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The ACL injury response: A collagen-based analysis.

Joshua S Everhart¹, John H Sojka², Christopher C Kaeding³

¹College of Medicine, The Ohio State University, United States; Orthopaedics, The Ohio State University Wexner Medical Center, United States.

|March 25, 2017

Summary

Torn anterior cruciate ligaments (ACL) show rapid collagen turnover, indicating active healing processes. This high tissue turnover occurs regardless of injury type and persists over time.

Keywords:

ACL injury Biopsy Collagen turnover Contact injury Non-contact injury

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Area of Science:

Orthopedics
Sports Medicine
Biochemistry

Background:

Anterior cruciate ligament (ACL) injuries have poor healing potential.
Tendon grafts used in ACL reconstruction undergo significant tissue turnover ('ligamentization').
The fate of native torn ACL tissue, specifically collagen turnover and influencing factors like injury mechanism and chronicity, remains unclear.

Purpose of the Study:

To investigate whether native torn anterior cruciate ligament (ACL) tissue exhibits significant collagen turnover.
To determine if injury mechanism (contact vs. non-contact) or time since injury affects collagen turnover in torn ACLs.

Main Methods:

Biopsies from 33 mid-substance ACLs obtained during arthroscopic reconstruction and 2 uninjured cadaveric ACLs.
Quantification of immature collagen cross-links using ninhydrin reagent assays as a marker for collagen turnover.
Histochemical analysis of ACL tears at different stages of chronicity.

Main Results:

Collagen cross-link content was consistently low across all ACL samples, irrespective of injury mechanism.
This low content suggests high tissue turnover occurred between injury and surgical intervention.
No significant demographic differences were observed between contact and non-contact injury groups.

Conclusions:

Collagen turnover in the anterior cruciate ligament (ACL) is rapid following injury.
This robust tissue turnover begins within weeks of injury and continues throughout the lifespan of the torn ligament.
The rate of turnover is not influenced by whether the injury was contact or non-contact.