The ACL Handbook: Knee Biology, Mechanics, and Treatment PDF
Preview The ACL Handbook: Knee Biology, Mechanics, and Treatment
Martha M. Murray Patrick Vavken Braden C. Fleming Editors The ACL Handbook Knee Biology, Mechanics, and Treatment 123 The ACL Handbook Martha M. Murray Patrick Vavken ● Braden C. Fleming Editors The ACL Handbook Knee Biology, Mechanics, and Treatment Editors Martha M. Murray Patrick Vavken Department of Orthopedic Surgery Department of Orthopedic Surgery Division of Sports Medicine Boston Children’s Hospital Boston Children’s Hospital Harvard Medical School Harvard Medical School Boston, MA, USA Boston, MA, USA Braden C. Fleming Department of Orthopedic Warren Alpert Medical School of Brown University/Rhode Island Hospital Providence, RI, USA ISBN 978-1-4614-0759-1 ISBN 978-1-4614-0760-7 (eBook) DOI 10.1007/978-1-4614-0760-7 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2013935492 © Springer Science+Business Media New York 2013 This work is subject to copyright. 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Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To our patients, who motivate us every day to put our best effort toward fi nding improved treatments for ACL injury. Preface Emily was driving toward the basket, a move she had done a 1,000 times before. She went up for the shot, and upon landing, her knee gave way. She felt a shifting in her knee microseconds before she heard a “pop.” After dropping to the court and grab- bing her knee, she was carried off the court by her concerned coach and trainer. They wrapped her knee in ice packs and sent her to see her doctor in hopes it was not a devastating ACL injury. Her visit with me, an Orthopedic surgeon, would confi rm a diagnosis of an ACL tear – a seeming death sentence for so many athletes. Upon hearing her diagnosis, her questions were numerous and understandably so. “Will I play again?” “Will I be as fast as I was before my injury?” Her most pressing question was “When can I get back on the court?” ACL injuries affect the lives of hundreds of thousands of people every year. The patients who sustain these injuries and the families, teammates, coaches, and health- care providers, who care for these patients through their injury and recovery, all have questions related to this injury. Currently, we know the answers to some of the questions. For the most part, we know that patients can get back to sports after ACL injury, and with proper training, their performance can be where it was before the injury. Other questions we do not know the answers to, such as who will develop arthritis after their ACL injury and how that can be prevented. Great work is going on in this fi eld in an effort to prevent injury and to improve treatment options for our ACL-injured patients. In this book, we attempt to distill all of this information to make the science behind the treatment of ACL injuries more understandable. As you will see, much has been learned in this fi eld, but there is substantial room for improvements. Emily went on to have ACL reconstruction surgery and is back playing basket- ball. She underwent an extensive period of rehabilitation, and her mom feels she is playing even better now than before her injury. But still we wonder – can we some- day return the joint to a more normal status? Can we prevent arthritis in these patients as they get older? Can we get the ACL to heal after a tear, rather than replacing it with a tendon graft? When given the right biological signal, could vii viii Preface ligament repair be a better long-term solution for Emily and individuals like her? These questions keep us, and many other doctors and researchers, working toward an improved understanding of the ACL and its response to injury. We hope you enjoy the material presented here, and we also hope the work in this area will lead us to better solutions for the treatment of ACL injuries, solutions which will involve repair and regeneration of this crucial ligament instead of its replacement. Boston, MA, USA Martha M. Murray Boston, MA, USA Patrick Vavken Providence, RI, USA Braden C. Fleming Contents Part I ACL Injury: The Clinical Problem 1 ACL Injury Epidemiology ..................................................................... 3 Patrick Vavken and Martha M. Murray 2 History of ACL Treatment and Current Gold Standard of Care .................................................................................... 19 Martha M. Murray 3 ACL Clinical Outcomes ......................................................................... 29 Carolyn M. Hettrich and Kurt P. Spindler 4 ACL Treatment in the Skeletally Immature Patient ........................... 41 Patrick Vavken and Martha M. Murray Part II ACL Injury: The Biologic Problem 5 The Biology of the Normal ACL ........................................................... 63 Martha M. Murray and Braden C. Fleming 6 The Role of Infl ammation and Blood Cells in Wound Healing ......... 73 Linda H. Chao and Martha M. Murray 7 The ACL Response to Injury ................................................................ 91 Martha M. Murray 8 The Biology of Impaired Healing of Joint Tissues .............................. 101 Martha M. Murray Part III Translational Medicine: In Vitro and In Vivo Models 9 Translational Medicine .......................................................................... 115 Patrick Vavken ix
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