Healing of the transected anterior cruciate ligament in the rabbit.

Hefti, Fritz; Kress, Annetrudi; Fasel, Jean; Morscher, E.

doi:10.2106/00004623-199173030-00008

Cited by 155 publications

(80 citation statements)

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“…When associated with symptomatic anterior knee instability, the injury may limit or preclude sports activity [12]. Multiple studies have shown the poor potential for primary healing in cases of complete rupture of the ACL [1,5,13,16,19,20]. These observations have led most surgeons to reconstruct the ACL in symptomatic patients.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study

Paz

Ayerza

Tanoira

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Most authors believe the ACL does not spontaneously heal after a complete rupture. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. Questions/purposes We therefore asked whether (1) a complete ACL rupture in patients can spontaneously heal without the use of a specific rehabilitation program or bracing and (2) patients are able to return to their athletic activity after spontaneous ACL healing. Patients and Methods We retrospectively reviewed 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Average age at injury was 31 years (range, 23-41 years). All patients were athletically active before injury. Surgery was indicated in all patients but for various reasons postponed. We obtained International Knee Documentation Committee scores, Lysholm-Gillquist scores, and MRI. The minimum followup was 25 months (mean, 30 months; range, 25-36 months).

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Section: Introductionmentioning

confidence: 99%

Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study

Paz

Ayerza

Tanoira

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Injuries involving the ACL are well known for hopeless of spontaneous healing. Several studies have investigated the mechanisms of low healing response and the approaches to accelerating spontaneous healing of ACL injuries, since the mid-1960s [1][2][3][4]. The reasons for the failure of the ACL to heal spontaneously are related to specific intra-articular features [5,6] as well as owing to various molecular biological characteristics [7,8].…”

Section: Current Treatment For Acl Injuriesmentioning

confidence: 99%

“…The reasons for the failure of the ACL to heal spontaneously are related to specific intra-articular features [5,6] as well as owing to various molecular biological characteristics [7,8]. A number of studies have addressed on explaining the reasons for the failure of the ACL to heal spontaneously [1,3,[9][10][11][12][13]. Since ACL injuries contribute to an increased risk of knee osteoarthritis [14,15], the current gold standard for the management of complete ACL rupture is reconstruction using a tendon autograft.…”

Section: Current Treatment For Acl Injuriesmentioning

confidence: 99%

Key Determinants of Anterior Cruciate Ligament Spontaneous Healing

Kokubun¹,

Kanemura²,

Murata³

et al. 2017

J Osteopor Phys Act

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Anterior cruciate ligament (ACL) injuries are known to have very low rates of spontaneous healing. There have been several studies since the mid-1960s concerning the approaches to accelerate spontaneous healing of ACL injuries. Recent studies have identified similarities in the healing response of ACL and other extra-articular ligaments, in terms of their cellular response and vascularity. Research has demonstrated that mechanical stress has an important influence on the biological response of tissue healing. Novel treatment approaches may exploit the role of mechanical loads on the regulation of gene expression in achieving spontaneous healing of injured ACL. This article reviews the determinants of the ACL healing response and their relationship to mechanical stress and spontaneous healing, and explores novel concepts that are emerging in the management of ACL injuries. Keywords Current Treatment for ACL injuriesThe anterior cruciate ligament (ACL) plays an important role in motion at the knee joint and therefore, in the related physical activities of daily living. The ACL stabilizes the knee and guides the movement of the tibia and femur at the joint. Injuries involving the ACL are well known for hopeless of spontaneous healing. Several studies have investigated the mechanisms of low healing response and the approaches to accelerating spontaneous healing of ACL injuries, since the mid-1960s [1][2][3][4]. The reasons for the failure of the ACL to heal spontaneously are related to specific intra-articular features [5,6] as well as owing to various molecular biological characteristics [7,8]. A number of studies have addressed on explaining the reasons for the failure of the ACL to heal spontaneously [1,3,[9][10][11][12][13]. Since ACL injuries contribute to an increased risk of knee osteoarthritis [14,15], the current gold standard for the management of complete ACL rupture is reconstruction using a tendon autograft. However, there are no highquality randomized controlled trials comparing ACL reconstruction with other modalities of treatment [16][17][18][19].However, it is clear that the spontaneous healing capacity of the ACL has been underestimated. Several clinical studies have reported results of ACL healing with non-surgical treatment alone [20][21][22]. Moreover, an organ culture model of the human ACL showed a high intrinsic healing capacity [23]. Although these studies have demonstrated that the human ACL remnant has functional healing capacities, this was not proved in rigorous scientific methods. Consequently, current non-surgical treatment for ACL injuries aims at rehabilitating patients to modify the patients' physical activities to continue their dairy living, but not to support their spontaneous healing of the injured ACL [24,25]. This comprises muscle strength exercises, range of motion exercises, neuro-muscular training, and bracing. To summarize, although surgical reconstruction with autograft is considered to be the standard of care for restoring knee function following complete ACL in...

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“…to reference the start and the direction of the exercises described by Gary W. Gray in 1995. 35 The 8 vectors are 45 degrees apart. The patient is oriented on the vectors in reference to the lower extremity that is being exercised and in reference to the direction of the exercise.…”

Section: Balance Trainingmentioning

confidence: 99%

Design and Implementation of a Neuromuscular Training Program Following Anterior Cruciate Ligament Reconstruction

Risberg

Mørk²,

Jenssen³

et al. 2001

J Orthop Sports Phys Ther

129

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Neuromuscular training programs are increasingly integrated into clinical practice for lower extremity rehabilitation. A few rehabilitation programs have been evaluated for patients with anterior cruciate ligament (ACL) deficiency and for injury prevention, but there is limited scientific evidence of the effect of neuromuscular training following ACL reconstruction. Therefore, a neuromuscular training program was developed for patients after ACL reconstruction. The objective of the neuromuscular training was to improve the ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, and to relearn movement patterns and skills necessary during activities of daily living and sports activities. The main areas considered when designing the postoperative rehabilitation program after ACL reconstruction were: ACL graft healing and ACL strain values during exercises, proprioception and neuromuscular control, and clinical studies on the effect of neuromuscular training programs. The rehabilitation program consists of balance exercises, dynamic joint stability exercises, jump traininglplyometric exercises, agility drills, and sportspecific exercise. The patients exercise 3 times a week for 6 months. The scientific and clinical evidence for the rehabilitation program are described and the main exercises in the program are outlined./ Orthop Sports Phys Ther 200 1;3 1 :62O-63 1.Key Words: dynamic joint control, knee surgery, proprioception euromuscular training has become integrated into clinical practice for both upper and lower extremity rehabilit a t i~n .~~.~~ According to the definition of neuromuscular control, neuromuscular training could be defined as training enhancing unconscious motor responses by stimulating both afferent signals and central mechanisms responsible for dynamic joint control. The biomechanics of the knee are altered after anterior cruciate ligament (ACL) injury, but neuromuscular training mayCenter for Clinical Research, Ullevaal University Hospital, Oslo, Norway. Department for Physical and Rehabilitation Medicine, Ullevaal University Hospital, Oslo, Norway. Biomechanics laboratory, National Hospital Orthopaedic Center, University of Oslo, Norway. Send correspondence to May Arm Risberg, Center for Clinical Research, Ullevaal University Hospital, 0407, Oslo, Norway. E-mail: mrisberg@enitel.no enhance control of abnormal joint translation during functional activities by inducing compensatory alterations in muscle activity patterns.The objectives of neuromuscular training are to improve the nervous system's ability to generate a fast and optimal muscle firing pattern, to increase dynamic joint stability, to decrease joint forces, and to relearn movement patterns and skills. The exercises are designed to induce compensatory changes in muscle activation patterns and facilitate dynamic joint stability in patients with ACL injury. The goal is to achieve a state of "readiness" of muscles to respond to joint forces resulting in enhanced motor ~ontrol.".~"Severa...

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Healing of the transected anterior cruciate ligament in the rabbit.

Cited by 155 publications

References 0 publications

Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study

Spontaneous Healing in Complete ACL Ruptures: A Clinical and MRI Study

Key Determinants of Anterior Cruciate Ligament Spontaneous Healing

Design and Implementation of a Neuromuscular Training Program Following Anterior Cruciate Ligament Reconstruction

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