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Proteoglycan fragments in anterior cruciate ligament reconstructed knees: a comparative study of two different surgical techniques


Proteoglycan fragments (PF) as chondroitin sulphate were monitored and compared in two groups of patients who had anterior cruciate ligament reconstruction with either patellar tendon (PT) or quadruple semitendinosus tendon (ST) autografts. There were 20 ST and 21 PT reconstructions. No difference existed between the groups in terms of associated lesion and time from injury to surgery. Synovial sample was collected at 6 weeks, 3 months and 18 months after the operation. No difference was noted between the groups at 18 months in terms of activity level and functional scores. Both groups demonstrated a sudden increase of PF at 6 weeks with respect to preoperative quantities (p<0.0001). A significant decrease occurred in the PT group at 3 months (p<0.008). Even at 18 months, it was significantly below the preoperative values (p<0.004). However, the decrease in ST cases relative to 6 weeks was insignificant at 3 months and quantities did not drop below the preoperative levels at 18 month (p=0.79). These results confirm again a gradual decrease of PF values in PT-reconstructed knees depending on time and surgery. Reconstruction with quadruple ST does not seem to have the same effect until 18 months postoperatively. Achievement of almost the same level of activity and function in both groups does not necessarily reflect the molecular status.

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  1. 1.

    Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1992) Arthroscopic anterior cruciate ligament reconstruction with patellar tendon. Arthroscopy 8:510–516

  2. 2.

    Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH (1986) The phenomenon of ‘ligamentization’: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4:162–172

  3. 3.

    Dahlberg L, Friden T, Roos H, Lark MW, Lohmander LS (1994) A longitudinal study of cartilage matrix metabolism in patients with cruciate ligament rupture—synovial fluid concentrations of aggrecan fragments, stromelysin-1 and tissue inhibitor of metalloproteinase-1. Br J Rheumatol 33:1107–1111

  4. 4.

    Dale D, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22:632–644

  5. 5.

    Dejour H, Walch G, Deschamps G, Chambat P (1987) Arthrose du genou sur laxite chronique anterieure [Arthrosis of the knee in chronic anterior laxity]. Rev Chir Orthop 73:157–170

  6. 6.

    Dye SF, Chew MH (1993) Restoration of osseous homeostasis after anterior cruciate ligament reconstruction. Am J Sports Med 21:748–750

  7. 7.

    Dye SF, Wojtys EM, Fu FH, Fithian DC, Gillquist J (1998) Factors contributing to function of the knee joint after injury or reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am 80:1380–1393

  8. 8.

    Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus autografts for anterior cruciate ligament reconstruction: a prospective randomised study with a two-year follow-up. Am J Sports Med 31:19–25

  9. 9.

    Eriksson K, Anderberg P, Hamberg P, Lofgren AC, Bredenberg M, Westman I, Wredmark T (2001) A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 83:348–354

  10. 10.

    Farndale RW, Buttle DJ, Barrett AJ (1986) Improved quantitation and discrimination of sulphated glycosaminoglycans by use of DMB. Biochim Biophys Acta 83:173–177

  11. 11.

    Freedman KB, D’Amato MJ, Nedeff DD, Kaz A, Bach BR (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11

  12. 12.

    Friederich NF, O’Brien WR (1993) Gonarthrose nach Verletzung des vorderen Kreuzbandes: Eine Multizenter-, Langzeitstudie [Gonarthrosis after injury of the anterior cruciate ligament: a multicenter, long-term study]. Z Unfallchir Versicherungsmed 86:81–89

  13. 13.

    Goradia VK, Rochat MC, Kida M, Grana WA (2000) Natural history of a hamstring tendon autograft used for anterior cruciate ligament reconstruction in a sheep model. Am J Sports Med 28:40–46

  14. 14.

    Heinegard D, Inerot S, Wieslander J, Lindblad G (1985) A method for the quantification of cartilage proteoglycan structures liberated to the synovial fluid during developing degenerative joint disease. Scand J Clin Lab Invest 45:421–427

  15. 15.

    Horstman JK, Ahmadu-Suka F, Norrdin RW (1993) Anterior cruciate ligament fascia lata allograft reconstruction: progressive histological changes towards maturity. Arthroscopy 9:509–518

  16. 16.

    Jomha NM, Borton DC, Clingeleffer AJ, Pinczewski LA (1999) Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. Clin Orthop 358:188–193

  17. 17.

    Kannus P, Jarvinen M (1987) Conservatively treated tears of the anterior cruciate ligament. Long-term results. J Bone Joint Surg Am 69:1007–1012

  18. 18.

    L’Insalata JC, Klatt B, Fu FH, Harner CD (1997) Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surg Sports Traumatol Arthrosc 5:234–238

  19. 19.

    Lohmander LS (1988) Proteoglycans of joint cartilage: structure, function, turnover and role as markers of joint disease. Baillière’s Clin Rheum 2:37–62

  20. 20.

    Lohmander LS, Dahlberg L, Ryd L, Heinegard D (1989) Increased levels of proteoglycan fragments in knee joint fluid after injury. Arthritis Rheum 32:1434–1442

  21. 21.

    Lohmander LS (1991) Markers of cartilage metabolism in arthrosis. Acta Orthop Scand 62:623–632

  22. 22.

    Lohmander LS, Hoerrner LA, Lark MW (1993) Metalloproteinases, tissue inhibitor, and proteoglycan fragments in knee synovial fluid in human osteoarthritis. Arthritis Rheum 36:181–189

  23. 23.

    Lohmander LS, Roos H (1994) Knee ligament injury, surgery and osteoarthrosis. Truth or consequences? Acta Orthop Scand 65:605–609

  24. 24.

    Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154

  25. 25.

    Manicourt DH, Lenz ME, Thonar EJ (1991) Levels of serum keratan sulfate rise rapidly and remain elevated following anterior cruciate ligament transection in the dog. J Rheumatol 18:1872–1876

  26. 26.

    Marder RA, Raskind JR, Carroll M (1991) Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med 19:478–484

  27. 27.

    McCarroll JR, Shelbourne KD, Patel DV (1995) Anterior cruciate ligament injuries in young athletes. Recommendations for treatment and rehabilitation. Sports Med 20 (2):117–127

  28. 28.

    Messner K, Gao J (1995) Synovial reaction and concentrations of proteoglycans fragments joint fluid after intraarticular knee injuries. Knee Surg Sports Traumatol Arthrosc 3:101–104

  29. 29.

    Niibayashi H, Shimizu K, Suzuki K, Yamamoto S, Yasuda T and Yamamuro T (1995) Proteoglycan degradation in hemarthrosis. Acta Orthop Scand 66:73–79

  30. 30.

    Page-Thomas DP, Bard D, King B and Dingle JT (1987) Clearance of proteoglycan from joint cavities. Ann Rheum Dis 46:934–937

  31. 31.

    Petersen W, Laprell H (2000) Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 8:26–31

  32. 32.

    Pinczewski LA, Deehan DJ, Salmon LJ, Russell VJ, Clingeleffer A (2002) A five-year comparison of patellar tendon versus four-strand hamstring tendon autograft for arthroscopic reconstruction of the anterior cruciate ligament. Am J Sports Med 30:523–536

  33. 33.

    Ratcliffe A, Billingham ME, Saed Nejad F, Muir H, Hardingham TE (1992) Increased release of matrix components from articular cartilage in experimental canine osteoarthritis. J Orthop Res 10:350–358

  34. 34.

    Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF (1993) Tendon healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 75:1795–1803

  35. 35.

    Rosenberg TD, Franklin JL, Baldwin GN, Nelson KA (1992) Extensor mechanism function after patellar tendon graft harvest for anterior cruciate ligament reconstruction. Am J Sports Med 20:519–526

  36. 36.

    Rosenberg TD, Brown GC, Deffner KT (1997) Anterior cruciate ligament reconstruction with a quadrupled semitendinosus autograft. Sports Med Arthrosc Rev 5:51–58

  37. 37.

    Rougraff B, Shelbourne KD, Gerth PK, Warner J (1993) Arthroscopic and histologic analysis of human patellar tendon autografts used for anterior cruciate ligament reconstruction. Am J Sports Med 21:277–284

  38. 38.

    Scranton PE, Lanzer WL, Ferguson MS, Kirkman TR, Pflaster DS (1998) Mechanism of anterior cruciate ligament neovascularization and ligamentization. Arthroscopy 14:702–716

  39. 39.

    Shelbourne KD, Nitz P (1990) Accelerated rehabilitation after anterior cruciate ligament reconstruction. Am J Sports Med 18:292–299

  40. 40.

    Shelbourne KD, Gray T (2000) Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery: five to fifteen-year evaluations. Am J Sports Med 28:446–452

  41. 41.

    Sommerlath K, Lysholm J, Gillquist J (1991) The long-term course after treatment of acute anterior cruciate ligament ruptures: a 9 to 16 year follow-up. Am J Sports Med 19:156–162

  42. 42.

    Taskiran E, Taskiran D, Duran T, Lök V (1998) Articular cartilage homeostasis after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:93–98

  43. 43.

    Taskiran D, Taskiran E, Ozsoy H, Lok V (1999) Effects of surgical trauma on articular cartilage. Turk J Med Sci 29:177–180

  44. 44.

    Tegner Y, Lysholm J, Gillquist J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

  45. 45.

    Toritsuka Y, Horibe S, Mitsuoka T, Nakamura N, Hamada M, Shino K (2003) Comparison between the cross sectional area of bone-patellar tendon-bone grafts and multistranded hamstring tendon grafts obtained from the same patients. Knee Surg Sports Traumatol Arthrosc 11:81–84

  46. 46.

    Uesaka S, Nakayama Y, Shirai Y, Yoshihara K (2001) Serum and synovial fluid levels of chondroitin sulfate in patients with osteoarthritis of the knee joint. J Nippon Med Sch 68:165–170

  47. 47.

    Yoshiya S, Nagano M, Kurosaka M, Muratsu H, Mizuna K (2000) Graft healing in the bone tunnel in anterior cruciate ligament reconstruction. Clin Orthop 376:278–286

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The authors thank Yeliz Tuna B.S. for editing the pictures in this article.

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Correspondence to Emin Taskiran.

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Taskiran, E., Taskiran, D. & Lok, V. Proteoglycan fragments in anterior cruciate ligament reconstructed knees: a comparative study of two different surgical techniques. Knee Surg Sports Traumatol Arthrosc 13, 385–392 (2005).

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  • Anterior cruciate ligament
  • Cartilage
  • Proteoglycan
  • Synovial fluid
  • Knee injury