Citation

McLean S, Mallett KF, Arruda EM. J. Biomech. Eng. 2014; 137(2): 020906.

Copyright

(Copyright © 2014, American Society of Mechanical Engineers)

DOI

10.1115/1.4029278

PMID

25474193

Abstract

Anterior cruciate ligament injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, where osteoarthritis is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past fifty years geared towards characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding and treating ACL injuries; injury rates, their well-established sex-based disparity and long-term sequelae have endured. In reviewing the vast amount of literature conducted to date in this area, the current paper identifies important knowledge gaps that appear to contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3-D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically flawed, being over-designed for stiffness compared to the native tissue. The net result is an increased risk of re-rupture and a modified and potentially hazardous joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number otherwise healthy individuals.

Language: en