Anterior cruciate ligament (ACL) injuries are a significant concern for athletes and healthcare professionals alike, with the risk of a second ACL injury after ACL reconstruction (ACL-R) being a particularly daunting prospect. While the multifactorial causes of second ACL injuries, including patient anatomy, surgical factors, and rehabilitation components, have been well-established through research conducted in the 2010s, additional contributors may be overlooked due to the focus on complex interactions between a subset of risk factors.
One such contributor is generalized joint hypermobility (GJH), which has been identified as a potential risk factor for reinjury after primary ACL injury. GJH is characterized by an increased range of motion in multiple joints, leading to joint instability and an increased risk of injury. In the context of ACL injuries, GJH may compromise the stability of the knee joint, making it more susceptible to reinjury even after ACL-R.
To address the increased risk of second ACL injury in patients with GJH and other risk factors, orthobiologics such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) have emerged as promising treatment options. These regenerative therapies harness the body’s natural healing processes to promote tissue repair and regeneration, potentially enhancing the recovery process after ACL-R and reducing re-injury risk.
PRP is a concentrated source of growth factors and bioactive molecules derived from a patient’s blood. When injected into the knee joint or used during ACL-R, PRP may help to reduce inflammation, stimulate the production of collagen and other extracellular matrix components, and promote the proliferation and differentiation of cells involved in ligament healing. Several studies have investigated the use of PRP in ACL-R, with some reporting improved graft maturation, reduced postoperative pain, and faster return to sports.
BMAC, on the other hand, is a concentration of mesenchymal stem cells and growth factors obtained from a patient’s bone marrow. These stem cells have the potential to differentiate into various cell types, including those involved in ligament and cartilage repair. When used with ACL-R, BMAC may enhance graft integration, improve ligament regeneration, and reduce the risk of osteoarthritis development, a common long-term complication of ACL injuries.
While the use of orthobiologics in ACL-R is still an emerging field, the potential benefits of these regenerative therapies must be addressed. By promoting tissue healing and regeneration, PRP and BMAC may help to address the increased risk of second ACL injury in patients with GJH and other risk factors, ultimately improving outcomes and reducing the burden of these devastating injuries.
As research continues to elucidate the complex interplay of factors contributing to second ACL injury risk, it is crucial to consider the role of orthobiologics as part of a comprehensive approach to ACL injury prevention and management. By embracing these innovative therapies and integrating them with established best practices in surgery and rehabilitation, we may provide better care for athletes and active individuals, reducing the incidence of second ACL injuries and helping them return to the activities they love with confidence.
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