Parsiyel Ön Çapraz Bağ Yaralanmalarında Ultrastrüktürel Değişiklikler

Abstract

A uniform definition of a partial Anterior Cruciat Ligament (ACL) tear does not exist and its diagnosis remains clinically challenging. İn partial ACL injuries, preserving the remnant will potentiate the healing of the ligament, and many authors advocating remenant presevation during repair. Knowledge about the anatomy and biomechanics of ACL have been established. Double bundle,single-bundle reconstuction and biological repairs like techniques has been developed. İn partial ACL tear decision of remnant preservation and repairing techniques should be linked with ultrasrtructural changes of preserved tissue. Many studies described different histological phases and ultrastuctural features after complete ACL tear in humans but the ultrastuctural analysis of partial ACL tears has not been established yet.The purpose of this study is determining the ultrastructural changes after parial tear and evaluate healing potential of ACL remnant. İn our study 8 patients in study group and 2 patients in control group(intact ACL) totaly 10 patient were included. İn study group patients with traumatic knee instability (4 male and 4 female), mean age 33 (26-45 years) , the avarage time from injury to the surgury was 4 mounths ( 2-6 months) and all patients diagnosed on partial tear by arthroscopic knee examination. Aftre the diagnosis of partial ACL tear will be established we took a sample from the remnant bandle that have bony attachment to the femur at distance of 6-7mm then we sent the samples to Anatomy Department to be analaysed by electron microscopy. Also we took a samples from intact ACL(control group) from 2 patients whoes undergo arthoscopy for meniscus tear to be analyse by electron microscop and determined the ultrastructural features, The results of study group showed signifgant increase in fibroblasts, perifibroblastic edema, numerous intracellular vacuoles were seen in the fibroblasts and fibrocytes and in some areas irregularity of collagen fibers were observed. In control group, normal fibroblasts, fibrocytes and collagen fibers were observed. As aresult of our study,after partial tear and during arthroscopic examination macroscopicly the injuried ligament have a continuity with attachment side,but by microscopic examination there is evidence of injury,at the same time the increasing in fibroblast numbers shows the potential of the remnant ligament to healing.İn conclusion these results shows significance of preserving the remnant ligament during any repair techniques.