Biomedical Engineering Reference
In-Depth Information
Chapter 13
Soft Tissue-to-Bone Healing in Anterior
Cruciate Ligament Reconstruction
John M. Solic and Scott A. Rodeo
13.1
Introduction
The anterior cruciate ligament (ACL) acts as the primary restraint to anterior
translation of the tibia and is a secondary restraint to varus and valgus stress [
1
,
2
].
It is estimated that 800,000 ACL tears occur annually in the USA, with the majority
occurring in individuals 15-30 years of age; however, this number may rise if
activity levels of middle aged patients increase. Nonoperative treatment of ACL
ruptures in patients with high activity levels leads to high levels of functional knee
instability, as well as meniscal and cartilage injuries [
3
-
5
]. The most common
treatment for ACL tears in active patients is reconstruction with intra-articular
grafts. ACL reconstruction is reliably able to improve knee stability and reduce
the incidence of subsequent meniscus tears [
6
-
9
]. However graft failure remains a
challenge in ACL reconstruction with failure rates ranging from 5 to 27% [
7
,
10
,
11
].
The ideal graft choice for ACL reconstruction remains controversial. The ideal
graft should have structural properties similar to the native ACL and should allow
secure early fixation, rapid biologic incorporation, and minimal donor site morbidity.
Graft options include autograft and allograft donor tissue. Autograft options include
the patellar, hamstring, and quadriceps tendons. Allograft options include patellar,
hamstring, quadriceps, achilles, and anterior and posterior tibialis tendons. Selection
of a graft is complex and includes factors such as patient age and activity level,
comorbidities, history of previous surgery and graft harvest, and future demand.
J.M. Solic
Sports Medicine and Shoulder Center, Triangle Orthopaedic Associates, Durham, NC, USA
e-mail:
SolicJ@hss.edu
S.A. Rodeo (
*
)
Department of Orthopaedic Surgery, Sports Medicine and Shoulder Service, The Hospital for
Special Surgery/Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA
e-mail:
RodeoS@hss.edu
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