Assistant Professor in the Department of Orthopaedics, Rhode Island Hospital/ Warren Alpert Medical School of Brown University in Providence, RI.
Assistant Professor in the Department of Orthopaedic Surgery at McGovern Medical School at University of Texas Health Science Center in Houston, TX.
R I Med J (2013). 2024 Aug 1;107(8):12-17.
Anterior cruciate ligament (ACL) injury, particularly in increasingly young and active adolescents, continues to pose a clinical challenge with re-injury rates reported as high as 30%. Evidence also suggests that current standard-of-care ACL reconstruction (ACLR) does not mitigate post-traumatic osteoarthritis (PTOA) risk. Bridge- enhanced ACL restoration (BEAR) is a recently developed and tested ACL surgery that promotes primary healing of the native ACL with excellent early results. BEAR has shown to reduce signs of early PTOA compared to ACLR in an animal model. Here, we describe a theoretical framework related to re-innervation that can clarify why the outcomes of ACLR and BEAR surgeries differ. We also discuss how ongoing and new challenges in determining return-to-sport readiness following the competing surgeries may differ, and how emerging imaging tools and measures of neuromuscular function may aid in clinical decision-making to decrease the likelihood of re-injury and PTOA risk.
前交叉韧带 (ACL) 损伤，尤其是在越来越年轻和活跃的青少年中，仍然是一个临床挑战，再损伤率高达 30%。有证据表明，目前 ACL 重建 (ACLR) 的标准治疗并不能降低创伤后骨关节炎 (PTOA) 的风险。桥接增强 ACL 修复术 (BEAR) 是一种最近开发和测试的 ACL 手术，它促进了原生 ACL 的原发性愈合，具有极好的早期结果。在动物模型中，BEAR 与 ACLR 相比，显示出可减少早期 PTOA 的迹象。在这里，我们描述了一个与再神经支配相关的理论框架，可以解释为什么 ACLR 和 BEAR 手术的结果不同。我们还讨论了在决定竞争手术后重返运动准备方面的持续和新挑战可能存在的差异，以及新兴的影像学工具和神经肌肉功能测量如何有助于临床决策，以降低再损伤和 PTOA 风险。
