“Biological failure” of the anterior cruciate ligament graft

Abstract

Anterior cruciate ligament (ACL) reconstruction has the best chance for success when the graft undergoes extensive biologic remodeling and incorporation after implantation. There are many factors that can lead to graft failure and possible revision surgery. These include patient selection; surgical technique such as graft placement and tensioning; the use of allograft versus autograft; mechanical factors such as secondary restraint laxity; lack of a correct, carefully controlled post-operative rehabilitation program; and biological factors. When a patient presents with knee instability following ligament reconstruction and there is no history of a new trauma or identifiable technical error, biological failure should be considered. However, the biologic response of the grafted tissue is closely linked to the mechanical and biochemical environment into which the graft is placed. Thus, the "biological failure" of the ACL graft is a complex pathological entity whose cause is not fully understood. Failure may be initiated by early extensive graft necrosis, disturbances in revascularization, problems in cell repopulation and proliferation, and as well difficulties in the ligamentization process. However, further study of the biological characterization of a failed graft placed in a correct mechanical environment is warranted.

Does Severity or Specific Joint Laxity Influence Clinical Outcomes of Anterior Cruciate Ligament Reconstruction?

“…First, mechanical factors such as secondary restraint laxity may influence knee stability or function [17]. There is a paucity of published information concerning the relationship between knee hyperextension and stress concentration on the reconstructed ACL.…”

Revisión sistemática: ligamento anterolateral de la rodilla

“…Además, se observó un aumento de cambios degenerativos en el compartimento lateral de la rodilla (85,86) . Posteriormente, se pasó a la reconstrucción intraarticular transtibial del LCA mediante fascí-culo único, convirtiéndose en el gold estándar, con una orientación más vertical de la misma, mejorando en este caso la inestabilidad anteroposterior, pero con resultados pobres en el control de la inestabilidad rotacional (87,88) . En un afán de mejorar este control rotacional se comenzaron a realizar reconstrucciones con doble fascículo del LCA (89)(90)(91) .…”

Tibial tunnel enlargement and joint instability after anterior cruciate ligament reconstruction. A prospective comparison between autograft and allograft

“…By meta-analysis, Kraeutler et al 25 assessed the knee stability after ACL reconstruction with autografts or allografts, and concluded that there was a lower level stability in the allograft group. The etiology of knee instability caused by the allograft is multifactorial, and accumulating evidences suggest that sterilization and preservation of the allograft 26 and immunological factors 27 are involved. The allograft that we used went through the process of irradiation, freezing, and thawing, which could affect their structural and mechanical properties.…”