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Controversies in the Technical Aspects of ACL Reconstruction pp 135–144Cite as

Acute ACL Rupture: A Biological Approach Through Primary ACL Repair and Augmentation with Bone Marrow Stimulation and Growth Factor Injection

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Abstract

Techniques of arthroscopically assisted anterior cruciate ligament (ACL) reconstruction have been used successfully to treat all types of ACL injury. In the event of partial ACL rupture, surgical management may include standard ACL reconstruction techniques typically used in complete rupture, or a more selective approach may be employed. Surgical repair of the disrupted ligament, or selective reconstruction of the injured ACL bundle, may be considered in the case of partial ACL rupture. Advances in the understanding of cellular repair mechanisms and the availability of various biologics may factor prominently in future treatment algorithms for certain types of ACL injury. ACL repair with bone marrow stimulation and growth factor application has the potential to restore ligamentous integrity and function, without altering the anatomic footprint of the ACL while partially maintaining proprioceptive function. Following a strict treatment protocol in our most recent cohort of patients suffering from acute partial ACL injury, high rates of functional recovery and return to sport were achieved after surgical repair of the ACL, with concurrent bone marrow stimulation and the application of growth factors.

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Selected Reading

  • Amiel D, Nagineni CN, Choi SH, Lee J (1995) Intrinsic properties of ACL and MCL cells and their responses to growth factors. Med Sci Sports Exerc 27(6):844–851

    Article  CAS  PubMed  Google Scholar 

  • Gobbi A, Bathan L, Boldrini L (2009) Primary repair combined with bone marrow stimulation in acute anterior cruciate ligament lesions: results in a group of athletes. Am J Sports Med 37:571–578

    Article  PubMed  Google Scholar 

  • Gobbi A, Boldrini L, Karnatzikos G et al (2012) Clinical outcomes and rehabilitation program after ACL primary repair and bone marrow stimulation. In: Doral MN (ed) Sports Injuries-prevention, diagnosis, treatment and rehabilitation. Springer, Berlin, pp 475–484

    Google Scholar 

  • Gobbi A, Karnatzikos G, Sankineani SR, Petrera M (2013) Biological augmentation of ACL re-fixation in partial lesions in a group of athletes: results at 5-year follow-up. Tech Orthop 28(2):180–184

    Article  Google Scholar 

  • Kaplan N, Wickiewicz TL, Warren RF (1990) Primary surgical treatment of anterior cruciate ligament ruptures: a long-term follow-up study. Am J Sports Med 18(4):354–358

    Article  CAS  PubMed  Google Scholar 

  • Murray MM, Martin SD, Martin TL et al (2000) Histological changes in the human anterior cruciate ligament after rupture. J Bone Joint Surg Am 82-A(10):1387–1397

    Article  CAS  PubMed  Google Scholar 

  • Noyes FR, Mooar LA, Moorman CT 3rd et al (1989) Partial tears of the anterior cruciate ligament. Progression to complete ligament deficiency. J Bone Joint Surg (Br) 71(5):825–833

    CAS  Google Scholar 

  • Steadman JR, Cameron-Donaldson ML, Briggs KK et al (2006) A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg 19(1):8–13

    Article  PubMed  Google Scholar 

  • Steadman JR, Matheny LM, Briggs KK et al (2012) Outcomes following healing response in older, active patients: a primary anterior cruciate ligament repair technique. J Knee Surg 25(3):255–260

    Article  PubMed  Google Scholar 

  • Steinert AF, Kunz M, Prager P et al (2011) Mesenchymal stem cell characteristics of human anterior cruciate ligament outgrowth cells. Tissue Eng A 17(9–10):1375–1388

    Article  CAS  Google Scholar 

  • Vavken P, Murray MM (2011) The potential for primary repair of the ACL. Sports Med Arthr 19(1):44–49

    Article  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, Gobbi NPO, GA Amadeo 24, 20133, Milan, Italy

    Alberto Gobbi MD, Graeme P. Whyte MD, MSc & Georgios Karnatzikos MD

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  1. Alberto Gobbi MD
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  2. Graeme P. Whyte MD, MSc
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  3. Georgios Karnatzikos MD
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Correspondence to Alberto Gobbi MD .

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Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Gobbi, A., Whyte, G.P., Karnatzikos, G. (2017). Acute ACL Rupture: A Biological Approach Through Primary ACL Repair and Augmentation with Bone Marrow Stimulation and Growth Factor Injection. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_13

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