J Knee Surg 2019; 32(05): 454-462
DOI: 10.1055/s-0038-1653964
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

Hongbin Lu
1  Department of Sports Medicine & Research Center of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
,
Can Chen
1  Department of Sports Medicine & Research Center of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
,
Shanshan Xie
1  Department of Sports Medicine & Research Center of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
,
Yifu Tang
1  Department of Sports Medicine & Research Center of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
,
Jin Qu
1  Department of Sports Medicine & Research Center of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha, People's Republic of China
› Author Affiliations
Funding This study was funded by the National Natural Science Foundation of China (81501898) and Central South University (2016zzts124).
Further Information

Publication History

24 February 2018

08 April 2018

Publication Date:
21 May 2018 (eFirst)

Abstract

Most studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon–bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft–bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon–bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon–bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction.