Patholaxity (Ligamentous) Issues
Pathology can be significantly affected by the approach and choice of treatment of ligamentous knee injuries. Non-operative treatment has recently been shown to greatly increase the rates of osteoarthritis of the knee, with a focus of anatomic restoration as the suggested means for surgical approaches, as this more accurately restores the kinematics of the knee. Subsequently, the timing for surgical intervention is key as acute injuries show far fewer incidences of osteoarthritis relative to chronic. Altered articular cartilage contact stress of the tibiofemoral joint occurs following graft placement that does not mimic its native anatomic positioning, but also occurs from the lack of restoring the structural integrity of the knee through each ligamentous stabilizer because of the residual ligamentous laxity that results. Patterns of incidence for concomitant knee injuries are important to understand for properly diagnosing and, furthermore, treating ligamentous injuries of the knee, due to the extreme complexity with both stages of patient care. Failure to reconstruct concomitant injuries adequately can lead to increased force load on the encompassing muscles, tendons, and/or ligaments and furthermore the articulation of the knee. Currently, the topic of greatest interest has been upon the usage of biologics to supplement or even supplant surgical procedures. Three treatment options are currently viewed as the future in biologics, and these include platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone marrow aspirate concentrate (BMAC). With the addition of growth factors, promotion of cellular proliferation, migration, survival, and differentiation stands at the forefront for more effective regeneration of damaged ligaments and also for the preservation and healing of articular cartilage.
KeywordsOsteoarthritis ACL PCL Articular cartilage Degenerative change Lesion Multiligament injury Biologics PRP
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