [Abstract] [Full Text] [PDF]

				J. B. Selby, D. L. Johnson, P. Hester, and D. N.M. Caborn Effect of Screw Length on Bioabsorbable Interference Screw Fixation in a Tibial Bone Tunnel Am. J. Sports Med., September 1, 2001; 29(5): 614 - 619. [Abstract] [Full Text] [PDF]

				C. D. Papageorgiou, C. B. Ma, S. D. Abramowitch, T. D. Clineff, and S. L-Y. Woo A Multidisciplinary Study of the Healing of an Intraarticular Anterior Cruciate Ligament Graft in a Goat Model Am. J. Sports Med., September 1, 2001; 29(5): 620 - 626. [Abstract] [Full Text] [PDF]

				Y. Ishibashi, S. Toh, Y. Okamura, T. Sasaki, and T. Kusumi Graft Incorporation within the Tibial Bone Tunnel after Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft Am. J. Sports Med., July 1, 2001; 29(4): 473 - 479. [Abstract] [Full Text] [PDF]

				P. E. Greis, R. T. Burks, K. Bachus, and M. G. Luker The Influence of Tendon Length and Fit on the Strength of a Tendon-Bone Tunnel Complex: A Biomechanical and Histologic Study in the Dog Am. J. Sports Med., July 1, 2001; 29(4): 493 - 497. [Abstract] [Full Text] [PDF]

				L. M. Dejardin, S. P. Arnoczky, B. J. Ewers, R. C. Haut, and R. B. Clarke Tissue-Engineered Rotator Cuff Tendon Using Porcine Small Intestine Submucosa: Histologic and Mechanical Evaluation in Dogs Am. J. Sports Med., March 1, 2001; 29(2): 175 - 184. [Abstract] [Full Text] [PDF]