2022
DOI: 10.3390/jcm11226704
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Graft Intra-Articular Remodeling and Bone Incorporation in ACL Reconstruction: The State of the Art and Clinical Implications

Abstract: The knee is one of the most frequently affected joints in sports trauma, and anterior cruciate ligament (ACL) injury and meniscal tears are the most common lesions. ACL reconstruction (ACLR) remains the treatment of choice for patients willing to return to their previous activity. There are different surgical techniques and different possible usable grafts. The graft used for ACLR surgery undergoes a bone incorporation process and an intra-articular remodelling named ligamentization until it reaches characteri… Show more

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Cited by 10 publications
(6 citation statements)
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“…Following the proliferative phase, graft maturation into well-organized functional tissue (ligamentization) with good biomechanical properties is characterized by a decrease in cellularity, a shift to spindle-shaped, rather than ovoid nuclei within cells, gradual replacement of collagen type 3 with type 1, and formation of fibrocartilage within the bone tunnels followed by complete osseointegration. 6 , 38 , 39 In our study, both male and female ALM-treated animals exhibited increased collagen organization and reduction in macrophages within the graft mid-substance, a narrowing of the fibrovascular interface, and increased fibrocartilage formation within the bone tunnels, compared to their respective controls. In contrast to ALM-treated males, however, mid-substance cellularity was decreased in grafts from ALM-treated females, with a predominance of spindle-shaped nuclei.…”
Section: Discussionsupporting
confidence: 51%
“…Following the proliferative phase, graft maturation into well-organized functional tissue (ligamentization) with good biomechanical properties is characterized by a decrease in cellularity, a shift to spindle-shaped, rather than ovoid nuclei within cells, gradual replacement of collagen type 3 with type 1, and formation of fibrocartilage within the bone tunnels followed by complete osseointegration. 6 , 38 , 39 In our study, both male and female ALM-treated animals exhibited increased collagen organization and reduction in macrophages within the graft mid-substance, a narrowing of the fibrovascular interface, and increased fibrocartilage formation within the bone tunnels, compared to their respective controls. In contrast to ALM-treated males, however, mid-substance cellularity was decreased in grafts from ALM-treated females, with a predominance of spindle-shaped nuclei.…”
Section: Discussionsupporting
confidence: 51%
“…Given that this is a biomechanical study of cadaveric bone, it is only representative of “time zero” fixation immediately after insertion of the graft. As such, it is difficult to extrapolate the true load to failure as would be expected in the setting of biological incorporation which occurs through the healing process [33]. Prior studies have demonstrated that biocomposite screws undergo resorption with up to 76% of initial volume of the screw remaining at 2 years and replacement of the biocomposite interference screw with calcified, osteoconductive material at a mean of 42 months after implantation [34, 35].…”
Section: Discussionmentioning
confidence: 99%
“…Return to sport was foreseen for the 7-8th month in the ST4 group and at the 4th-5th month in the LARS group [ 17 ].…”
Section: Methodsmentioning
confidence: 99%
“…Te stifness and strength of the autograft may decrease during the ligamentization process [17][18][19].…”
Section: Introductionmentioning
confidence: 99%