Anterior cruciate ligament repair - past, present and future.
Anterior cruciate ligament repair - past, present and future.
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DOI：
10.1186/s40634-018-0136-6
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发表时间：
2018-06-15
影响因子：
1.8
通讯作者：
Anand, Bobby S
中科院分区：
文献类型：
--
作者：
Mahapatra, Piyush;Horriat, Saman;Anand, Bobby S
背景技术背景：本文提供了一个详细的叙述性审查的历史和目前的概念，韧带修复技术在运动患者。特别是，我们将集中在前交叉韧带（ACL）作为韧带损伤和韧带修复技术的案例研究。所有参与作者检索了PubMed（MEDLINE）、EMBASE和科克伦图书馆数据库中与初次前交叉韧带重建相关的论文。所有相关历史文献均纳入分析。对同一数据库进行了额外的检索，以寻找与生物学增强韧带愈合相关的论文。当前标准：ACL愈合能力差是当前运动患者ACL损伤的金标准手术治疗的主要原因之一，是使用来自腘绳肌或髌骨肌腱的自体移植物进行ACL重建。据推测，通过保留和修复自体组织并消除自体移植物的需要，初次ACL修复可能代表了ACL损伤治疗的关键步骤。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。最近，人们对初次ACL修复术的兴趣有所回升。成像技术的改进现在允许识别撕裂位置，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的策略，以使初级愈合发生。特别是，我们将解释机械补充，如内支架韧带增强和动态韧带内稳定技术。这些都是新的技术，旨在保护主要修复提供一个稳定的结构，连接股骨和胫骨，从而桥接repair.BIO增强修复：此外，生物补充正在研究作为一种辅助手段，我们将审查目前的文献中关于生物增强的形式血小板丰富的血浆，生物支架和干细胞。目前的证据的基础上，似乎有一个生物增强的作用，然而，这是尚未转化为临床practice.CONCLUSIONS：几个有前途的途径，进一步研究现在存在的形式，机械和生物增强技术。显然还需要进一步的工作，但人们对初次ACL修复重新产生了兴趣和关注，这可能是韧带修复的新前沿。
BACKGROUND: 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.CURRENT STANDARD: 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.HISTORY OF PRIMARY ACL REPAIR: 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.NEW PRIMARY REPAIR TECHNIQUES: 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.BIO ENHANCED 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.CONCLUSIONS: 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.