Natural history of anterior cruciate tears

Arnold, James A.; Coker, Tom P.; Heaton, Lynn M.; Park, John P.; Harris, Walter D.

doi:10.1177/036354657900700601

Cited by 264 publications

(125 citation statements)

References 39 publications

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“…The human anterior cruciate ligament (ACL) fails to heal after complete rupture [3]. Loss of the ACL has been found to result in early and progressive radiographic changes consistent with joint deterioration in the active athletic population [13].…”

Section: Introductionmentioning

confidence: 99%

The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three‐dimensional collagen‐GAG scaffold

Murray

Rice

Wright

et al. 2003

Journal Orthopaedic Research

124

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Our work focuses on development of a collagen-glycosamimoglycan (CC) scaffold to facilitate ligament healing in the gap between the ruptured ends of the human anterior cruciate ligament (ACL). In the present investigation, we evaluated the effects of selected growth factors on human ACL cell responses important in tissue regeneration, namely cell migration, proliferation, collagen production, and expression of a-smooth muscle actin (SMA).Methods: Explants from six human ACLs were cultured on top of a CG scaffold. Culture conditions were with either 2% FBS (control), or 2% FBS supplemented with TGF-01, PDGF-AB, EGF, or FGF-2. Histologic cell distribution, total DNA content, proliferation rate, rate of collagen synthesis, scaffold diameter and percentage of SMA positive cells were determined at two, three and four weeks.Results: The addition of TGF-01 to the culture medium resulted in increased cell number, increased collagen production and increased expression of SMA within the scaffold. Supplementation with PDGF-AB resulted in increased cell proliferation rates within the scaffold and increased collagen production. The addition of FGF-2 resulted in increased cell proliferation rates and slowed rates of scaffold shrinkage when compared with the control group.Discussion: This work suggests that certain growth factors can alter the biologic functions of human ACL cells in a CG scaffold implanted as a bridge at the site of an ACL rupture. Based on these findings, the addition of selected growth factors to an implantable CG scaffold may facilitate ligament healing in the gap between the ruptured ends of the human ACL.

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Section: Introductionmentioning

confidence: 99%

The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three‐dimensional collagen‐GAG scaffold

Murray

Rice

Wright

et al. 2003

Journal Orthopaedic Research

124

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“…In summary, our study showed that (1) immature collagen I11 can be substantially elevated within grafts relative to normal tendons; (2) there is substantially more pN collagen 111 in grafts with smaller diameter fibrils relative to grafts with larger fibrils; (3) there is more pN collagen 111 in failed grafts than in functional ones.…”

Section: Discussionmentioning

confidence: 58%

“…It is the most common ligament to tear in the knee with an incidence of 80,0001yr and an estimated cost of $900,000,000/yr [ 171. In addition, the ACL is notoriously poor at healing even if suture repaired [2,6,16,27]. As a result, surgical reconstruction of the ACL with a tendon graft (such as freeze dried achilles tendon (FDAT), freeze dried fascia lata (FDFL) or bone-patellar tendon-bone (BTB) autografts) is used to restore stability to the ACL deficient knee [S].…”

Section: Introductionmentioning

confidence: 99%

pN collagen type III within tendon grafts used for anterior cruciate ligament reconstruction

Sluss

Liberti

Jiranek

et al. 2001

Journal Orthopaedic Research

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This study measured the amount of immature collagen type 111 present in tendon rafts obtained from anterior cruciate ligament (ACL) reconstructions. These values werc compared with those obtained from control grafts typically used for reconstructionAchilles, patellar, and fascia lata -and also to the normal ACL. Andyses were performed using a commercially available radioimmunoassay (RIA). The RIA made use of a rabbit polyclonal antibody specific to the amino terminus of procollagen type 111. The specificity of the Ab was confirmed by a western blot. Fibril diameter of each of the above samples was measured by transmission electron microscopy (TEM). We thus were able to determine if there was a relationship between pN collagen 111 content and fibril diameter.The mean amount of pN collagen type 111 in the normal tendon control group was 0.8 f 0.3 nglpg total protein (range 0.0-2.5 ng/pg). There was significantly greater pN collagen 111 (16 i 3.7 ng/pg total protein) in the grafts containing an average fibril diameter <55 nm than in the normal tendons or ACL ( P < 0.05). Grafts with an average fibril diameter >55 nm had similar levels of pN collagen 111 (1.0 i 0.79 ng/pg) as the controls. There was also significantly less pN-collagen 111 within the functional grafts (5.3 f 1.9 ng/pg) as compared to failed grafts, (21.6 f 5.1 ng/pg, P < 0.05).These results indicate that incomplete processing of procollagen I11 may be responsible for some of the ultrastructural alterations seen in tendon grafts. Since ultrastructural organization is believed to influence mechanical properties of these tissues, p N collagen I11 levels may be a possible indicator of ligament or tendon weakness.

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“…4,5 The middle third of the patellar tendon autograft for ACL reconstruction can be readily procured and firmly fixed. It can tolerate the loads produced by an intensive rehabilitation programme.…”

Section: Discussionmentioning

confidence: 99%

“…The ACL is the primary stabilizer against anterior translation of the tibia over the femur and is important in counteracting rotation and valgus stresses. 4,5 ACL injuries if left untreated result in recurrent instability of the knee and thus results in an increased risk of intra-articular damage, including meniscal tears and degenerative changes. 4 Disruption of the ACL often leads to significant disability, which can lead to changes in lifestyle.…”

Section: Introductionmentioning

confidence: 99%

A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score

et al. 2016

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Background: ACL injuries result in persistent recurrent instability and increased risk of meniscal tears and intra-articular damage, leading on to degenerative changes in the knee. There are many studies about ACL reconstruction using bone patellar tendon bone graft (BPTB) and its outcome, but there is not enough literature on the subjective assessment following reconstruction. We decided to do a study of the patient’s subjective outcome as per the International knee documentation committee score (IKDC) and other clinical parameters following ACL reconstruction using the BPTB graft.Methods: This was a prospective study consisting of 50 patients who presented with ACL injury and underwent arthroscopic ACL reconstruction using BPTB graft in our hospital in the period from May 2008 to July 2010. Patients were followed at regular intervals at 4 weeks, 8 weeks, 3 months & 6 months and 1 year. Patients were assessed at every visit with clinical tests and IKDC subjective assessment score.Results: 50 patients with ACL insufficiency underwent ACL reconstruction. Postoperative knee flexion improved; the mean flexion was 131.70 with standard deviation of 6.534, which was significant. The mean preoperative IKDC was 56.97 and standard deviation of 9.188 and postoperative IKDC score was 92.33 and standard deviation 5.198 which showed a marked improvement and was statistically significant. The complications included; 8 patents with anterior knee pain, 1 case of patellar fracture while harvesting graft, which healed with wiring and 2 patients, had re-rupture of ACL due to road traffic accident.Conclusions: ACL reconstruction with BPTB graft showed a significantly good subjective outcome on assessment using IKDC score. Isolated ACL reconstruction showed a better subjective outcome compared to the patients who had associated meniscal injury.

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Natural history of anterior cruciate tears

Cited by 264 publications

References 39 publications

The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three‐dimensional collagen‐GAG scaffold

The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three‐dimensional collagen‐GAG scaffold

pN collagen type III within tendon grafts used for anterior cruciate ligament reconstruction

A study on the functional outcome of arthroscopic anterior cruciate ligament reconstruction done with bone patellar tendon bone graft using the IKDC score

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