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Interarticular bone tunnel healing.

E E Berg1, M E Pollard, Q Kang

  • 1New Hampshire Bone & Joint Institute, Bedford, New Hampshire, USA.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|February 15, 2001
PubMed
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Interarticular bone tunnels heal from the outside in, with the peripheral segments healing faster than the articular segments. Healing is incomplete near the joint surface, potentially impacting anterior cruciate ligament reconstruction outcomes.

Area of Science:

  • Orthopedic Surgery
  • Biomedical Engineering
  • Tissue Regeneration

Background:

  • Bone tunnels are created during anterior cruciate ligament (ACL) reconstruction surgery.
  • The synovial environment's effect on bone tunnel healing is not fully understood.
  • Understanding bone healing in tunnels is crucial for improving ACL reconstruction success.

Purpose of the Study:

  • To evaluate the healing process of interarticular bone tunnels within a continuous synovial environment.
  • To assess the rate and extent of new bone formation in bone tunnels over time.

Main Methods:

  • An experimental in vivo animal model using 26 adult rabbits.
  • 3.2-mm diameter tunnels were created in the femur and tibia of stifle joints.
  • Histomorphometric analysis quantified new bone formation at 1, 2, 4, and 12 weeks post-surgery.

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Main Results:

  • Bone tunnel healing was most rapid between 1 and 2 weeks post-surgery.
  • By 2 weeks, 71% of the bone tunnel volume showed ingrowth; peripheral segments healed significantly faster (99% occlusion).
  • Healing in the articular third of the tunnel was delayed and incomplete, especially in the femur (69.1% ingrowth at 12 weeks).

Conclusions:

  • Interarticular bone tunnels demonstrate an 'outside-in' healing pattern.
  • Delayed healing in the articular segment may be influenced by factors affecting ACL healing.
  • Incomplete bone healing in the articular zone could contribute to bone tunnel enlargement post-ACL reconstruction.