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The Biology of Impaired Healing of Joint Tissues

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The ACL Handbook

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Abstract

Tissues that are exposed to synovial fluid when they tear (ACL, rotator cuff, meniscus, articular cartilage) are notoriously difficult to get to heal, even with surgical repair. These tissues differ from other tissues, including the medial collateral ligament (MCL) of the knee, which heals even without surgery. In an attempt to learn more about this defect in wound healing for tissues within the joint, we compared the response of tissues within the joint with those outside the joint to try to find the defective mechanism. We found that the deficiency appears to be a premature loss of the provisional scaffold in the wound site. Without this scaffold, the tissues will not reunite and any suture repair is likely to eventually fail when the sutures break. However, identification of this mechanism also gives us something to work toward – what if we could design a substitute scaffold that we could place between the torn tissue ends to stimulate healing? This will be the topic of the next two book sections on engineering a solution for ACL injury.

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Acknowledgement

Research reported in this chapter was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers RO1-AR052772 and RO1-AR054099. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Division of Sports Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA

    Martha M. Murray MD

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  1. Martha M. Murray MD
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Correspondence to Martha M. Murray MD .

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Editors and Affiliations

  1. Boston Children's Hospital, Harvard Medical School, Department of Orthopedic Surgery, Longwood Avenue 300, Boston, 02115, Massachusetts, USA

    Martha M. Murray

  2. Boston Children's Hospital, Harvard Medical School, Department of Orthopedic Surgery, Longwood Avenue 300, Boston, 02115, Massachusetts, USA

    Patrick Vavken

  3. Brown University, Rhode Island Hospital, Warren Alpert Medical School, Hoppin Street 1, Providence, 02903, Rhode Island, USA

    Braden Fleming

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Murray, M.M. (2013). The Biology of Impaired Healing of Joint Tissues. In: Murray, M., Vavken, P., Fleming, B. (eds) The ACL Handbook. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0760-7_8

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  • DOI: https://doi.org/10.1007/978-1-4614-0760-7_8

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-0759-1

  • Online ISBN: 978-1-4614-0760-7

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