title: A histological and ultrastructural evaluation of the patellar tendon 10 years after reharvesting its central third.
abstract: OBJECTIVE
  This study was undertaken to evaluate the histologic and ultrastructural characteristics of the patellar tendon 10 years after reharvesting its central third.
  
  
  OBJECTIVE
  In the long term, after its central third is reharvested, the patellar tendon does not regain a normal histological and ultrastructural appearance.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  Twelve consecutive patients (4 women, 8 men) who underwent anterior cruciate ligament revision surgery using reharvested ipsilateral patellar tendon autografts were included in the study. Percutaneous biopsy samples were obtained from the central and lateral parts of the patellar tendon under ultrasonographic guidance at a median of 116 months (range, 102-127 months) after the revision procedure. Eleven biopsy specimens from asymptomatic patellar tendons obtained from open anterior cruciate ligament reconstructions served as controls. The histologic characteristics and the presence of glycosaminoglycans were assessed using a light microscope, and the ultrastructure was assessed using a transmission electron microscope.
  
  
  RESULTS
  The histological evaluation revealed deterioration in fiber structure, increased cellularity, and increased vascularity in both the central and peripheral parts of the reharvested patellar tendon specimens compared with normal tendon specimens. No difference in the amount of glycosaminoglycans was seen in specimens from either part of the reharvested patellar tendons and the control specimens. The ultrastructural evaluation revealed that all the control specimens had a normal morphologic appearance and a compact extracellular matrix with regularly oriented collagen fibrils. Furthermore, in the control specimens, the fibril diameter was heterogeneous, with all fibril size classes present. Specimens from the central and the lateral part of the reharvested tendon displayed pathological cell appearance and a more heterogeneous extracellular matrix. The lateral specimens from the reharvested tendons also displayed all fibril size classes but with a more homogeneous distribution. In the central specimens, the largest fibril size class was absent.
  
  
  CONCLUSIONS
  Ten years after its central third was reharvested for anterior cruciate ligament revision surgery, the patellar tendon had not normalized in terms of its histological and ultrastructural appearance.
authors.affiliation: Department of Plastic Surgery, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. mattias.liden@vgregion.se
authors.forename: Mattias
authors.initials: M
authors.lastname: Lidén
authors.forename: Tomas
authors.initials: T
authors.lastname: Movin
authors.forename: Lars
authors.initials: L
authors.lastname: Ejerhed
authors.forename: Nikos
authors.initials: N
authors.lastname: Papadogiannakis
authors.forename: Eva
authors.initials: E
authors.lastname: Blomén
authors.forename: Kjell
authors.initials: K
authors.lastname: Hultenby
authors.forename: Jüri
authors.initials: J
authors.lastname: Kartus
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017847:Patellar Ligament / Q000637:transplantation* / Q000648:ultrastructure*; D012086:Reoperation / Q000534:rehabilitation*; D014182:Transplantation, Autologous