Chinese Journal of Tissue Engineering Research ›› 2025, Vol. 29 ›› Issue (4): 713-720.doi: 10.12307/2025.222

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Internal tension relieving technique assisted anterior cruciate ligament reconstruction to promote ligamentization of Achilles tendon grafts in small ear pigs in southern Yunnan province

Xiong Bohan1, Wang Guoliang1, Yu Yang1, Xue Wenqiang2, Yu Hong1, Liu Jinrui1, Ruan Zhaohui1, Li Yajuan1, Liu Haolong1, Dong Kaiyan1, Long Dan1, Chen Zhao3   

  1. 1Department of Sports Medicine, 2Department of Anesthesiology, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China; 3School of Public Health, Southwest Medical University, Luzhou 646000, Sichuan Province, China
  • Received:2023-12-14 Accepted:2024-02-07 Online:2025-02-08 Published:2024-05-30
  • Contact: Wang Guoliang, PhD, Associate chief physician, Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • About author:Xiong Bohan, Master candidate, Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
  • Supported by:
    Technology Innovation Talent Project of Yunnan Province, No. 202105AD160018 (to WGL); Master’s Education Innovation Fund Project of Kunming Medical University, No. 2023S061 (to XBH); PhD Research Fund Project within First Affiliated Hospital of Kunming Medical University, No. 2023BS022 (to YY)

Abstract:

BACKGROUND: We have successfully established an animal model of small ear pig in southern Yunnan province with internal tension relieving technique combined with autologous Achilles tendon for anterior cruciate ligament reconstruction, and verified the stability and reliability of the model. However, whether internal tension relieving technique can promote the ligamentalization process of autologous Achilles tendon graft has not been studied.

OBJECTIVE: To investigate the differences in the process of ligamentalization between conventional reconstruction and internal reduction reconstruction of the anterior cruciate ligament by gross view, histology and electron microscopy.

METHODS: Thirty adult female small ear pigs in southern Yunnan province were selected. Anterior cruciate ligament reconstruction was performed on the left knee joint with the ipsilateral knee Achilles tendon (n=30 in the normal group), and anterior cruciate ligament reconstruction was performed on the right knee joint with the ipsilateral knee Achilles tendon combined with the internal relaxation and enhancement system (n=30 in the relaxation group). The autogenous right forelimb was used as the control group; the anterior cruciate ligament was exposed but not severed or surgically treated. At 12, 24, and 48 weeks after surgery, 10 animals were sacrificed, respectively. The left and right knee joint specimens were taken for gross morphological observation to evaluate the graft morphology. MAS score was used to evaluate the excellent and good rate of the ligament at each time point. Hematoxylin-eosin staining was used to evaluate the degree of ligament graft vascularization. Collagen fibers and nuclear morphology were observed, and nuclear morphology was scored. Ultrastructural remodeling was evaluated by scanning electron microscopy and transmission electron microscopy.
RESULTS AND CONCLUSION: (1) The ligament healing shape of the relaxation group was better at various time points after surgery, and the excellent and good rate of MAS score was higher (P < 0.05). Moreover, the relaxation group could obtain higher ligament vascularization score (P < 0.05). (2) The arrangement of collagen bundles and fiber bundles in the two groups gradually tended to be orderly, and the transverse fiber connections between collagen gradually increased and thickened, suggesting that the strength and shape degree of the grafts were gradually improved, but the ligament remodeling in the relaxation group was always faster than that in the normal group at various time points after surgery. (3) The diameter, distribution density, and arrangement degree of collagen fibers in the relaxation group were better than those in the normal group at all time points, especially in the comparison of collagen fiber diameter between and within the relaxation group (P < 0.05). 

Key words: anterior cruciate ligament, internal tension relieving technique, ligamentization, ultrastructure, vascularization

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