Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic Review“Ligamentization” in Hamstring Tendon Grafts After Anterior Cruciate Ligament Reconstruction: A Systematic Review of the Literature and a Glimpse Into the Future
Section snippets
Search Strategy
We performed a systematic review of the literature in Medline, PubMed, Embase, and The Cochrane Library databases on July 7, 2012 to identify all published studies reporting on the postoperative remodeling processes of HT grafts after ACL reconstruction. The search included all entries from the respective database's starting date to the day of our search, including articles published online as “Epub ahead of print.” For the computerized search, a combination of search terms related to the
Search Results
Our search revealed 906 potentially relevant articles. After the removal of duplicates, titles and abstracts of the remaining 383 articles were screened for relevance. This process identified 17 articles that were obtained for detailed evaluation.
Additionally, the reference lists of these articles were manually screened for relevant publications to ensure comprehensiveness of the literature search. This complementary search revealed one additional article, which was retrieved for further
Discussion
According to the progression of cellularity, vessel density, and other histologic signs of graft maturity, all included studies reported the identification of 3 consecutive distinguishable phases of postoperative remodeling.
Controlled human studies illustrating ligamentization of PT grafts found that an initial healing phase was finished 6 months after surgery, followed by intense remodeling, which was shown to recede at 12 months, to a final maturation phase, which was shown to be ongoing at
Conclusions
In principle, ligamentization occurs in human and animal hamstring grafts in a way similar to that previously reported in PT grafts. Furthermore, the postoperative healing process of HT grafts shows a typical progression through 3 chronological, distinguishable remodeling phases, whereas the progression and intensity of remodeling is distinctly increased in animals.
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2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :Additionally, there may be further benefit to performing ACL reconstruction with a larger graft beyond the biomechanical properties of the graft at time zero. ACL grafts undergo progressive biological remodeling and neovascularization after reconstruction in a process of ligamentization.23-26 This process includes cellular repopulation, vascularization, and synthesis of an extracellular matrix comprised of both large and small diameter collagen fibrils, as is seen in the native ACL, and results in tissue that resembles normal ACL both histologically and ultrastructurally.23,24
The authors report that they have no conflicts of interest in the authorship and publication of this article.