ACL grafting options

ACL grafting options - EBIO 3940 Literature Review ACL...

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EBIO 3940 Literature Review ACL grafting options: Autografts versus Allografts Abstract : The number of people having ACL reconstruction surgery has increased drastically over the years and it is crucial for surgeons to be aware of the success rates of specific tendons in order to advise their patients on which option to use based on their individual needs. Every knee is unique and research has yet to determine a “best” or perfect ACL graft. At our present state of knowledge, the only up to date, concrete conclusion from the research available is that allograft tendons are better suited for those patients with limited tissue available. An evaluation of the patients’ surgical history, along with their daily activity and overall tissue strength contribute to which tendon they chose. With very little concrete documentation of the tendons success rates, we will have to rely on the present research available. As more experimental evidence and adequate research becomes available, surgeons will have the information to accurately and individually diagnose the patient given their circumstances. Introduction The Anterior Cruciate Ligament (ACL) is a ligament in the center of the knee that prevents the tibia from moving forward on the femur. A tear of this ligament can cause
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the knee to give way during physical activity. This is not an uncommon injury, however, rupture of the ACL is one of the most common sports injuries in active young people, with an estimated 250,000 new ACL ruptures in the US each year (11). The knee is the joint between the two longest bones of the body, and the entire weight of the body is transferred to the foot through the knee. The knee is also more prone to injury because its stability decreases as it bends. Research suggests that if a torn ACL is left untreated, and the knee repeatedly gives way, cartilage damage and early arthritis may occur (5). This will lead to ACL reconstruction, which has become a standard of care with over 100,000 procedures performed annually in the US (11). While reconstructive surgery can improve the function of a torn ACL, the biologic and physiologic characteristics of the normal ACL are usually not restored (3). There are options available, regarding which tendon to use and where the tendon should be extracted from (the cadaver or self), when ACL reconstruction surgery is necessary to repair the damaged ligament. An autograft reconstruction involves extracting a tendon from the patient’s body to repair the ruptured ACL. This process involves extracting a preserved, harvested tendon from a cadaver to replace the ACL. To prepare for the reconstruction, the tendon is sized to accommodate the bone tunnels of the tibia and femur into which the new ligament is inserted at the site of the old ACL (5). Autografts are readily available and easily incorporated, however some disadvantages associated include the morbidity associated with harvesting the tendon, muscle weakness where the graft was obtained and the increased surgical time required to harvest and prepare the graft for implantation.
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  • Spring '08
  • Anterior Cruciate Ligament, Tendon, Anterior cruciate ligament reconstruction, patellar tendon, ACL reconstruction

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