Re-examining ACL Reconstruction: A call for Standardization in the Fight against Osteoarthritis

Abstract

The anterior cruciate ligament (ACL) is an essential component of the knee joint, necessary for the proper function and stability of one of the most used joints in our body. A tear of the ACL is a very common injury that immediately causes extreme pain, swelling and immobilization. Unlike most other ligaments, the ACL is unable to heal itself using natural wound repair processes due to a lack of vasculature inside the knee joint where the ACL is located. This leads to a long and arduous recovery process that involves reconstruction of the ligament through surgery and a lengthy therapy regimen. Currently, there is no gold standard for ACL reconstruction and there are a large number of options available to surgeons that involve different graft materials and operative techniques. The major concern with ACL reconstruction is that it drastically increases the prevalence of a degenerative joint condition called osteoarthritis (OA) compared to the normal population. In an attempt to reduce these rates, new operative techniques have been tried and this has led to a diverse but separated group of researchers attempting to solve the same problem. To go along with the large number of surgeries, recent biological research has shown that one of a number of molecular treatments could be used during surgery to accelerate the wound healing at the site of graft insertion. This is a very promising development, however it has not been implemented to its full potential as of yet. I believe that a more focused approach towards improving ACL reconstruction, involving a standardization of one protocol that includes the best graft, operative technique and molecular treatment could lead to a reduction in rates of OA and other complications. This standardization, along with an implementation strategy, is discussed in detail in the contents of this thesis.