Z Orthop Unfall 2023; 161(05): 500-510
DOI: 10.1055/a-1717-2889

Histopathological Analysis of the Degree of Tendinosis in Failed Anterior Cruciate Ligament Grafts

Article in several languages: deutsch | English
Katja Weinert
1   Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle, Halle, Deutschland (Ringgold ID: RIN14942)
Hans-Jürgen Holzhausen
2   Amedes MVZ für Pathologie, Zytodiagnostik und Humangenetik in Halle GmbH, Halle, Deutschland
Thomas Bartels
3   MVZ Sportklinik Halle: Zentrum für Gelenkchirurgie, Halle, Deutschland
Gunter Spahn
4   Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland (Ringgold ID: RIN39065)
5   Unfallchirurgie und Orthopädie, Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
Gunter O. Hofmann
6   Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost Halle, Halle, Deutschland (Ringgold ID: RIN39781)
4   Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Jena, Deutschland (Ringgold ID: RIN39065)
› Author Affiliations


Introduction After reconstruction of the anterior cruciate ligament, the modification processes in the transplanted tendon tissue directly influence the biomechanical properties of the knee. The histopathological alterations in failed grafts have hardly been studied.

Objective Our study focused on examining the presence and extent of tendinosis (low or high grade) in the tendon tissue of failed anterior cruciate ligament reconstructions. We considered its relationship to the type of transplant, the symptoms, the arthroscopic appearance, the mode of trauma, and the timing of the failure.

Materials and Methods The tendon tissue of failed anterior cruciate ligament reconstructions in 30 patients was gathered during revision surgery and its histopathology was analysed for the occurrence of structural alterations. The classification of the tendinosis as low or high grade was semiquantitative based on five qualities. We used a standardised questionnaire to collect patient data and we used the Marburg Arthroscopy Score for the intraoperative evaluation of the graft.

Results We found histological vitality and, except for two samples, structural alterations consistent with tendinosis, predominantly high grade, in all failed anterior cruciate ligament grafts. No direct link could be proved between the degree of tendinosis and the type of graft used, the symptoms (except for instability) or the timing of the graft failure, the mode of trauma, or the arthroscopic appearance of the failed plasty. However, the accumulation of high-grade tendinosis in patients with hamstring tendons, subjective instability, and graft failure between 1 to 5 years postoperatively was noteworthy.

Conclusion Structural alterations consistent with tendinosis could be detected, with different expressions, in the vital tendon tissue of anterior cruciate ligament reconstructions. This indicates that the graft is subject to repetitive microtrauma. However, it is still unclear how tendinosis influences the failure of anterior cruciate ligament reconstructions.

Publication History

Received: 07 July 2021

Accepted after revision: 06 December 2021

Article published online:
23 February 2022

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