Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease?

Murray, James R. D.; Lindh, Amy M.; Hogan, Niall; Trezies, A; Hutchinson, James; Parish, E. N.; Read, John; Cross, Mervyn V.

doi:10.1177/0363546511428580

Cited by 83 publications

(53 citation statements)

References 43 publications

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“…To date, there has been no evidence to demonstrate that ACL reconstruction or subsequent revision surgery can prevent OA [91]. In study after study [168,[171][172][173][174], the consensus has been that there is a substantial risk of progression to OA once an ACL injury has been sustained. One study did indicate that ACL reconstruction cannot prevent OA, but may lead to a lower prevalence of its onset and reported that the rate of osteoarthritis progression showed more severe changes in non-reconstructed patients with additional meniscus injury [175].…”

Section: Surgerymentioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

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Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injures create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structures in and around the joint. The long-term consequence of nonhealed ligament injury is osteoarthritis, the most common joint disorder in the world today.Ligaments heal through a distinct sequence of cellular events that take place in three consecutive stages: an acute inflammatory phase, a proliferative or regenerative phase, and a tissue remodeling phase. The process can take months to resolve itself, and despite advances in therapeutics, many ligaments do not regain their normal tensile strength.Various diagnostic procedures have been used to determine and assess ligament injury. Traditionally, MRI and X-rays have been the most utilized techniques; however, because ligaments do not show up clearly with these devices, there have been many false positives and negatives reported due to inconclusive or inaccurate readings. Newer technologies, such as ultrasound and digital motion X-ray, are able to provide a more detailed image of a ligament's structure and function.Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue's response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal antiinflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all.Regenerative medicine techniques, such as prolotherapy, have been shown, in both case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints. More research and additional studies are needed to better assess ligament injuries and healing properties.

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Section: Surgerymentioning

confidence: 99%

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Hauser¹

2013

TOREHJ

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“…Despite reasonable success of ACL reconstruction, the current gold standard of treatment, in restoring the gross stability of the ACL-deficient knee, it fails to restore normal joint kinematics and kinetics [8,22,24,25,43,52]. Moreover, ACL reconstruction is associated with reduced activity level [5], an increased rate of secondary injury [48], and high risk of posttraumatic osteoarthritis (OA), up to 74%, even with advanced anatomic reconstruction techniques [13,32,33,40,50,56]. The associated complications with ACL reconstruction, in addition to the advent of functional tissue engineering, precipitated a move in ACL research from improving replacement techniques to developing procedures for biologically augmented repair of the ligament.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model

Kiapour

Fleming

Murray

2015

Clinical Orthopaedics &Amp; Related Research

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The current findings highlight the critical role of sex on the biomechanical outcomes of bridge-enhanced ACL repair in a relevant large animal model. Better understanding of the mechanisms responsible for these observations using preclinical models and concomitant clinical studies in human patients may allow for additional development of sex-specific surgical and rehabilitative strategies with potentially improved outcomes in women.

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“…[3][4][5][6] Se han propuesto distintas técnicas, que difieren entre sí en el tipo de injerto utilizado: hueso-tendón-hueso, tendones isquiotibiales, método de fijación tibial y femoral, ubicación de los túne-les y utilización de portales accesorios, por nombrar las más frecuentes.…”

Section: Discussionunclassified

Evaluación a largo plazo de plástica de ligamento cruzado anterior: 22 años de seguimiento. Reporte de un caso

Corinaldesi¹,

Paz²,

Múscolo³

2013

Rev. Asoc. Arg. Ort. y Traumatol

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Caso clínicoPaciente de sexo masculino de 62 años de edad, con antecedente de plástica artroscópica de ligamento cruzado anterior en su rodilla derecha con hueso-tendón-hueso, realizada por uno de los autores (D. L. M.), en 1988.En 2010, el paciente concurre a la consulta con dolor en el compartimiento medial de la rodilla derecha y bloqueos, secundario a actividad deportiva (fútbol recreativo). Luego del examen físico y de evaluar los estudios por imágenes, se llega al diagnóstico de cuerpo libre intraarticular. Se decide realizar una artroscopia de rodilla derecha, en la cual se observó una lesión del cartílago articular en el cóndilo lateral grado 3, según la clasificación de la ICRS, y un cuerpo libre, que fue extraído y se pudo visualizar la integridad de las fibras del neoligamento cruzado anterior. En el mismo acto quirúrgico, se tomaron muestras para análisis anatomopatológico (Fig. 1). El resultado de la evaluación anatomopatológica informó: "estructura ligamentaria con mínimos cambios mixoides de la matriz extracelular" (Fig. 2).A los 15 meses del posoperatorio, el paciente continúa con sus actividades deportivas habituales. Tiene un puntaje de Lysholm de 80 y un valor de 77 en la escala IKDC. En cuanto a la evaluación radiográfica a los 24 años de la cirugía inicial, la escala radiográfica IKDC fue B (leve estrechamiento de la luz articular con incipientes cambios degenerativos) y similar a su rodilla contralateral (Fig. 3). DiscusiónLa rotura del ligamento cruzado anterior es, hoy en día, una de las lesiones más frecuentes en pacientes jóvenes que realizan actividad deportiva. Actualmente, no existen dudas sobre las ventajas de efectuar una reconstrucción del ligamento cruzado anterior para evitar posteriores cambios degenerativos en la rodilla (artrosis). 1,2 Artículos recientes han postulado a la traslación anterior de la tibia y la aparición de lesiones meniscales y del cartílago articular como algunos de los factores que podrían determinar la aparición de artrosis en pacientes con lesiones del ligamento cruzado anterior.Numerosas publicaciones han reportado los beneficios de la reconstrucción artroscópica del ligamento cruzado anterior a mediano y largo plazo. [3][4][5][6] Se han propuesto distintas técnicas, que difieren entre sí en el tipo de injerto utilizado: hueso-tendón-hueso, tendones isquiotibiales, método de fijación tibial y femoral, ubicación de los túne-les y utilización de portales accesorios, por nombrar las más frecuentes.El empleo del autoinjerto hueso-tendón-hueso está descrito desde 1936 y, por muchos años, se consideró la téc-nica de elección en este tipo de reconstrucciones. 7 Algunas de las ventajas de esta técnica por sobre otras son el mayor nivel de estabilidad y un mejor balance entre las fuerzas musculares cuádriceps-isquiotibiales, aunque algunos autores la asocian con una incidencia más alta de artrosis en relación con otras técnicas. Sin embargo, en cuanto a la evolución a largo plazo, si bien, en los últimos años, se han publicado artículos con evaluaciones clínicas...

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Does Anterior Cruciate Ligament Reconstruction Lead to Degenerative Disease?

Abstract: At 13 years, BTB ACL reconstruction provides a good outcome. Chondral and meniscal damage at surgery were associated with a poor radiological outcome, indicating that injuries sustained during ACL rupture may be the main predictors of degenerative bone disease.

Cited by 83 publications

References 43 publications

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Biomechanical Outcomes of Bridge-enhanced Anterior Cruciate Ligament Repair Are Influenced by Sex in a Preclinical Model

Evaluación a largo plazo de plástica de ligamento cruzado anterior: 22 años de seguimiento. Reporte de un caso

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