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Partial Anterior Cruciate Ligament Lesions: A Biological Approach to Repair

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Bio-orthopaedics

Abstract

Although treatment options for complete ruptures of the anterior cruciate ligament (ACL) are well studied, there is considerably more controversy in cases of partial ACL tears, and there remains no consensus on classification of these injuries. ACL reconstruction has been reported to achieve excellent restoration of biomechanical function in symptomatic patients. Unfortunately, in cases of partial ACL injury, the natural evolution of these lesions is poorly understood and evidence-based treatment options are limited. In cases of ACL injury, there is poor capacity for spontaneous healing of the ligamentous tissue due to the inhibitory properties of the intra-articular synovial fluid within the knee on fibrin-platelet clot formation and ACL fibroblast migration. Surgical reconstruction with tendon graft is often undertaken to restore knee stability. The use of biologics to augment repair of partial ACL injuries that include various growth factors, platelet-rich plasma (PRP), stem cells, and scaffolds have been a focus of current research into accelerating and optimizing ACL repair and healing. These alternatives to current surgical reconstruction techniques may preserve the native footprint of the remaining ligamentous fibers, thereby preserving proprioceptive function and restoring more natural biomechanics.

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References

  1. Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14(10):1021–8. Epub 2006 Feb 22.

    Article  PubMed  Google Scholar 

  2. Gobbi A, Mahajan V, Karnatzikos G, Nakamura N. Single- versus double bundle ACL reconstruction: is there any difference in stability and function at 3-year follow up? Clin Orthop Relat Res. 2012;470(3):824–34.

    Article  PubMed  Google Scholar 

  3. Gobbi A, Domzalski M, Pascual J, Zanazzo M. Hamstring anterior cruciate ligament reconstruction: is it necessary to sacrifice the gracilis? Arthroscopy. 2005;21(3):275–80.

    Article  PubMed  Google Scholar 

  4. Kartus J, Movin T, Karlsson J. Donor-site morbidity and anterior knee problems after anterior cruciate ligament reconstruction using autografts. Arthroscopy. 2001;17(9):971–80.

    Article  CAS  PubMed  Google Scholar 

  5. Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756–69.

    Article  PubMed  Google Scholar 

  6. Petersen W, Zantop T. Partial rupture of the anterior cruciate ligament. Arthroscopy. 2006;22(11):1143–5.

    Article  PubMed  Google Scholar 

  7. Amiel D, Ishizue KK, Harwood FL, Kitabayashi L, Akeson WH. Injury of the anterior cruciate ligament: the role of collagenase in ligament degeneration. J Orthop Res. 1989;7(4):486–93.

    Article  CAS  PubMed  Google Scholar 

  8. Amiel D, Nagineni CN, Choi SH, Lee J. Intrinsic properties of ACL and MCL cells and their responses to growth factors. Med Sci Sports Exerc. 1995;27(6):844–51.

    Article  CAS  PubMed  Google Scholar 

  9. Vavken P, Murray MM. The potential for primary repair of the ACL. Sports Med Arthrosc. 2011;19(1):44–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wiig ME, Amiel D, Ivarsson M, Nagineni CN, Wallace CD, Arfors KE. Type I procollagen gene expression in normal and early healing of the medial collateral and anterior cruciate ligaments in rabbits: an in situ hybridization study. J Orthop Res. 1991;9(3):374–82.

    Article  CAS  PubMed  Google Scholar 

  11. Nagineni CN, Amiel D, Green MH, Berchuck M, Akeson WH. Characterization of the intrinsic properties of the anterior cruciate and medial collateral ligament cells: an in vitro cell culture study. J Orthop Res. 1992;10(4):465–75.

    Google Scholar 

  12. Rosc D, Powierza W, Zastawna E, Drewniak W, Michalski A, Kotschy M. Post-traumatic plasminogenesis in intraarticular exudate in the knee joint. Med Sci Monit. 2002;8:CR371–8.

    PubMed  Google Scholar 

  13. Andrish J, Holmes R. Effects of synovial fluid on fibroblasts in tissue culture. Clin Orthop Relat Res. 1979;(138):279–83.

    Google Scholar 

  14. Noyes FR, Mooar LA, Moorman III CT, McGinniss GH. Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg Br. 1989;71(5):825–33.

    CAS  PubMed  Google Scholar 

  15. Gobbi A, Karnatzikos G, Sankineani SR, Petrera M. Biological augmentation of ACL refixation in partial lesions in a group of athletes: results at the 5-year follow-up. Tech Orthop. 2013;28(2):180–4.

    Article  Google Scholar 

  16. Braggion M, Fioruzzi C. Partial tear of the anterior cruciate ligament. Contrasting anatomical and clinical reality [La lesione parziale del legamento crociato anteriore. Realta’ anatomica e clinica contrastanti]. Minerva Ortop Traumatol. 1998;49(9):301–4.

    Google Scholar 

  17. Sommerlath K, Odensten M, Lysholm J. The late course of acute partial anterior cruciate ligament tears. A nine to 15-year follow-up evaluation. Clin Orthop Relat Res. 1992;281:152–8.

    Google Scholar 

  18. Buckley S, Barrack R, Alexander A. The natural history of conservatively treated partial anterior cruciate ligament tears. Am J Sports Med. 1989;17(2):221–5.

    Article  CAS  PubMed  Google Scholar 

  19. Fujimoto E, Sumen Y, Ochi M, Ikuta Y. Spontaneous healing of acute anterior cruciate ligament (ACL) injuries-conservative treatment using an extension block soft brace without anterior stabilization. Arch Orthop Trauma Surg. 2002;122(4):212–6.

    Article  PubMed  Google Scholar 

  20. O’Donoghue DH. Surgical treatment of fresh injuries to the major ligaments of the knee. J Bone Joint Surg Am. 1950;32(A: 4):721–38.

    Article  PubMed  Google Scholar 

  21. Robson AW. VI. Ruptured crucial ligaments and their repair by operation. Ann Surg. 1903;37(5):716–8.

    Google Scholar 

  22. Feagin JA, Curl WW. Isolated tear of the anterior cruciate ligament: five-year follow-up study. J Orthop Sports Phys Ther. 1990;12(6):232–6.

    Article  CAS  PubMed  Google Scholar 

  23. Cabaud HE, WG R, Feagin JA. Experimental studies of acute anterior cruciate ligament injury and repair. Am J Sports Med. 1979;7(1):18–22.

    Article  CAS  PubMed  Google Scholar 

  24. Gobbi A, Bathan L, Boldrini L. Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes. Am J Sports Med. 2009;37:571–8.

    Article  PubMed  Google Scholar 

  25. Kaplan N, Wickiewicz TL, Warren RF. Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study. Am J Sports Med. 1990;18(4):354–8.

    Article  CAS  PubMed  Google Scholar 

  26. Sherman MF, Lieber L, Bonamo JR, Podesta L, Reiter I. The long-term follow-up of primary anterior cruciate ligament repair. Defining a rationale for augmentation. Am J Sports Med. 1991;19(3):243–55.

    Article  CAS  PubMed  Google Scholar 

  27. Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG. A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg. 2006;19(1):8–13.

    PubMed  Google Scholar 

  28. Steadman JR, Rodkey WG. Role of primary anterior cruciate ligament repair with or without augmentation. Clin Sports Med. 1993;12(4):685–95.

    CAS  PubMed  Google Scholar 

  29. 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  CAS  PubMed  PubMed Central  Google Scholar 

  30. Seijas R, Ares O, Cusco X, Alvarez P, Steinbacher G, Cugat R. Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors. World J Orthop. 2014;5(3):373–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kobayashi D, Kurosaka M, Yoshiya S, Mizuno K. Effect of basic fibroblast growth factor on the healing of defects in the canine anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 1997;5(3):189–94.

    Article  CAS  PubMed  Google Scholar 

  32. Aspenberg P, Forslund C. Enhanced tendon healing with GDF 5 and 6. Acta Orthop Scand. 1999;70(1):51–4.

    Article  CAS  PubMed  Google Scholar 

  33. Chen CH. Strategies to enhance tendon graft—bone healing in anterior cruciate ligament reconstruction. Chang Gung Med J. 2009;32(5):483–93. Review.

    PubMed  Google Scholar 

  34. Marui T, Niyibizi C, Georgescu HI, et al. Effect of growth factors on matrix synthesis by ligament fibroblasts. J Orthop Res. 1997;15(1):18–23.

    Article  CAS  PubMed  Google Scholar 

  35. Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648–57.

    Article  PubMed  Google Scholar 

  36. Gobbi A, Karnatzikos G, Scotti C, et al. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full thickness knee cartilage lesions: results at 2 year follow up. Cartilage. 2011;2(3):286–99.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Steinert AF, Kunz M, Prager P, et al. Mesenchymal stem cell characteristics of human anterior cruciate ligament outgrowth cells. Tissue Eng Part A. 2011;17(9–10):1375–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Kiapour AM, Murray MM. Basic science of anterior cruciate ligament injury and repair. Bone Joint Res. 2014;3(2):20–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Centeno CJ, Pitts J, Al-Sayegh H, Freeman MD. Anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow nucleated cells: a case series. J Pain Res. 2015;8:437–47.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Cornell University, Weill Medical College, New York Presbyterian Hospital/Queens, New York, NY, USA

    Graeme P. Whyte

  2. O.A.S.I. Bioresearch Foundation NPO, Milan, Italy

    Graeme P. Whyte & Alberto Gobbi

  3. The Ludwik Rydygier Provincial Polyclinical Hospital, Toruń, Poland

    Dawid Szwedowski

Authors
  1. Graeme P. Whyte
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  2. Alberto Gobbi
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  3. Dawid Szwedowski
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Corresponding author

Correspondence to Alberto Gobbi .

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Editors and Affiliations

  1. O.A.S.I. Bioresearch Foundation NPO, Milan, Italy

    Alberto Gobbi

  2. Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  3. Musculoskeletal and Joint Research Foundation, San Diego, California, USA

    John G. Lane

  4. Department of Orthopedics, Acibadem University, Istanbul, Turkey

    Mustafa Karahan

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Whyte, G.P., Gobbi, A., Szwedowski, D. (2017). Partial Anterior Cruciate Ligament Lesions: A Biological Approach to Repair. In: Gobbi, A., Espregueira-Mendes, J., Lane, J., Karahan, M. (eds) Bio-orthopaedics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-54181-4_52

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  • DOI: https://doi.org/10.1007/978-3-662-54181-4_52

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-54180-7

  • Online ISBN: 978-3-662-54181-4

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