Anatomical discoveries and a growing appreciation of the knee as a complex organ are driving innovations in patient care decision-making following anterior cruciate ligament (ACL) injury. Surgeons are increasing their efforts to restore combined mechanical-neurosensory ACL function and placing more consideration on when to reconstruct versus repair native anatomical structures. Surgical options now include primary repair with or without reinforcing the injured ACL with suture-based internal bracing, and growing evidence supports biological augmentation using platelet-rich plasma and mesenchymal stem cells to enhance tissue healing. Physical therapists and athletic trainers are increasing their efforts to facilitate greater athlete cognitive engagement during therapeutic exercise performance to better restore nonimpaired neuromuscular control activation amplitude and timing. Knee brace design and use needs to evolve to better match these innovations and their influence on the rehabilitation plan timetable. There is a growing appreciation for the multifaceted characteristics of the rehabilitation process and how they influence neuromuscular, educational, and psychobehavioral treatment goal achievement. Multiple sources may influence the athlete during the return to sports process and clinical outcome measures need to be refined to better evaluate these influences. This update summarizes contemporary ACL surgical, medical, and rehabilitation interventions and future trends.
The aim of this study was to prepare bone like mineral (BLM) layers rapidly on the exterior surfaces of chitosan (CS) microparticles (MPs). The CS MPs were fabricated using a scale-up double emulsification method. The CS MPs were in the spherical shape and the size of 30-60 microm. The MPs were then placed in 5x concentrated simulated body fluid (5 x SBF) and allowed to undergo biomineralization to form a BLM layers on the surface of CS MPs at 37 degrees C over a 24 h period. The BML layers on the exterior surface of CS MPs were characterized using wide angle X-ray diffraction (XRD), Fourier transform infrared microscopy (FTIR), and scanning electron microscopy (SEM). Insulin like growth factor-1 (IGF-1) was dissolved at a concentration of 1 microg/ml in 5 x SBF to incorporate into the BLM layer. The CS MPs (100 mg) were incubated in a sample of 4 ml of 5 x SBF containing IGF-1 at a concentration of 1 microg/ml for 24 h. The IGF-1 release from BML layers on CS MPs were studied by placing MPs in 4 ml of phosphate buffered saline (PBS) and incubating MPs at 37 degrees C for 30 days. Samples (100 microl) were taken over the course of the 30 days and analyzed using Enzyme-linked Immunosorbent assay (ELISA). The release IGF-1 from BML layers was in a burst manner followed by a sustained release during the 30-day period. This study suggests that the CS MPs have the potential to be used to help deliver therapeutic drugs to localized areas and hence increase and accelerate bone growth.
This ACL reconstruction method combines the high ultimate load to failure and low graft slippage of extra-cortical button suspensory fixation with the high stiffness of aperture fixation. Biomechanical test findings were comparable or better to previous reports for displacement during submaximal loading, ultimate failure load, and construct stiffness. Based on current understanding of soft tissue graft ACL reconstruction biomechanics, this fixation method should enhance graft-bone socket integration during healing, facilitate long-term graft survival, and improve patient outcomes. Clinical studies are needed to confirm in vivo efficacy.
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