Boyd Evan, Endres Nathan K, Geeslin Andrew G
Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
Ann Jt. 2024 Jun 28;9:30. doi: 10.21037/aoj-24-3. eCollection 2024.
Injury to the anterior cruciate ligament (ACL) is a devastating injury to athletes of all ages. The current gold standard treatment following complete rupture of the ACL is reconstruction of the torn ligament with autograft or allograft tendon. Commonly used tendon grafts include patellar tendon, hamstring tendon, and quadriceps tendon. Although ligaments and tendons have similar collagen and proteoglycan compositions, they maintain a unique composition and arrangement of cells to serve their unique biomechanical needs. Therefore, following ACL reconstruction (ACLR), the implanted tendon tissue undergoes a process of remodeling which is termed "ligamentization". The process of ligamentization is divided into three main phases, which include the early healing phase, the proliferative phase, and the maturation phase. Following the process of ligamentization, the graft tissue closely mimics the appearance of ligament tissue on an ultrastructural level. Successful outcome following ACLR is contingent upon adequate remodeling of the tissue as well as healing of the graft within the bone tunnels in the femur and tibia. Choice of graft has individual implications regarding their associated risk of complications, failure, and infection. The purpose of this review is to summarize the process of ligamentization and graft healing and to discuss how graft type influences the rate and types of complications, failures, and infections.
前交叉韧带（ACL）损伤对各年龄段的运动员来说都是一种极具破坏性的损伤。ACL完全断裂后，目前的金标准治疗方法是用自体移植物或同种异体肌腱重建撕裂的韧带。常用的肌腱移植物包括髌腱、腘绳肌腱和股四头肌肌腱。尽管韧带和肌腱具有相似的胶原蛋白和蛋白聚糖组成，但它们保持着独特的细胞组成和排列方式，以满足其独特的生物力学需求。因此，在ACL重建（ACLR）后，植入的肌腱组织会经历一个称为“韧带化”的重塑过程。韧带化过程分为三个主要阶段，包括早期愈合阶段、增殖阶段和成熟阶段。经过韧带化过程后，移植组织在超微结构水平上与韧带组织的外观非常相似。ACLR后的成功结果取决于组织的充分重塑以及移植物在股骨和胫骨骨隧道内的愈合情况。移植物的选择对其相关的并发症、失败和感染风险有各自的影响。本综述的目的是总结韧带化和移植物愈合的过程，并讨论移植物类型如何影响并发症、失败和感染的发生率及类型。
