TY - JOUR
T1 - Biological enhancement of graft-tunnel healing in anterior cruciate ligament reconstruction
AU - Saccomanno, Maristella Francesca
AU - Capasso, Luigi
AU - Fresta, Luca
AU - Milano, Giuseppe
PY - 2016
Y1 - 2016
N2 - The sites where graft healing occurs within the bone tunnel and where the intra-articular ligamentization process takes place are the two most important sites of biological incorporation after anterior cruciate ligament (ACL) reconstruction, since they help to determine the mechanical behavior of the femur-ACL graft-tibia complex. Graft-tunnel healing is a complex process influenced by several factors, such as type of graft, preservation of remnants, bone quality, tunnel length and placement, fixation techniques and mechanical stress. In recent years, numerous experimental and clinical studies have been carried out to evaluate potential strategies designed to enhance and optimize the biological environment of the graft-tunnel interface. Modulation of inflammation, tissue engineering and gene transfer techniques have been applied in order to obtain a direct-type fibrocartilaginous insertion of the ACL graft, similar to that of native ligament, and to accelerate the healing process of tendon grafts within the bone tunnel. Although animal studies have given encouraging results, clinical studies are lacking and their results do not really support the use of the various strategies in clinical practice. Further investigations are therefore needed to optimize delivery techniques, therapeutic concentrations, maintenance of therapeutic effects over time, and to reduce the risk of undesirable effects in clinical practice.
AB - The sites where graft healing occurs within the bone tunnel and where the intra-articular ligamentization process takes place are the two most important sites of biological incorporation after anterior cruciate ligament (ACL) reconstruction, since they help to determine the mechanical behavior of the femur-ACL graft-tibia complex. Graft-tunnel healing is a complex process influenced by several factors, such as type of graft, preservation of remnants, bone quality, tunnel length and placement, fixation techniques and mechanical stress. In recent years, numerous experimental and clinical studies have been carried out to evaluate potential strategies designed to enhance and optimize the biological environment of the graft-tunnel interface. Modulation of inflammation, tissue engineering and gene transfer techniques have been applied in order to obtain a direct-type fibrocartilaginous insertion of the ACL graft, similar to that of native ligament, and to accelerate the healing process of tendon grafts within the bone tunnel. Although animal studies have given encouraging results, clinical studies are lacking and their results do not really support the use of the various strategies in clinical practice. Further investigations are therefore needed to optimize delivery techniques, therapeutic concentrations, maintenance of therapeutic effects over time, and to reduce the risk of undesirable effects in clinical practice.
KW - Anterior cruciate ligament reconstruction
KW - Biological enhancement
KW - Graft-tunnel healing
KW - Orthopedics and Sports Medicine
KW - Physical stimulation
KW - Rehabilitation
KW - Surgery
KW - Anterior cruciate ligament reconstruction
KW - Biological enhancement
KW - Graft-tunnel healing
KW - Orthopedics and Sports Medicine
KW - Physical stimulation
KW - Rehabilitation
KW - Surgery
UR - http://hdl.handle.net/10807/92877
UR - http://www.jointsjournal.eu/common/php/portiere.php?id=845a22ef88737a4267df17c3de730e16
U2 - 10.11138/jts/2016.4.3.174
DO - 10.11138/jts/2016.4.3.174
M3 - Article
VL - 4
SP - 174
EP - 182
JO - Joints
JF - Joints
SN - 2282-4324
ER -