Mahapatra Piyush, Horriat Saman, Anand Bobby S
Trauma and Orthopaedic Department, Croydon University Hospital, 530 London Road, London, CR7 7YE, UK.
J Exp Orthop. 2018 Jun 15;5(1):20. doi: 10.1186/s40634-018-0136-6.
This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing.
The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries.
The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed.
There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair.
In addition, biological supplementation is being investigated as an adjunct and we will review the current literature with regards to bio-enhancement in the form platelet rich plasma, bio-scaffolds and stem cells. On the basis of current evidence, there appears to be a role for bio-enhancement, however, this is not yet translated into clinical practice.
Several promising avenues of further research now exist in the form of mechanical and biological augmentation techniques. Further work is clearly needed but there is renewed interest and focus for primary ACL repair that may yet prove the new frontier in ligament repair.
本文对运动患者韧带修复技术的历史和当前概念进行了详细的叙述性综述。特别是，我们将重点关注前交叉韧带（ACL），作为韧带损伤和韧带修复技术的一个案例研究。所有参与作者检索了PubMed（MEDLINE）、EMBASE和Cochrane图书馆数据库中与初次前交叉韧带重建相关的论文。纳入所有相关的历史文献进行分析。对同一数据库进行了额外检索，以查找与韧带愈合生物增强相关的论文。
ACL愈合能力差是运动患者ACL损伤当前金标准手术治疗为采用腘绳肌或髌腱自体移植物进行ACL重建的主要原因之一。据推测，通过保留和修复天然组织并消除对自体移植物的需求，初次ACL修复可能代表ACL损伤治疗的关键一步变革。
初次ACL修复的历史：将讨论初次ACL修复的历史，并回顾导致初次ACL修复技术几乎被放弃的情况。
近来人们对初次ACL修复的兴趣有所复苏。现在成像技术的改进使得能够确定撕裂位置，股骨侧损伤更适合修复。我们将详细讨论改善机械和生物环境以实现初次愈合的策略。特别是，我们将解释机械辅助方法，如内部支撑韧带增强和动态韧带内稳定技术。这些是旨在通过提供连接股骨和胫骨的稳定结构来保护初次修复从而跨越修复部位的新技术。
此外，正在研究生物辅助方法，我们将回顾关于富血小板血浆、生物支架和干细胞形式的生物增强的当前文献。根据目前的证据，生物增强似乎有一定作用，然而，这尚未转化为临床实践。
现在存在以机械和生物增强技术形式的几个有前景的进一步研究途径。显然还需要进一步的工作，但对初次ACL修复有了新的兴趣和关注，这可能最终证明是韧带修复的新前沿。
