Reconstruction of the anterior cruciate ligament (ACL) with patellar tendon (PT) is a common procedure for the symptomatic ACL-deficient knee. Questions regarding graft incorporation, viability, and nutrition of the transplanted tissue are of concern. This relates to the graft's response to its new intrasynovial milieu and new physical forces. These factors were studied in a rabbit model of ACL reconstruction using PT and were evaluated with histological and biochemical parameters with respect to time. A histological and biochemical metamorphosis of the grafted PT occurred in this study. Autografts demonstrated a gradual assumption of the microscopic properties of normal ACL; by 30 weeks postoperatively, cell morphology was ligamentous in appearance. Normally, type III collagen is not observed in PT, however, a gradual increase in its concentration was seen in the grafts; by 30 weeks its concentration (10%) was the same as in normal ACL. Similarly, glycosaminoglycans content increased from its normally low level in PT to that found in native ACL. Collagen-reducible crosslink analysis demonstrated that grafted tissue changed from the normal PT pattern of low dihydroxylysinonorleucine (DHLNL) and high histidinohydroxymerodesmosine (HHMD) to the pattern seen in normal ACL (high DHLNL and low HHMD) by 30 weeks. These data suggest that when PT is placed in the anatomic and environmental milieu of the ACL, a "ligamentization" of the grafted tissue results; also the autograft initially depends on synovial fluid nutrition, as revascularization occurs after 6 weeks.

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The purpose of this study was to compare selected rabbit tendons and ligaments morphologically and biochemically. Five representative structures from each of six age-and sex-matched rabbits were compared. Biochemical analyses included total collagen, reducible collagen cross-links, quantitative collagen typing, DNA, and glycosaminoglycans. Histological and chemical differences were demonstrated between the tendons and the ligaments. Smaller differences were also found between the individual ligaments (collateral and cruciate) and between the two tendons (patellar and Achilles) that were examined. These findings suggest that ligaments are more metabolically active than tendons, having more plump cellular nuclei, higher DNA content, larger amounts of reducible cross-links, and the presence of more type I11 collagen, as compared with tendons. They also contain slightly less total collagen than tendons and more glycosaminoglycans. We conclude that the tendons and ligaments studied have unique histological and biochemical characteristics, despite their gross similarities. Relatively increased metabolic activity in ligaments, implied by our findings, may be species specific, age related (transient), or may truly represent a structural expression of functional need for more rapid adaptation. Further investigation of other similarities or differences between particular ligaments (or tendons) is indicated, and attention is directed toward the importance of such variables in development of models for tendon and ligament studies. Key Words: Tendon-Ligament-DNA concentration-Collagen cross-linking-Glycosaminoglycans-Comparison.Chronic knee ligament instabilities are most commonly treated by functional replacement with other periarticular structures, mainly tendons. These replacements have included the use of various parts of the quadriceps tendon mechanism (1 1,20,28), pes anserinus (39), semitendinosis tendon (8,36), biceps femoris tendon (38), gracilis tendon (43), iliotibial bank (17,31,34), and lengths of fascia lata twisted or rolled into tendonlike forms (24,25).

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Positive effects on the tensile characteristics of swine digital extensors were found following twelve months of exercise training. Compared to sedentary controls, the tendons from the exercised animals became stronger as a material and exhibited hypertrophy. These biomechanical results were supported by biochemical analyses of tendon composition. Exercise increased the concentration of collagen as well as the total weights of the tendons. For determining stress and strain in tendon material, we used specially designed instruments to measure the tendon cross-sectional area, and a video dimensional analyzer system to measure accurately its "non-contact" tensile strain. With these newly developed apparatus, the mechanical properties of the tendons were accurately determined so that the effects of exercise training could be compared.

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