New biological approaches in the reconstruction of anterior cruciate ligament (ACL)
Abstract
Background: Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries. The operative reconstruction is usually performed as the standard treatment. The success of the operative technique is between 73–95 %, and 37–75 % of patients return to the preoperative physical activity. The main problem after surgical reconstruction is the long rehabilitation period. Patients are not allowed to perform sports activities for 6 months after surgery. The outcome after ACL reconstruction depends upon the healing of the graft in the bone tunnel and upon the ligamentization of the intraarticular part of the graft; this is a process during which the graft attains the features of a native ACL. The biomechanical factors (anatomical tunnel position, fixation, adequacy of the graft and postoperative rehabilitation) and biological response (revascularization and the number of collagen fibers) seem to play a crucial role after surgery. The biological response can be accelerated with the use of growth factors (GF), periosteum and mesenchymal stem cells (MSCs). Nowadays platelet-rich plasma (PRP) from autologous blood is applied at the graft insertion site to promote healing and ligamentization of the graft. Conclusion: The review focuses on the factors that influence the outcome of ACL reconstruction. A better understanding of the graft’s biological response and its modulation is the basis of new approach in the treatment of ACL rupture, which enables the patient and athlete to quicker resume their everyday and sports activities.Downloads
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