Means of accelerating tendon graft healing after anterior cruciate reconstruction

Anterior cruciate ligament (ACL) tear is common in sports and accidents, and accounts for over 50% of all knee injuries. ACL reconstruction (ACLR) is commonly indicated to restore the knee stability, prevent anterior–posterior translation, and reduce the risk of developing post-traumatic osteoarthritis. However, the outcome of biological graft healing is not satisfactory with graft failure after ACLR. Tendon graft-to-bone tunnel healing and graft mid-substance remodeling are two key challenges of biological graft healing after ACLR. Mounting evidence supports excessive inflammation due to ACL injury and ACLR, and tendon graft-to-bone tunnel motion negatively influences these two key processes. To tackle the problem of biological graft healing, we believe that an inductive approach should be adopted, starting from the endpoint that we expected after ACLR, even though the results may not be achievable at present, followed by developing clinically practical strategies to achieve this ultimate goal. We believe that mineralization of tunnel graft and ligamentization of graft mid-substance to restore the ultrastructure and anatomy of the original ACL are the ultimate targets of ACLR. Hence, strategies that are osteoinductive, angiogenic, or anti-inflammatory should drive graft healing toward the targets. This paper reviews pre-clinical and clinical literature supporting this claim and the role of inflammation in negatively influencing graft healing. The practical considerations when developing a biological therapy to promote ACLR for future clinical translation are also discussed.

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Tendon Healing in Bone Tunnel after Human Anterior Cruciate Ligament Reconstruction: A Systematic Review of Histological Results

The Journal of Knee Surgery ◽

10.1055/s-0038-1653964 ◽

2018 ◽

Vol 32 (05) ◽

pp. 454-462 ◽

Cited By ~ 4

Author(s):

Hongbin Lu ◽

Can Chen ◽

Shanshan Xie ◽

Yifu Tang ◽

Jin Qu

Keyword(s):

Systematic Review ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Healing Process ◽

Tendon Healing ◽

Tendon Graft ◽

Bone Tunnel ◽

Bone Interface ◽

Graft Healing ◽

Anterior Cruciate

AbstractMost studies concerning to tendon healing and incorporation into bone are mainly based on animal studies due to the invasive nature of the biopsy procedure. The evidence considering tendon graft healing to bone in humans is limited in several case series or case reports, and therefore, it is difficult to understand the healing process. A computerized search using relevant search terms was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases, as well as a manual search of reference lists. Searches were limited to studies that investigated tendon graft healing to bone by histologic examination after anterior cruciate ligament (ACL) reconstruction with hamstring. Ten studies were determined to be eligible for this systematic review. Thirty-seven cases were extracted from the included studies. Most studies showed that a fibrovascular interface would form at the tendon–bone interface at the early stage and a fibrous indirect interface with Sharpey-like fibers would be expected at the later stage. Cartilage-like tissue at tendon graft–bone interface was reported in three studies. Tendon graft failed to integrate with the surrounding bone in 10 of the 37 cases. Unexpectedly, suspensory type of fixation was used for the above failure cases. An indirect type of insertion with Sharpey-like fibers at tendon–bone interface could be expected after ACL reconstruction with hamstring. Regional cartilage-like tissue may form at tendon–bone interface occasionally. The underlying tendon-to-bone healing process is far from understood in the human hamstring ACL reconstruction. Further human studies are highly needed to understand tendon graft healing in bone tunnel after hamstring ACL reconstruction.

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Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120961082 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712096108

Author(s):

Fabiano da Silva Marques ◽

Pedro Henrique Borges Barbosa ◽

Pedro Rodrigues Alves ◽

Sandro Zelada ◽

Rodrigo Pereira da Silva Nunes ◽

...

Keyword(s):

Patellar Tendon ◽

Knee Pain ◽

Anterior Knee Pain ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Extension Deficit ◽

Anterior Cruciate ◽

Anterior Knee

Background: Anterior knee pain is a frequent condition after anterior cruciate ligament reconstruction (ACLR), but its origin remains uncertain. Studies have suggested that donor site morbidity in autologous bone–patellar tendon–bone reconstructions may contribute to patellofemoral pain, but this does not explain why hamstring tendon reconstructions may also present with anterior pain. Purpose: To evaluate the prevalence of anterior knee pain after ACLR and its predisposing factors. Study Design: Case-control study; Level of evidence, 3. Methods: We evaluated the records of all patients who underwent ACLR between 2000 and 2016 at a private facility. The prevalence of anterior knee pain after surgery was assessed, and possible risk factors (graft type, patient sex, surgical technique, range of motion) were evaluated. Results: The records of 438 patients (mean age, 30 years) who underwent ACLR were analyzed. Anterior knee pain was found in 6.2% of the patients. We found an increased prevalence of anterior knee pain with patellar tendon graft, with an odds ratio of 3.4 ( P = .011). Patients who experienced extension deficit in the postoperative period had an odds ratio of 5.3 of having anterior pain ( P < .001). Anterior knee pain was not correlated with patient sex or surgical technique. Conclusion: The chance of having anterior knee pain after ACLR was higher when patellar tendon autograft was used compared with hamstring tendon graft, as well as in patients who experienced extension deficit in the postoperative period.

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Revascularization in the tendon graft following anterior cruciate ligament reconstruction of the knee: Its mechanism and regulation

Journal of Biomechanics ◽

10.1016/s0021-9290(06)83128-3 ◽

2006 ◽

Vol 39 ◽

pp. S61

Author(s):

H. Tohyama ◽

T. Yoshikawa ◽

K. Yasuda

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Tendon Graft ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Augmented short undersized hamstring tendon graft with LARS® artificial ligament versus four-strand hamstring tendon in anterior cruciate ligament reconstruction: preliminary results

Orthopaedics & Traumatology Surgery & Research ◽

10.1016/j.otsr.2015.01.021 ◽

2015 ◽

Vol 101 (5) ◽

pp. 535-538 ◽

Cited By ~ 8

Author(s):

F. Hamido ◽

H. Al Harran ◽

A.R. Al Misfer ◽

T. El Khadrawe ◽

M.G. Morsy ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Hamstring Tendon Graft ◽

Artificial Ligament ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Arthroscopic anterior cruciate ligament reconstruction with periosteum-enveloping hamstring tendon graft

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-004-0498-4 ◽

2004 ◽

Vol 12 (5) ◽

Cited By ~ 12

Author(s):

Chih-Hwa Chen ◽

Wen-Jer Chen ◽

Chun-Hsiung Shih ◽

Shih-Wei Chou

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Hamstring Tendon ◽

Tendon Graft ◽

Hamstring Tendon Graft ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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Arthroscopic anterior cruciate ligament reconstruction with semitendinosus graft versus peroneus longus tendon graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200735 ◽

2020 ◽

Vol 6 (2) ◽

pp. 386

Author(s):

Pudari Manoj Kumar ◽

Ishan Shevte ◽

Mukesh Phalak ◽

Abhishek Nair ◽

Parth .

Keyword(s):

Anterior Cruciate Ligament ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Tendon Graft ◽

Collateral Ligament ◽

Peroneus Longus Tendon ◽

Longus Tendon ◽

Peroneus Longus ◽

Anterior Cruciate ◽

Tendon Autograft

Background: Arthroscopic anterior cruciate ligament (ACL) reconstruction can be performed using autograft from various sources namely, bone patellar tendon graft, hamstring tendons (semitendinosus, gracilis) or peroneus longus tendon.Methods: A prospective study of 30 patients who underwent arthroscopic ACL reconstruction using quadrupled semitendinosus tendon autograft and peroneus longus tendon autograft during the study period.Results: Statistically, there is very little comparable difference between semitendinosus and peroneus longus when used for arthroscopic ACL reconstruction. However, peroneus longus tendon shows superior results when used in patients with grade 3 medial collateral ligament (MCL) injury combined with ACL injury.Conclusions: Our study brings forth the superior efficacy and quality of the double stranded peroneus longus tendon especially in cases associated with complicated injuries involving the medial collateral ligament with a follow up date of about 2 years and as a healthy supplement to other choices of autografts and revision cases.

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