OBJECTIVE: To review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. METHODS: The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. RESULTS: At present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient. CONCLUSION With the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.
Animals ; Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Anterior Cruciate Ligament Reconstruction ; Tendons/surgery*

Anterior Cruciate Ligament Injuries/surgery* ; Anterior Cruciate Ligament Reconstruction ; Humans

OBJECTIVE: To assess the mid-to-long term clinical outcomes after anterior cruciate ligament (ACL) revision surgery and to analyze their predictors. METHODS: The medical records of 235 patients undergoing ACL revision surgery between Jan. 2001 and Dec. 2015 at Department of Sports Medicine, Peking University Third Hospital were reviewed. Data were collected including demographic information, information related to revision surgery (time and cause of graft failure, date of revision surgery, surgical technique, combined injuries and management, etc.), as well as information related to primary ACL reconstruction (time, cause and mechanism of first-time ACL rupture, date of primary ACL reconstruction, surgical technique, combined injuries and management, etc.). Patients were followed up at least 2 years after revision surgery for clinical outcomes [Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee score]. Post-revision surgeries on the involved knee and the contralateral knee joint were also documented. Multivariate regression model was used to analyze the predictors of clinical outcomes after ACL revision surgery. RESULTS: A total of 166 (70.63%) patients were followed up at a mean of (4.44±2.40) years (2.03-14.63 years). Clinical outcomes improved significantly at the last follow-up from pre-operative level, with the Lysholm, Tegner, and IKDC scores improving from 70.51±21.25, 3.39±1.77, 63.78±15.04 to 88.64±14.36, 4.67±1.739, 80.23±13.31 (P < 0.05), respectively. Three (1.81%) patients experienced infection while 39 (23.49%) patients underwent surgery after revision surgery during the follow-up. Compared with that those occurred during sports, graft failure that occurred during daily activities or due to surgical technical errors that led to poorer clinical outcomes, with the Lysholm, Tegner, and IKDC scores of 9.90 (95%CI: 1.49-18.31), 1.41 (95%CI: 0.10-2.72), 10.35 (95%CI: 0.17-20.54), and 8.53 (95%CI: 1.31-15.75), 1.28 (95%CI: 0.14-2.43), 9.39 (95%CI: 1.03-17.74) lower, respectively. Compared with antero-medial portal, transtibial technique for placement of the femoral bone tunnel showed poorer Lysholm scores of 11.18 (95%CI: 4.73-17.63, P=0.001). Concurrent repair of medial meniscus yielded higher IKDC scores of 11.06 (95%CI: 1.21-20.92, P=0.029) than those with intact medical meniscus. Other factors showed no significant effect. CONCLUSION ACL revision surgery is able to restore knee stability and improve knee function. Graft failure caused by sports, concurrent repair of medical meniscus and antero-medial portal technique predicts better outcomes after revision surgery.
Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Anterior Cruciate Ligament Reconstruction ; Humans ; Knee Joint/surgery* ; Reoperation ; Treatment Outcome

Anterior Cruciate Ligament Reconstruction ; Femur/surgery*

Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; methods ; Humans ; Knee Injuries ; surgery

Posterior tibial slope angle (PTSA) is a risk factor for anterior cruciate ligament (ACL) injury and has attracted a lot of attention, but its mechanism of action and diagnosis are still not systematically studied in the field of sports medicine. In this paper, we believe that PTSA should be measured by full-length lower extremity films and combined with multiple imaging data for comprehensive assessment to reduce errors. A large PTSA may increases risk of anterior cruciate ligament injury, so patients with more than 12 degrees of PTSA should be treated by preserving meniscus as much as possible during ACL reconstruction and combining with tibial osteotomy if necessary, which could effectively prevent risk of ligament re-injury. At the same time, gait analysis has an important reference value for preoperative pathogenic pattern and postoperative rehabilitation function, so the author believes that it will have a guiding significance for the development of individualized rehabilitation strategy based on PTSA, in order to achieve the best treatment effect.
Humans ; Anterior Cruciate Ligament/surgery* ; Tibia/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Lower Extremity

Humans ; Anterior Cruciate Ligament Injuries/surgery* ; Knee Joint/surgery* ; Anterior Cruciate Ligament/surgery*

No abstract available.
Anterior Cruciate Ligament/*surgery ; Anterior Cruciate Ligament Reconstruction/*methods ; Humans ; Knee Joint/*surgery ; Posterior Cruciate Ligament/*surgery

OBJECTIVETo retrospectively evaluate the early results of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction and compare with the results of native ACL of the contralateral knee.

METHODSThe results of a consecutive series of 118 patients receiving arthroscopic ACL reconstruction were evaluated. Eight patients were lost to the latest follow-up, leaving a total of 110 patients available for study within at least 3 years'clinical follow-up. Among them, 63 patients underwent postoperative MRI and CT scan, as well as clinical evaluation.

RESULTSAfter reconstruction, the knees were stable and pain-free. Mean postoperative Lysholm score was 95.54 in 110 patients after 3 years. CT and MRI assessment showed that the reconstruction centered in the femoral footprint of ACL (n equal to 63). The sagittal ACL angle in the reconstructed ACL (52.16 degree+/-2.45 degree was much close to that in the contralateral intact ACL (51.31 degree +/-2.18 degree, P larger than 0.05). By ACL-Blumensaat line angle analysis, there was no difference between double-bundle reconstructed knees and their contralateral normal knees (4.67 degree+/-0.43 degree vs. 4.62 degree+/-0.60degree, P larger than 0.05).

CONCLUSIONAnatomic double-bundle ACL reconstruction can place grafts more precisely in the anatomic footprint of the ACL and better restore knee kinematics.

Anterior Cruciate Ligament Injuries/surgery* ; Anterior Cruciate Ligament Reconstruction ; Athletic Injuries ; Humans ; Knee Joint/surgery* ; Sports