The long-term followup of primary anterior cruciate ligament repair

Sherman, Mark F.; Lieber, Lawrence; Bonamo, Joel R.; Podesta, Luga; Reiter, I.

doi:10.1177/036354659101900307

Cited by 285 publications

(277 citation statements)

References 21 publications

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“…Most ACLs are ruptured in the proximal half, 13 and most mechanoreceptors have been reported to be located in the subsynovial layer near the tibial insertion of the ACL. [14][15][16][17] Therefore it seems reasonable to assume that the remnant tissue could be preserved, especially the tibial side, as a source of reinnervation if impingement and cyclops lesions can be prevented.…”

Section: Discussionmentioning

confidence: 99%

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Ahn

Lee

2014

Arthroscopy Techniques

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We established a method for creation of an anatomic femoral tunnel with minimal damage to the remnant bundle in remnant-preserving anterior cruciate ligament (ACL) reconstruction. The goals of this surgical technique were to preserve the remnant bundle as much as possible, especially at the femoral insertion, and to make the tunnel at the anatomic position. The critical points are that the posterior side of the femoral footprint of the ACL is observed through the posterolateral portal using a 70 arthroscope and a femoral tunnel is made by use of an outside-in technique with remnant preservation. This technique allows for easy viewing of the posterior side of the ACL and enables performance of an anatomic ACL reconstruction.

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Section: Discussionmentioning

confidence: 99%

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Ahn

Lee

2014

Arthroscopy Techniques

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“…The reported success rates after suture repair of the ACL varied between 0% and 60%. [1][2][3] Due to this inconsistent outcome, suture repair was abandoned in favor of ACL reconstruction with tendon grafts. In retrospect, these low success rates could be attributed to the previously used suture techniques.…”

Section: Introductionmentioning

confidence: 99%

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Nguyen

Geel

Schulze

et al. 2013

Tissue Engineering Part A

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Primary suture repair of the anterior cruciate ligament (ACL) has been used clinically in an attempt to heal the ruptured ACL. The results, however, were not satisfactory, which in retrospect can be attributed to the used suturing technique and the suboptimal healing conditions. These constraining conditions can be improved by introducing a new suturing technique and by using small intestinal submucosa (SIS) as a bioscaffold. It is hypothesized that the suturing technique keep the torn ends together and that SIS enhance and promote the healing of the ACL. The goat was used as the study model. In the Suture group, the left ACL was transected and suture repaired with a new locking suture repair technique (n = 5) allowing approximation and fixation under tension. The Suture-SIS group underwent the same procedure with the addition of SIS (n = 5). The right ACL served as control. After 12 weeks of healing, anterior-posterior translation and in situ force of the healing ACL were measured, followed by the measurement of the cross-sectional area and structural stiffness. Routine histology was performed on tissue samples. Gross morphology showed that the healing ACL was continuous with collagenous tissue in both groups. The cross-sectional area of the Suture and the Suture-SIS group was 35% and 50% of the intact control, respectively. The anterior-posterior translations at different flexion angles were statistically not different between the Suture group and the Suture-SIS group. Only the in situ force at 30°in the Suture-SIS group was higher than in the Suture group. Tensile tests showed that the stiffness for the Suture group was not different from the Suture-SIS group (31.1 -8.1 N/mm vs. 41.9 -18.0 N/mm [p > 0.05]). Histology showed longitudinally aligned collagen fibers from origo to insertion. More fibroblasts were present in the healing tissue than in the control intact tissue. The study demonstrated the proof of concept of ACL repair in a goat model with a new suture technique and SIS. The mechanical outcome is not worse than previously reported for ACL reconstruction. In conclusion, the approach of using a new suture technique, with or without a bioscaffold to heal the ACL is promising.

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“…The internal brace acts as a secondary stabiliser after repair, which may allow accelerated rehabilitation and return to sports, whilst resisting injury recurrence when this is possible. In 1991, Sherman et al [8] established the first classification for types of ACL tear based upon anatomic location. (Type I is where the ligament literally pulls right off the bone from where it takes its origin in the notch of the femur.…”

Section: Introductionmentioning

confidence: 99%

Results with primary repair of the avulsed anterior cruciate ligament and internal fiber ligament augmentation

Agrawal¹,

Siddiqui²,

Khera³

et al. 2017

Int. J. Orthop. Sci.

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Introduction: ACL repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. Modern arthroscopic surgical instrumentation has made repair of ACL tissue easier and advancements in functional tissue engineering and regenerative medicine have resulted in a renewed interest in ACL repair. This is an attractive option to restore normal patient anatomy, retaining proprioceptive fibers, and not causing donor site morbidity that can be associated with reconstructions. Material & Methods:The study included 10 consecutive patients who presented with traumatic ACL avulsions (including bony avulsions) in outpatient or emergency department in last 2 years. Our inclusion criteria were cases with primary ACL injury (avulsion / proximal or distal end) not exceeding 3 months. Patients with severe arthritis of knee, multiligamantous ligament injury, history of previous surgery, bleeding disorders, any comorbidility leading to a non-operable condition were excluded from the study. Results: Out of 10 cases three cases had an avulsion from femoral end while seven had it from the tibial end. The injury surgey interval was in a range of six days to sixtythree days. Post operatively four patients had restriction of knee extension (5 degrees) at 4 weeks follow up. Rest of the cases had attained full range of motion at four weeks. All the cases had pain free gait pattern but needed aggressive physiotherapy to reinforce the normal gait pattern. There was no clinical ACL laxity in any of the cases, whenever seen at routine follow ups Conclusion: The internal brace acts as secondary pillar which supports the strength of the repaired ligament. Patients have a better proprioception, faster recovery to work & are safe guarded against an unpredictable outcome of ACL reconstruction.

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The long-term followup of primary anterior cruciate ligament repair

Cited by 285 publications

References 21 publications

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Creation of an Anatomic Femoral Tunnel With Minimal Damage to the Remnant Bundle in Remnant-Preserving Anterior Cruciate Ligament Reconstruction Using an Outside-In Technique

Healing of the Goat Anterior Cruciate Ligament After a New Suture Repair Technique and Bioscaffold Treatment

Results with primary repair of the avulsed anterior cruciate ligament and internal fiber ligament augmentation

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