title: Intra-articular remodelling of hamstring tendon grafts after anterior cruciate ligament reconstruction.
abstract: OBJECTIVE
  A summary is provided on the existing knowledge about the specific healing phases of the intra-articular hamstring tendon graft used for ACL reconstruction. Differences between human and animal in vivo studies are explained, and implications for the postoperative time period are laid out.
  
  
  METHODS
  A systematic review of the existing literature was performed on the topic of tendon remodelling of hamstring grafts in ACL reconstruction using Medline database. Publications between 1982 and 2012 were included. Special focus was directed on in vivo human and animal studies analysing intra-articular free tendon graft remodelling.
  
  
  RESULTS
  Animal and human in vitro and vivo researches have demonstrated three characteristic stages of graft healing after ACL reconstruction: an early graft healing phase with central graft necrosis and hypocellularity and no detectable revascularization of the graft tissue, followed by a phase of proliferation, the time of most intensive remodelling and revascularization and finally, a ligamentization phase with characteristic restructuring of the graft towards the properties of the intact ACL. However, a full restoration of either the biological or biomechanical properties of the intact ACL is not achieved.
  
  
  CONCLUSIONS
  Significant knowledge on human cruciate ligament remodelling has been added in the understanding of the processes during the course of graft healing. Most importantly, the remodelling process in humans is prolonged compared to animal studies. While today´s rehabilitation protocols are often extrapolated from findings of animal in vivo healing studies, current findings of human in vivo healing studies might require new post-operative regimens following hamstring ACL reconstruction.
authors: Orthopaedic Center Máxima, Máxima Medical Center, Ds. Th. Fliednerstraat 1, 5631 BM, Eindhoven, The Netherlands, r.janssen@mmc.nl.
authors: Rob P A
authors: RP
authors: Janssen
authors: Sven U
authors: SU
authors: Scheffler
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D013710:Tendons / Q000503:physiopathology* / Q000637:transplantation; D019737:Transplants / Q000503:physiopathology; D014945:Wound Healing / Q000502:physiology*
references: Knee Surg Sports Traumatol Arthrosc. 1999;7(1):9-14
references: 10024956
references: J Orthop Res. 1996 May;14(3):384-9
references: 8676250
references: J Orthop Res. 1989;7(4):474-85
references: 2738766
references: Knee Surg Sports Traumatol Arthrosc. 2012 May;20(5):947-56
references: 21953379
references: Arthroscopy. 1998 Oct;14(7):702-16
references: 9788366
references: J Bone Joint Surg Br. 1984 Nov;66(5):672-81
references: 6501359
references: Am J Sports Med. 1997 Jul-Aug;25(4):554-9
references: 9240991
references: J Orthop Res. 1986;4(4):466-74
references: 2946835
references: Arthroscopy. 1993;9(2):149-53
references: 8461071
references: Knee Surg Sports Traumatol Arthrosc. 2012 Jun;20(6):1168-74
references: 22310901
references: Am J Sports Med. 1990 May-Jun;18(3):292-9
references: 2372081
references: J Bone Joint Surg Am. 1991 Feb;73(2):201-13
references: 1993715
references: Am J Sports Med. 2006 Dec;34(12):1918-25
references: 17092923
references: Knee Surg Sports Traumatol Arthrosc. 2000;8(2):120-6
references: 10795676
references: Arthroscopy. 2010 Apr;26(4):470-80
references: 20362825
references: J Orthop Res. 1989;7(2):235-42
references: 2918422
references: J Orthop Res. 1995 Jul;13(4):602-8
references: 7674076
references: Clin Orthop Relat Res. 1995 Sep;(318):265-78
references: 7671527
references: Knee Surg Sports Traumatol Arthrosc. 2008 Sep;16(9):834-42
references: 18516592
references: Am J Sports Med. 2011 Nov;39(11):2476-83
references: 21515806
references: Knee Surg Sports Traumatol Arthrosc. 2008 Dec;16(12):1087-93
references: 18712354
references: Knee Surg Sports Traumatol Arthrosc. 2011 Aug;19(8):1299-306
references: 21293848
references: J Bone Joint Surg Br. 2002 Apr;84(3):440-6
references: 12002508
references: Am J Sports Med. 2005 Aug;33(8):1166-73
references: 16000668
references: Clin Orthop Relat Res. 2003 Sep;(414):276-88
references: 12966303
references: Arthroscopy. 2002 Feb;18(2):124-35
references: 11830805
references: J Orthop Res. 1993 Jul;11(4):592-602
references: 8340831
references: J Orthop Res. 2002 Mar;20(2):310-7
references: 11918311
references: J Bone Joint Surg Am. 2000 Oct;82(10):1387-97
references: 11057466
references: J Orthop Res. 1996 Nov;14(6):851-6
references: 8982125
references: Arch Orthop Trauma Surg. 2004 Nov;124(9):585-91
references: 15378321
references: Knee Surg Sports Traumatol Arthrosc. 2008 Apr;16(4):360-9
references: 18183370
references: Am J Sports Med. 2011 Dec;39(12):2536-48
references: 21952714
references: Am J Sports Med. 2004 Jun;32(4):881-91
references: 15150033
references: Acta Orthop Belg. 1991;57 Suppl 2:44-53
references: 1792884
references: J Bone Joint Surg Am. 1996 Jun;78(6):814-25
references: 8666598
references: Am J Sports Med. 1995 Jan-Feb;23(1):42-9
references: 7726349
references: Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):1977-88
references: 23081710
references: J Orthop Res. 1986;4(2):162-72
references: 3712125
references: Cell Tissue Bank. 2005;6(2):109-15
references: 15909098
references: Am J Sports Med. 1994 May-Jun;22(3):344-51
references: 8037275
references: Arthroscopy. 2010 Oct;26(10):1318-25
references: 20800986
references: Arch Phys Med Rehabil. 2004 Feb;85(2):298-302
references: 14966717
references: J Rheumatol. 1997 Jul;24(7):1253-9
references: 9228120
references: J Bone Joint Surg Br. 2007 Sep;89(9):1165-71
references: 17905952
references: Br Med Bull. 2012;104:91-111
references: 22257853
references: Am J Sports Med. 1986 Nov-Dec;14(6):449-62
references: 3799871
references: Am J Sports Med. 2001 Nov-Dec;29(6):751-61
references: 11734489
references: J Orthop Res. 1984;1(3):257-65
references: 6481509
references: J Bone Joint Surg Am. 1982 Feb;64(2):217-24
references: 7056776
references: Arthroscopy. 2002 Feb;18(2):113-23
references: 11830804
references: Eur Surg Res. 2010;45(2):77-85
references: 20814217
references: Arthroscopy. 1993;9(2):131-42
references: 8461069
references: Am J Sports Med. 1993 Mar-Apr;21(2):176-85
references: 8465909
references: Am J Sports Med. 2005 Mar;33(3):347-59
references: 15716250
references: Knee Surg Sports Traumatol Arthrosc. 2008 Mar;16(3):224-31
references: 18183368
references: Knee Surg Sports Traumatol Arthrosc. 2009 Jul;17(7):770-7
references: 19305977
references: Knee Surg Sports Traumatol Arthrosc. 2010 Aug;18(8):1052-8
references: 19787336
references: Arthroscopy. 1998 Mar;14(2):197-205
references: 9531133
references: Knee. 2007 Mar;14(2):87-93
references: 17188877
references: Am J Sports Med. 2001 Sep-Oct;29(5):620-6
references: 11573921
references: Arthroscopy. 1993;9(4):394-405
references: 8216570
references: Orthopedics. 1993 Apr;16(4):403-10
references: 8493146
references: Am J Knee Surg. 2000 Summer;13(3):143-51
references: 11277242
references: Arch Orthop Trauma Surg. 2004 Nov;124(9):603-7
references: 14586627
references: J Orthop Res. 2005 Nov;23(6):1425-32
references: 16111854