Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement

Abstract

Recent improvements in anterior cruciate ligament (ACL) reconstruction have been notable for strategies to improve ACL healing and to improve graft placements. The controversial choice of 1-bundle or 2-bundle grafts requires an advanced knowledge of native ACL insertional anatomy and an appreciation for the kinematic effects of graft placements. Understanding the limitations of surgical techniques to place tunnels is important. Once grafts are placed, new biologic strategies to promote intra-articular and intraosseous healing are evolving. Although these biologic engineering strategies are currently experimental, they are projected for clinical application in the near future.

Reconstruction Technique Affects Femoral Tunnel Placement in ACL Reconstruction

“…Instead, the ACL appeared to be a continuous structure consisting of many different fiber bundles of different lengths and orientations. Although we did not separate the ACL stump into two or three bundles, the data generated from this study are important, as anatomic femoral tunnel placement has been a concern in single-and double-bundle ACL reconstructions [16,55], and whether a single-or double-bundle reconstruction should be performed remains controversial [1,10,26,41,43,47,49,52] and is outside the scope of this study. Finally, we do not know how much difference in placement will substantially alter the risk of either graft failure or long-term degeneration; both would require clinical confirmation.…”

“…Previous studies describe the femoral ACL footprint as an oval [47], semicircular [20], rounded triangular [5], or a more circular [24] shape. Accounting for the 3-D geometry of the ACL footprint, as performed in our study, might provide a more realistic description of the ACL because of its attachment on the curved surface of the intercondylar notch.…”

Anatomical single bundle anterior cruciate ligament reconstruction

“…It is still relatively common to describe the position of the femoral tunnel according to a clock face [60,61]. Lower positions e.g.…”

Potential of Tissue-Engineered Ligament Substitutes for Ruptured ACL Replacement

“…Accurate tunnel placement minimizes graft excursion and impingement against the roof of www.intechopen.com the intercondylar notch. This will result in maximum knee stability and motion (Fineberg et al, 2000;Steiner et al, 2008).…”

“…As previously mentioned, accurate tunnel placement should be performed with respect to the original insertion sites of the torn ACL, to limit graft excursion and impingement against the roof of the intercondylar notch, (Fineberg et al, 2000;Steiner et al, 2008). The ACL substitute must be able to resist an initial graft tension ranging from 44 to 88 N (Woo et al, 2006).…”