Mineralized tissue loss at the femoral ACL enthesis in young male ACL-injured patients

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-01-28 DOI:10.1002/jeo2.70106

Mélanie L. Beaulieu, Yuchen Wang, Stephen H. Schlecht, James A. Ashton-Miller, Edward M. Wojtys

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Abstract

Purpose

Primary anterior cruciate ligament (ACL) reconstruction graft failure remains a significant health concern in young patients. Despite the high incidence of poor graft integration in these patients and the resulting high failure rate, little consideration has been given to the quality of the bone into which the graft is anchored at reconstruction. Therefore, we investigated post ACL injury mineralized tissue changes in the ACL femoral entheses of young males and compared them to changes previously reported for young females.

Methods

ACL femoral entheses and adjacent bone specimens were harvested from the injured knees of 51 young males during primary ACL reconstructive surgery and from 10 non-injured male cadaveric donors. The specimens were imaged via nano-computed tomography and analyzed for volumetric bone mineral density (vBMD) and architectural changes.

Results

Male femoral ACL explant specimens had significantly lower cortical vBMD (p < 0.001), lower relative bone volume (BV/TV, p = 0.027) and greater cortical bone porosity (Ct.Po, p = 0.027) but similar trabecular bone parameters (p's > 0.05) to those of control specimens from male cadaveric donors. Cortical and trabecular bone loss increased significantly with time from ACL injury to reconstructive surgery (p's < 0.05). While cortical loss occurred in both males and females, significant trabecular loss occurred only in females (p = 0.009).

Conclusion

Femoral entheseal bone loss occurs in males following ACL injury. This bone loss increases with time following ACL injury, with cortical bone loss occurring sooner after injury than trabecular bone loss. The effects of ACL injury and time from injury to surgery on trabecular bone microarchitecture differed between male and female patients.

Level of Evidence

N/A.

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年轻男性ACL损伤患者股骨前交叉韧带末端矿化组织丢失。

目的：原发性前交叉韧带（ACL）重建移植失败仍然是年轻患者的重要健康问题。尽管在这些患者中移植物整合不良的发生率很高，导致失败率很高，但在重建时很少考虑移植物锚定的骨质量。因此，我们研究了年轻男性前交叉韧带股骨髋臼损伤后矿化组织的变化，并将其与之前报道的年轻女性的变化进行了比较。方法：从51例年轻男性初次前交叉韧带重建手术中受伤的膝关节和10例未受伤的男性尸体供体中采集前交叉韧带股骨内腔及邻近骨标本。通过纳米计算机断层扫描对标本进行成像，并分析体积骨矿物质密度（vBMD）和建筑变化。结果：男性股骨前交叉韧带移植标本的骨皮质vBMD显著降低（p p = 0.027），骨皮质孔隙率显著提高(Ct。Po, p = 0.027)，但骨小梁参数与男性尸体供体的对照标本相似（p = 0.05）。从ACL损伤到重建手术，随着时间的推移，皮质骨和小梁骨丢失显著增加（p = 0.009）。结论：男性前交叉韧带损伤后可发生股骨干骨丢失。这种骨丢失随着前交叉韧带损伤后时间的推移而增加，损伤后皮质骨丢失比小梁骨丢失发生得更快。前交叉韧带损伤及损伤至手术时间对男女患者骨小梁微结构的影响存在差异。证据级别：无。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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