Suture residues are associated with histomorphological changes in failed anterior cruciate ligament hamstring autografts
Steffen F. Siemoneit, Alexander Bosse, Steffen T. Ubl, Daniel Günther, Julius M. Wehrmann, Bertil Bouillon, Maiti Münchgesang, Thomas R. PfeifferAbstract
Purpose
This study aimed to evaluate histomorphological changes associated with residual foreign material in failed anterior cruciate ligament (ACL) autografts. We hypothesised that retained suture material is associated with histopathological regression phenomena in ligamentous and osseous compartments following ACL reconstruction failure.
Methods
In this prospective study, 43 consecutive patients (mean age 29.7 ± 9.0 years; 20.9% female) undergoing revision surgery after failed autologous ACL reconstruction were included and analysed. A total of 76 bone‐graft specimens were obtained by over‐reaming femoral and tibial drill tunnels to retrieve the periarticular tunnel segment. Specimens were processed using Hematoxylin–Eosin, Masson–Goldner and Elastika–van Gieson staining. Morphological alterations related to foreign material were assessed qualitatively and semi‐quantitatively using a four‐point grading system under light microscopy. Evaluations were performed independently by two observers (a pathology professor and a trained investigator), with consensus in case of disagreement.
Results
Foreign material residues were identified in 92.6% of specimens. Polarised light microscopy revealed birefringent suture remnants frequently associated with histiocytic inflammatory reactions and multinucleated giant cells. Observed regression phenomena included inflammatory reactions (IR), capillary proliferation (CP), osteonecrosis (ON), fissural splitting (FS) and intraligamentous cyst formation. Severe tissue destruction of the autograft or bony compartment was present in approximately 20% of femoral and tibial samples. Descriptive contingency analysis indicated that regression phenomena predominantly occurred in association with adjacent foreign body reactions, whereas isolated regression changes without detectable foreign material were rare.
Conclusion
Residual suture material in failed ACL reconstructions is frequently associated with inflammatory and degenerative histomorphological changes in both tendon graft and bone tunnel compartments. Although causality cannot be established, these findings suggest that foreign body reactions may contribute to local tissue degradation. Further studies are needed to clarify the clinical and biomechanical relevance of these observations.
Level of Evidence
N/A.