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Permanent knee sensorimotor system changes following ACL injury and surgery

  • John NylandEmail author
  • Collin Gamble
  • Tiffany Franklin
  • David N. M. Caborn
Knee

Abstract

The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions.

Level of evidence IV.

Keywords

Proprioception Neuroanatomy Repair biology Neuromuscular control Therapeutic exercise 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study received no funding to complete.

Ethical approval

This study did not require ethics approval at its institution.

Informed consent

As there was no individual participants in this study informed consent was not required.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • John Nyland
    • 1
    Email author
  • Collin Gamble
    • 2
  • Tiffany Franklin
    • 1
  • David N. M. Caborn
    • 3
  1. 1.Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural SciencesSpalding UniversityLouisvilleUSA
  2. 2.School of MedicineUniversity of LouisvilleLouisvilleUSA
  3. 3.Shea Orthopedic GroupKentuckyOne HealthLouisvilleUSA

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