ACL graft maturity

Graft selection in anterior cruciate ligament (ACL) reconstruction is critical, as it remains one of the most easily adjustable factors affecting graft rupture and reoperation rates. Commonly used autografts, including hamstring tendon, quadriceps tendon and bone-patellar-tendon-bone, are reported to be biomechanically equivalent or superior compared to the native ACL. Despite this, such grafts are unable to perfectly replicate the complex anatomical and histological characteristics of the native ACL. While there remains inconclusive evidence as to the superiority of one autograft in terms of graft incorporation and maturity, allografts appear to demonstrate slower incorporation and maturity compared to autografts...

PURPOSE: To evaluate the degree of graft healing after "tension suspension" reconstruction of "Sherman II" anterior cruciate ligament injuries versus non-remnant preserving anatomical reconstruction and to compare the clinical outcomes of the two procedures. METHOD: The clinical data of 64 patients were retrospectively included. There were 31 cases in the "tension suspension" remnant-preserving reconstruction group and 33 cases in the non-remnant-preserving anatomical reconstruction group...

BACKGROUND: 3D printing technology has become a research hotspot in the field of scientific research because of its personalized customization, maneuverability and the ability to achieve multiple material fabrications. The focus of this study is to use 3D printing technology to customize personalized poly L-lactic acid (PLLA) porous screws in orthopedic plants and to explore its effect on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction. METHODS: Preparation of PLLA porous screws with good orthogonal pore structure by 3D printer...

CASE: A 32-year-old healthy woman tore her right anterior cruciate ligament (ACL) and underwent reconstruction with quadriceps tendon autograft. Twelve weeks postoperatively, she had anterior thigh pain limiting knee flexion and a palpable mass in the anterior thigh. Imaging revealed a calcified mass near the graft site, concerning for heterotopic ossification (HO). After maturation of the heterotopic bone, she underwent debridement and HO removal. CONCLUSION: This is a case of HO at the quadriceps tendon autograft site after ACL reconstruction...

BACKGROUND: Graft maturation is an important prognostic factor for hamstring autograft anterior cruciate ligament reconstruction (ACLR). It remains unclear whether extracorporeal shock wave therapy (ESWT) can promote graft healing after ACLR. PURPOSE: To evaluate the therapeutic and graft maturation effects of ESWT in hamstring autograft ACLR. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Between May 18, 2019, and September 20, 2019, we randomly assigned 30 patients who met study inclusion criteria to 2 groups...

PURPOSE: To evaluate the association of posterior tibial slope (PTS) with anterior cruciate ligament (ACL) reinjury following primary ACL reconstruction. METHODS: PubMed, Scopus, Embase, and CINAHL databases were searched from inception through March 1, 2021, to retrieve relevant studies. Comparative studies reporting PTS measurements in a cohort of patients experiencing ACL graft failure versus patients with intact primary ACL reconstruction or studies comparing patients undergoing revision ACL reconstruction versus primary ACL reconstruction were included for analysis...

Bone morphogenetic protein-2 (BMP-2) and transforming growth factor-β1 (TGF-β1) reportedly induce the osteogenic and tenogenic differentiation of anterior cruciate ligament (ACL)-derived stem cells (LDSCs), respectively. However, few studies have investigated the effect of BMP-2/TGF-β1 on the differentiation of LDSC. We developed a BMP-2/TGF-β1 gene insertion into an LDSC cell sheet that promotes tendon-bone healing in a mouse ACL reconstruction (ACLR) model.. CD34+ LDSCs were isolated from human ACL stump tissues, virally transduced to express BMP-2 or TGF-β1, and then embedded within cell sheets...

The paediatric population is at particularly high risk for anterior cruciate ligament (ACL) injuries due to high rates of sports participation. Other risk factors for ACL injuries in children include but are not limited to being female, generalised ligamentous laxity, a high body mass index (BMI), and poor neuromuscular control. ACL reconstruction (ACLR) is commonly done to treat ACL injuries and allow for return to sports and daily activities. ACL repair is another option with ongoing techniques being developed...

BACKGROUND: The incidence of second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) is high in young, active populations. Failure to successfully meet return-to-sport (RTS) criteria may identify adult athletes at risk of future injury; however, these studies have yet to assess skeletally mature adolescent athletes. OBJECTIVE: To determine if failure to meet RTS criteria would identify adolescent and young adult athletes at risk for future ACL injury after ACLR and RTS...

PURPOSE: To evaluate the initial safety of the combined use of ultra-high molecular weight polyethylene (UHMWPE) sutures for suture augmentation (SA) in a porcine ACL reconstruction model and examine whether the procedure can affect the anterior knee laxity and structural properties of the tendon graft itself, influence histological remodeling, and cause a foreign body-induced inflammation. METHODS: Ten pigs were divided into SA and non-SA Groups to undergo ACL reconstruction using an autologous semitendinosus tendon with and without SA, respectively...

Anterior cruciate ligament (ACL) insufficiency can be disabling, given the physical and sports activity constraints that negatively impact the quality of life. Consequently, surgery is the main approach for most active patients. Nonetheless, ACL reconstruction cannot be successful without adequate pre- and postoperative rehabilitation. Since the 1960s, post-ACL reconstruction rehabilitation has evolved, mainly from advances in surgery, coupled with a better understanding of the biological concepts of graft revascularization, maturation and integration, which have impacted ACL postoperative rehabilitation protocols...

Background: Joint infection after anterior cruciate ligament (ACL) reconstruction is a rare but serious complication. Purpose: To assess the effect of joint infection on the graft, cartilage, and bone tunnel using magnetic resonance imaging (MRI) after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendons. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective matched cohort study included 26 patients who underwent arthroscopic single-bundle ACL reconstruction with hamstring tendon graft at the authors' institute between January 2002 and December 2017 and developed postoperative joint infection...

The Micheli anterior cruciate ligament (ACL) procedure is a combined intra-articular and extra-articular knee stabilization technique that combines lateral augmentation with ACL reconstruction using the iliotibial band as an autograft for both aspects of the technique. Its primary indication is for ACL reconstruction in skeletally immature patients with more than 2 years of growth remaining. Studies have shown it to be effective at restoring knee biomechanics to have minimal risk of complications, including those associated with growth disturbances and a relatively low ACL graft rupture rate...

In recent years, the frequency of anterior cruciate ligament (ACL) tears and ACL reconstruction (ACLR) in skeletally immature patients has increased. Because distal femoral and proximal tibial physes account for the majority of lower-extremity growth, surgical technique and graft selection are crucial to minimize iatrogenic physeal injury. Combined extra- and intra-articular, all-epiphyseal, and transphyseal with soft-tissue grafts are the most common ACLR techniques used in children. Combined extra- and intra-articular ACLR typically is offered to prepubescent patients with ≥2 years of growth remaining...

BACKGROUND: Two primary surgical femoral drilling techniques are used to reconstruct the anterior cruciate ligament (ACL): the transtibial (TT) technique and the anteromedial portal (AMP) technique. Currently there is no consensus on which surgical technique elicits the best clinical and functional outcomes. MRI-derived measures of the signal intensity (SI) of the ACL graft have been described as an independent predictor of graft properties. The purpose of this study was to assess MRI-derived SI measurements of the ACL graft one year after ACL reconstruction, in order to compare graft maturation of both AMP and TT ACL reconstruction techniques...

PURPOSE: To investigate the effects of a new remnant-preserving double-bundle anterior cruciate ligament reconstruction (ACLR) technique, focused on avoiding remnant damage and preserving continuity of remnants, on graft maturity using magnetic resonance imaging (MRI). METHODS: A total of 169 patients were divided into three groups: 41 in the preservation group, 70 in the resection group, and 58 in the absent group. In the preservation group, rather than passing the graft through the remnant tissue, the graft was reconstructed such that the anteromedial and posterolateral bundles sandwiched the remnant to avoid damage to the remnant and maintain its continuity...

BACKGROUND: The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height. METHODS: Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study...

The anterior cruciate ligament (ACL) is a commonly injured ligament in the knee. Bone tunnel widening is a known phenomenon after soft-tissue ACL reconstruction and etiology and the clinical relevance has not been fully elucidated. Osteoconductive compounds are biomaterials providing an appropriate scaffold for bone formation such as a demineralized bone matrix. Osteoinductive materials contain growth factors stimulating bone lineage cells and bone growth. A possible application of osteoinductive/osteoconductive (OIC) material is in ACL surgery...

PURPOSE: Anterior cruciate ligament reconstruction (ACLR) using a short, quadrupled semitendinosus (ST-4) autograft, fixed  with an adjustable suspensory fixation (ASF), has several potential advantages. However, the construct is suspected to generate micromotion, tunnel widening and poor graft maturation. The aim of this study was to evaluate post-operative tibial tunnel expansion, graft maturation and clinical outcomes for this type of ACLR. METHODS: One-hundred and forty-nine patients were reviewed at a minimum of 2 years following 4-ST ACLR, mean 25...

Accelerating graft healing in anterior cruciate ligament reconstruction (ACLR) continues to be an elusive proposition. In vivo assessments of graft histology are challenging to perform, especially in human subjects. Multiple authors have reported on the utility of magnetic resonance imaging as a noninvasive modality in characterizing postoperative changes, suggestive of graft maturation. However, previous literature, by and large, has been limited by heterogenous scanning protocols and underpowered comparisons of dissimilar treatment techniques, and these issues complicate efforts to assess the benefits (if any) of adjuncts focused on improving graft healing after ACLR...