Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament

Abstract

Background:Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue.Purpose:To review the biologic treatment options for partial tears of the ACL.Study Design:Review.Methods:A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy.Results:The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes.Conclusion:The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.

Inside-out Tibial Tunnel Drilling Technique for All-inside Anterior Cruciate Ligament Reconstruction

“…A limitation of the described technique is the impossibility of preserving the ACL tibial remnant, which we know contributes to its proprioception and vascularization, biomechanically protecting the graft. 9 Therefore, when the ACL rupture leaves a large tibial remnant, to preserve it, we recommend alternative techniques as previously described (complete outside-in tibial tunnel). 10 …”

Partial Anterior Cruciate Ligament Ruptures: Advantages by Intraligament Autologous Conditioned Plasma Injection and Healing Response Technique—Midterm Outcome Evaluation

“…The prevalence ranges up to 28% [ 1 – 3 ]. Diagnosis and management of this type of ACL lesions are still under discussion [ 3 , 4 ]. A reliable assessment of the extension of injury of partial ACL tears usually requires multiple findings by clinical examination, MRI examination, and almost confirming arthroscopically examination [ 3 ].…”

“…Conservative therapy of partial ACL tears is associated with a high failure rate and often consecutive complete ACL rupture, followed by ACL reconstruction. Initial ACL reconstruction is reported to be potentially associated with diminished proprioception, postoperative muscular weakness, no fully restoration of normal kinematics, donor site morbidity, and possible premature osteoarthritis [ 4 ]. Thus, ACL preserving techniques have to be favoured.…”

“…Regarding the awareness on the role of biologic agents, such as growth factors and stem cells, in promoting tissue healing further therapeutic options for the therapy of partial ACL tears were developed. In the most known “healing response technique” introduced by Steadman et al bone marrow stimulation by microfracturing of the lateral fossa intercondylaris of the femur is performed to obtain a clot formation near to the femoral insertion of the torn ACL [ 4 – 7 ]. However, the clinical results are still under discussion.…”

MRI signs of anterior cruciate ligament graft restructuring in bone canal

“…Key words: anterior cruciate ligament, graft, MRI Введение Восстановление передней крестообразной связки (ПКС) -одно из самых распространенных хирургических вмешательств в области коленного сустава [4]. Успех ее реконструкции зависит от нескольких факторов -хирургической техники, механической прочности выбранного трансплантата и жесткости фиксации [3,5]. Другой немаловажной причиной является понимание биологических процессов, которые происходят во время ремоделирования трансплантата и его перестройки на границе «сухожилие -кость» в костном канале.…”