NAGELLI, C.V. AND HEWETT, T.E., 2017
The “ligamentization” process in anterior cruciate ligament reconstruction: what happens to the human graft?
Claes, et al 2011.
“The key finding of this systematic review is that a free tendon graft replacing a ruptured human anterior cruciate ligament undergoes a series of biologic processes termed ‘ligamentization’.The graft seems to remain viable at any time during this course. Histologically, the mature grafts may resemble the normal human anterior cruciate ligament, but ultrastructural differences regarding collagen fibril distribution do persist. \Different stages of the ligamentization process are described, but no agreement exists on their time frame.”
Wright, R.W., Magnussen, R.A., Dunn, W.R. and Spindler, K.P., 2011. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. The Journal of Bone and Joint Surgery. American volume., 93(12), p.1159.
Webster, Kate E., and Julian A. Feller. “Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction.” The American journal of sports medicine 44.11 (2016): 2827-2832.
In this great BJSM podcast with Professor Karim Khan, he explains that all exercise-based rehabilitation relies on the cells of the injured tissue sensing the exercise stimulus, converting that signal to protein synthesis, and repairing tissue – referred to as mechanotherapy.
He explains why ‘rest doesn’t work’ and argues that mechanotherapy has substantial evidence in its favour. The process applies to all body tissues – to injuries / pathology in bone, muscle, tendon and cartilage.
https://soundcloud.com/bmjpodcasts/bjsm-podcast-mechanotherapy
Additionally here is a great paper, open access, led by Professor Khan on the potential for exercise to facilitate tissue healing:
Key points summarised:
- A process that helps tissue repair
- Cellular process in strength exercise prescription
- Mechanotherapy and mechanotransduction
An understanding of tissue healing allows the clinician to improve their clinical reasoning and to minimise damage throughout the rehabilitation program. Healing in most tissues of the human body include (1) Inflammation, (2) proliferation, and (3) repair and remodelling. These stages must be understood as a continuum, not as separate entities that occur as lockstep, with no definitive beginning or end points.
This audio file covers the three phases of healing and inflammation, plus an additional healing times section.
Intro
1. Inflammation phase – 35 seconds
2. Proliferation phase – 2mins 39 seconds
3. Remodelling phase – 3 minutes 11 seconds
4. Typical Healing Times – 3 minutes 58 seconds
See below for a rough timeline for different healing times
