![]() While they provide immediate stability, they stress-shield the healing ACL fibers-often leading to scar formation rather than true ligament formation. These devices have the benefit of being easy to insert. Permanent reinforcements-such as internal braces made of suture materials-are also in vogue. Today we always add these bioactive factors to every donor graft we use. Growth factors may be able to speed this process by recruiting the body’s own progenitor and self-repair cells to the injury. It takes a full year for an ACL reconstruction to remodel into a strong replacement. Growth factors from PRP, bone marrow, fat, and birth tissues are being added to most tissue injuries and surgical repairs. And most often the entire ligament is involved. But it will prove inappropriate, or fail, in injuries where the entire structure of the ligament is damaged. This effort, recently approved by the FDA, is likely to succeed in ligaments with little damage, and certain isolated injuries. Sorting out which injuries will do well with a repair, which do well without surgery, and which require reconstruction is still not clear.Ĭollagen scaffolds are being added to the top of the ligament, in hopes that the healing of the ruptured ACL to the bone will be more effective than suture repair alone. The story of ACL repair improvements is as old as the surgical treatment itself, with every new generation of surgeons and scientists trying to identify which patients will do well with a repair, which new techniques work, and which biological or artificial additives can help improve the outcomes. ACL repair rather than replacement (commonly called reconstruction), first pioneered in the 1800s, is being reevaluated. Unfortunately, reconstruction of the ACL is still not performed by surgeons with accuracy or consistency, and long rehabilitation times are required, so there is a renewed push to focus on primary repair of the torn ligamentous fibers. The reconstructions return most people to sports-but not without a 50% incidence of arthritis after 10 years and a too-high failure rate. ![]() The ligament, once ruptured, leads to knee instability and, eventually, arthritis. ![]() ![]() The anterior cruciate ligament (ACL) continues to be the athlete’s Achilles’ heel. ![]() Ankle and foot rehabilitation protocols. ![]()
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