Effect of Calcium Phosphate–Hybridized Tendon Graft in Anatomic Single-Bundle ACL Reconstruction in Goats

Abstract

Background: We previously developed a novel technique using an alternate soaking process that improves tendon-bone healing by hybridizing the tendon graft with calcium phosphate (CaP). However, the effects of the CaP-hybridized tendon graft on anatomic single-bundle anterior cruciate ligament (ACL) reconstruction remain unclear. Purpose: To determine the effects of CaP-hybridized tendon grafts compared with untreated tendon grafts 6 months after anatomic single-bundle ACL reconstruction using a goat model. Study Design: Controlled laboratory study. Methods: Animals were divided into a CaP group (n = 5 goats) and a control group (n = 5 goats), and we analyzed (1) knee kinematics and in situ forces under applied anterior tibial loads of 50 N and internal tibial torque of 2.0 N·m in the grafts at full extension and at 60° and 90° of knee flexion, (2) the mean percentage of bone tunnel enlargement using computed tomography (CT), and (3) the histology of the tendon-bone interface. Results: The in situ forces under applied anterior tibial loads of 50 N at 60° and 90° of knee flexion in the CaP group were greater than those in the control group ( P < .05). The red safranin-O–stained area, indicating glycosaminoglycans in the cartilage layers at the joint aperture sites of the anterior femoral and posterior tibial bone tunnel, was greater in the CaP group than that in the control group ( P < .05). The lengths of the nonbonding gap area between the anterior femoral and posterior tibial bone tunnels in the control group were greater than those in the CaP group ( P < .05). No significant difference could be detected in the mean percentage of bone tunnel enlargement between the 2 groups. Conclusion: The CaP-hybridized tendon graft enhanced tendon-bone healing at the joint aperture site in both anterior femoral and posterior tibial tunnels 6 months after anatomic single-bundle ACL reconstruction in goats. The in situ forces under applied anterior tibial loads at greater flexion angles in the CaP group increased compared with controls. Clinical Relevance: Anatomic single-bundle ACL reconstruction using CaP-hybridized tendon grafts may lead to better postoperative knee function.