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Lookup NU author(s): Professor David Deehan,
Emeritus Professor Tim Cawston
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In summary, with greater understanding of the biology of ACL autograft reconstruction, there should be fewer atraumatic failures and a reduced revision workload. The results after revision surgery for recurrent pathological laxity are far inferior to those after primary intervention.14,75-77 Controlled modulation of the early graft-host interaction in ACL reconstruction offers the exciting possibility of a reproducible, accelerated clinical response to surgical intervention and may reduce the incidence of clinical failures. Many mechanical and biological agents are now under investigation. We have provided a simplified overview of the current knowledge of the biology of the graft-host bone interaction for hamstring and patellar tendon autografts. We have not addressed the complex subject of allograft or synthetic agents, as the majority of primary ACL reconstructions in the United Kingdom use either patellar tendon or hamstring tendon autografts. The specific use of highly potent agents to enhance graft ingrowth requires careful clinical in vivo study through randomised controlled trials. It is clear that any one of these agents may, if incorrectly administered, result in deleterious local and even systemic effects. Studies of the basic mechanisms of tendon-to-bone healing may lead to new methods of treatment which improve healing. These could apply to any situation in which a tendon graft is placed into bone tunnels, such as reconstruction of the anterior or posterior cruciate ligaments, ankle ligaments reconstruction, or ulnar collateral ligament stabilisation at the elbow. Knowledge of gene expression at healing tendon insertion sites may suggest ways to manipulate the chemical and molecular signals in order to improve healing. The use of chemical messengers presumes an expertise in delivery systems which does not currently exist in vivo. It is possible that the use of topical adjuvant therapy may herald the widespread interest and use of such novel treatment as this is controllable and does not appear to have any deleterious side effects. This area of interest is in its infancy. © 2005 British Editorial Society of Bone and Joint Surgery.
Author(s): Deehan DJ, Cawston TE
Publication type: Article
Publication status: Published
Journal: Journal of Bone and Joint Surgery: British Volume
ISSN (print): 0301-620X
Publisher: British Editorial Society of Bone and Joint Surgery
PubMed id: 15972898
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