Abstract
The sites where graft healing occurs within the bone tunnel and where the intra-articular
ligamentization process takes place are the two most important sites of biological
incorporation after anterior cruciate ligament (ACL) reconstruction, since they help
to determine the mechanical behavior of the femur-ACL graft-tibia complex. Graft-tunnel
healing is a complex process influenced by several factors, such as type of graft,
preservation of remnants, bone quality, tunnel length and placement, fixation techniques
and mechanical stress. in recent years, numerous experimental and clinical studies
have been carried out to
evaluate potential strategies designed to enhance and optimize the biological environment
of the graft-tunnel interface.
Modulation of inflammation, tissue engineering and gene transfer techniques have been
applied in order to obtain a direct-type fibrocartilaginous insertion of the ACL graft,
similar to that of native ligament, and to accelerate the healing process of tendon
grafts within the bone tunnel. Although animal studies have given encouraging results,
clinical studies are lacking and their results do not really support the use of the
various strategies in clinical practice. Further investigations are therefore needed
to optimize delivery techniques, therapeutic concentrations, maintenance of therapeutic
effects over time, and to reduce the risk of undesirable effects in clinical practice.
Key Words
graft-tunnel healing - anterior cruciate ligament reconstruction - biological enhancement
- physical stimulation
