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Can We Get a Complete ACL Tear to Heal?

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Abstract

Many factors are likely to significantly affect the outcome of a bioenhanced primary repair of the ACL. These factors include the choice of implanted scaffold, bioactive agent, and suture technique as only a few variables. In this chapter, we will review how each of these factors influences functional ACL healing in a complete ACL transection model. We will also demonstrate the discovery that by optimizing all of these factors, the current technique of bioenhanced ACL repair used in our laboratory results in a healing ACL with equal strength to an ACL reconstruction after 3 months of healing in a large animal model. These findings provide hope that 1 day, bioenhanced ACL repair will be a viable option for patients with ACL injuries.

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References

  1. Feagin Jr JA, Curl WW. Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med. 1976;4(3):95–100.

    Article  PubMed  Google Scholar 

  2. Proffen BL et al. A comparative anatomical study of the human knee and six animal species. Knee. 2012;19(4):493–9.

    Article  PubMed  Google Scholar 

  3. Murray MM, Spindler KP, Abreu E, et al. Collagen-platelet rich plasma hydrogel enhances primary repair of the porcine anterior cruciate ligament. J Orthop Res. 2007;25(1):81–91.

    Article  PubMed  Google Scholar 

  4. Joshi SM, Mastrangelo AN, Magarian EM, Fleming BC, Murray MM. Collagen-platelet composite enhances biomechanical and histologic healing of the porcine anterior cruciate ligament. Am J Sports Med. 2009;37(12):2401–10.

    Article  PubMed  Google Scholar 

  5. Murray MM, Palmer M, Abreu E, Spindler KP, Zurakowski D, Fleming BC. Platelet-rich plasma alone is not sufficient to enhance suture repair of the ACL in skeletally immature animals: an in vivo study. J Orthop Res. 2009;27(5):639–45.

    Article  PubMed  Google Scholar 

  6. Harrold AJ. The defect of blood coagulation in joints. J Clin Pathol. 1961;14:305–8.

    Article  PubMed  CAS  Google Scholar 

  7. Andersen RB, Gormsen J. Fibrin dissolution in synovial fluid. Acta Rheumatol Scand. 1970;16:319–33.

    PubMed  CAS  Google Scholar 

  8. Palmer M, Stanford E, Murray MM. The effect of synovial fluid enzymes on the biodegradability of collagen and fibrin clots. Materials. 2011;4(8):1469–82.

    Article  PubMed  CAS  Google Scholar 

  9. Fufa D, Shealy B, Jacobson M, Kevy S, Murray MM. Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg. 2008;66(4):684–90.

    Article  PubMed  Google Scholar 

  10. Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D, Murray MM. Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med. 2011;39(4):729–34.

    Article  PubMed  Google Scholar 

  11. Jacobson M, Fufa D, Abreu EL, Kevy S, Murray MM. Platelets, but not erythrocytes, significantly affect cytokine release and scaffold contraction in a provisional scaffold model. Wound Repair Regen. 2008;16(3):370–8.

    Article  PubMed  Google Scholar 

  12. Abreu EL, Palmer MP, Murray MM. Collagen density significantly affects the functional properties of an engineered provisional scaffold. J Biomed Mater Res A. 2010;93(1):150–7.

    PubMed  Google Scholar 

  13. Meaney Murray M, Rice K, Wright RJ, Spector M. The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three-dimensional collagen-GAG scaffold. J Orthop Res. 2003;21(2):238–44.

    Article  PubMed  CAS  Google Scholar 

  14. Murray MM, Bennett R, Zhang X, Spector M. Cell outgrowth from the human ACL in vitro: regional variation and response to TGF-beta1. J Orthop Res. 2002;20(4):875–80.

    Article  PubMed  CAS  Google Scholar 

  15. Murray MM, Forsythe B, Chen F, et al. The effect of thrombin on ACL fibroblast interactions with collagen hydrogels. J Orthop Res. 2006;24(3):508–15.

    Article  PubMed  CAS  Google Scholar 

  16. Murray MM, Martin SD, Spector M. Migration of cells from human anterior cruciate ligament explants into collagen-glycosaminoglycan scaffolds. J Orthop Res. 2000;18(4):557–64.

    Article  PubMed  CAS  Google Scholar 

  17. Murray MM, Spector M. The migration of cells from the ruptured human anterior cruciate ligament into collagen-glycosaminoglycan regeneration templates in vitro. Biomaterials. 2001;22(17):2393–402.

    Article  PubMed  CAS  Google Scholar 

  18. Cheng M, Wang H, Yoshida R, Murray MM. Platelets and plasma proteins are both required to stimulate collagen gene expression by anterior cruciate ligament cells in three-dimensional culture. Tissue Eng Part A. 2010;16(5):1479–89.

    Article  PubMed  CAS  Google Scholar 

  19. Harrison SL, Vavken P, Murray MM. Erythrocytes inhibit ligament fibroblast proliferation in a collagen scaffold. J Orthop Res. 2011;29(9):1361–6.

    Article  PubMed  CAS  Google Scholar 

  20. Fleming BC, Magarian EM, Harrison SL, Paller DJ, Murray MM. Collagen scaffold supplementation does not improve the functional properties of the repaired anterior cruciate ligament. J Orthop Res. 2010;28(6):703–9.

    PubMed  CAS  Google Scholar 

  21. Fleming BC, Carey JL, Spindler KP, Murray MM. Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res. 2008;26(11):1500–5.

    Article  PubMed  Google Scholar 

  22. Murray MM, Magarian E, Zurakowski D, Fleming BC. Bone-to-bone fixation enhances functional healing of the porcine anterior cruciate ligament using a collagen-platelet composite. Arthroscopy. 2010;26(9 Suppl):S49–57.

    PubMed  Google Scholar 

  23. Vavken P, Fleming BC, Mastrangelo AN, Machan JT, Murray MM. Biomechanical outcomes after bioenhanced anterior cruciate ligament repair and anterior cruciate ligament reconstruction are equal in a porcine model. Arthroscopy. 2012;28(5):672–80.

    Article  PubMed  Google Scholar 

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Acknowledgement

Research reported in this chapter was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Number RO1-AR054099. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Correspondence to Carla Maria Haslauer PhD .

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Haslauer, C.M., Murray, M.M. (2013). Can We Get a Complete ACL Tear to Heal?. In: Murray, M., Vavken, P., Fleming, B. (eds) The ACL Handbook. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0760-7_16

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  • DOI: https://doi.org/10.1007/978-1-4614-0760-7_16

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0759-1

  • Online ISBN: 978-1-4614-0760-7

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