Permanent knee sensorimotor system changes following ACL injury and surgery.
The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions. Level of evidence IV.
Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA. jnyland@spalding.edu.
John
J
Nyland
School of Medicine, University of Louisville, 323 East Chestnut Street, Louisville, KY, 40202, USA.
Collin
C
Gamble
Athletic Training Program Director and Professor, Kosair Charities College of Health and Natural Sciences, Spalding University, 901 South 4th Street, Louisville, KY, 40203, USA.
Tiffany
T
Franklin
Shea Orthopedic Group, KentuckyOne Health, 201 Abraham Flexner Way, Ste. 100, Louisville, KY, 40202, USA.
David N M
DNM
Caborn
D000818:Animals; D016118:Anterior Cruciate Ligament / Q000098:blood supply / Q000294:innervation* / Q000503:physiopathology* / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology* / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000534:rehabilitation*; D001696:Biomechanical Phenomena; D018450:Disease Progression; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D007719:Knee Joint / Q000098:blood supply / Q000294:innervation / Q000503:physiopathology / Q000601:surgery; D053657:Platelet-Rich Plasma; D011446:Prospective Studies; D014945:Wound Healing / Q000502:physiology
Neuroanatomy; Neuromuscular control; Proprioception; Repair biology; Therapeutic exercise