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Is the ACL degenerated before rupture? John Magne Hoseth, M.D. Kristiansund Hospital.

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Presentation on theme: "Is the ACL degenerated before rupture? John Magne Hoseth, M.D. Kristiansund Hospital."— Presentation transcript:

1 Is the ACL degenerated before rupture? John Magne Hoseth, M.D. Kristiansund Hospital

2 ACL injuries Incidence - approximately 1 per 3000 individuals Predominantly in a young and sports-active population Five times higher in females. Rate of posttraumatic osteoarthritis is unchanged after ACL reconstruction (Maguire et al 09)

3 Tendon vs Ligament Almost identical anatomy Collagen fiber bundles arranged into fascicles, with variable amounts of elastic fibers (Wheater`s 93) ACL – biomechanically acts the same way as tendons

4 Degeneration in tendons Chronic degenerative changes in tendons predispose to rupture (Kannus et al 91) Eccentric excercise increases synthesis of type I collagen in achilles tendinosis (Langberg et al 05)

5 Aims of study To examine whether there is an underlying degenerative process in the ACL prior to rupture

6 Methods Biopsy study Histopathological analysis

7 Biopsy study By explorative arthroscopy within 24 hours on patients presenting with traumatic hemarthrosis Reduces arthrofibrosis Shortens rehabilitation time before a possible reconstructive procedure Removal of the ACL if ruptured

8 Histopathology Samples are fixed in 70 % ethanol, dehydrated and paraffin embedded Investigation of angiofibroblastic change. A reparative process that is a strong indicator of chronic degeneration Apoptosis starts immediately after ACL rupture Uncertain if findings related to apoptosis can be attributed to pre-rupture ( A. Scott )


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