Graft remodeling and ligamentization after cruciate ligament reconstruction

Abstract

After reconstruction of the cruciate ligaments, replacement grafts have to undergo several phases of healing in the intra-articular graft region and at the site of graft-to-bone incorporation. The changes in the biological and mechanical properties of the healing graft in its intra-articular region are described as the ligamentization process. Significant knowledge has been added in the understanding of the several processes during the course of graft healing and is summarized in this article. The understanding of the spatial and time-dependent changes as well as the differences between the different models of graft healing are of significant importance to develop strategies of improved treatment options in cruciate ligament surgery, so that full restoration of function and mechanical strength of the intact cruciate ligaments will be achieved.

Return to sport following anterior cruciate ligament reconstruction

“…On the other hand, animal studies suggest that the graft goes through a maturation process that involves a number of stages that may put the graft at risk [11,12,39]. An initial period of necrosis and hypocellularity is followed by a phase of cellular proliferation and revascularisation.…”

“…On this basis, a graft would be expected to be at increased risk of injury between six weeks and three months, a time period that corresponds to an increase in the demand of activities in most rehabilitation protocols. However, the mismatch between findings from animal studies and the limited evidence available from human grafts has been noted [12,39]. It appears that in humans tendon autografts survive in the intra-articular environment and may therefore be less susceptible to damage.…”

Remodeling of ACL Allografts is Inhibited by Peracetic Acid Sterilization

“…Analyses of the mechanical function of bone-patellar tendon-bone grafts in vitro revealed no adverse effects of PAA sterilization compared to nonsterilized grafts [21]. However, cellularity and vascularity are substantially upregulated during the first 3 months of healing [23]. However, cellularity and vascularity are substantially upregulated during the first 3 months of healing in ACL autografts.…”

“…However, cellularity and vascularity are substantially upregulated during the first 3 months of healing in ACL autografts. The extent of remodeling activity is seen in reorganization and/or dissolution of the extracellular matrix [3,14,23], including the crimp length and crimp pattern. The remodeling behavior of PAA sterilized allografts in-vivo is unknown.…”

Εφαρμογή Συστήματος Διοστικών Υπέρηχων Στη Διεπιφάνεια Οστού-Τένοντα Και Στα Κατάγματα Μακρών Οστών. Πειραματική Και Κλινική Μελέτη

“…Η διαδικασία της ενσωμάτωσης του μοσχεύματος στο οστούν επιτυγχάνεται με το σχηματισμό κάθετων ινών κολλαγόνου, που ομοιάζουν με τις ίνες του Sharpey, στη διεπιφάνεια οστού-τενοντίου μοσχεύματος κατά τις πρώτες 6 εβδομάδες και στη συνέχεια με τη διείσδυση ινοβλαστών, μυοβλαστών και χονδροβλαστών στο μόσχευμα [29][30][31][32][33][34] . Μέσω της μεταβολικής δραστηριότητας των κυττάρων, από τις 6 εβδομάδες ως 3 μήνες, επιτυγχάνεται οστεοποίηση εντός του τούνελ και καθώς συνεχίζεται η νεοαγγειογένεση τα λεία μυϊκά κύτταρα και οι χονδροβλάστες συμβάλλουν στη συνδεσμοποίηση του μοσχεύματος.…”