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Is the ACL degenerated before rupture?

Is the ACL degenerated before rupture?. John Magne Hoseth, M.D. Kristiansund Hospital. ACL injuries. Incidence - approximately 1 per 3000 individuals Predominantly in a young and sports-active population Five times higher in females.

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Is the ACL degenerated before rupture?

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  1. Is the ACL degenerated before rupture? John Magne Hoseth, M.D. Kristiansund Hospital

  2. ACL injuries • Incidence - approximately 1 per 3000 individuals • Predominantly in a young and sports-active population • Five times higher in females. • Rate of posttraumatic osteoarthritis is unchanged after ACL reconstruction (Maguire et al 09)

  3. Tendon vs Ligament • Almost identical anatomy • Collagen fiber bundles arranged into fascicles, with variable amounts of elastic fibers (Wheater`s 93) • ACL – biomechanically acts the same way as tendons

  4. Degeneration in tendons • Chronic degenerative changes in tendons predispose to rupture (Kannus et al 91) • Eccentric excercise increases synthesis of type I collagen in achilles tendinosis (Langberg et al 05)

  5. Aims of study To examine whether there is an underlying degenerative process in the ACL prior to rupture

  6. Methods • Biopsy study • Histopathological analysis

  7. Biopsy study • By explorative arthroscopy within 24 hours on patients presenting with traumatic hemarthrosis • Reduces arthrofibrosis • Shortens rehabilitation time before a possible reconstructive procedure • Removal of the ACL if ruptured

  8. Histopathology • Samples are fixed in 70 % ethanol, dehydrated and paraffin embedded • Investigation of angiofibroblastic change. A reparative process that is a strong indicator of chronic degeneration • Apoptosis starts immediately after ACL rupture • Uncertain if findings related to apoptosis can be attributed to pre-rupture ( A. Scott )

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