Biomedical Engineering Reference
In-Depth Information
13.5.6 Effect of Mechanical Load
Further information about the effect of mechanical load on healing between soft
tissue and bone may help identify methods to improve healing by modulating the
postoperative mechanical environment. It is likely that specific types and
magnitudes of mechanical loading, as well as specific timing, will affect healing.
Moreover, it is possible that “biologic augmentation” modalities, such as cytokines
and stem cells, will be affected by the concurrent mechanical environment. It is
clear that there is a complex interaction between biology and biomechanics. For
example, it may be found that exogenous agents to improve healing may be more
effective if applied after early tendon-to-bone healing has occurred. Further
investigations are required to expand our understanding of the complex interplay
between biomechanical factors and the cellular and molecular events in soft tissue
healing.
13.6 Conclusions
ACL reconstruction is a commonly performed procedure; given the demand of an
increasingly active middle-age population, its prevalence is likely to increase.
Essential to successful ACL reconstruction is biologic incorporation of the graft,
regardless of the type of graft or source. Basic science and clinical data suggests that
graft healing depends on many factors including but not limited to graft source, graft
fixation technique, tunnel position and bone quality, and timing and magnitude of
load applied during the rehabilitation period. The effects of changes in these
variables, as well as their interactions, are the subjects of ongoing investigation.
Recent data also suggest that modifying the graft healing process with growth
factors and biologic augmentation will have a role in improving ACL reconstruction
outcomes in the future.
References
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4. Henry J, Chotel F, Chouteau J, Fessy MH, Berard J, Moyen B (2009) Rupture of the anterior
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