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Systematic Review of Biological Modulation of Healing in Anterior Cruciate Ligament Reconstruction.

Fu SC, Cheuk YC, Yung SH, Rolf CG, Chan KM - Orthop J Sports Med (2014)

Bottom Line: Ten clinical studies and 50 animal studies were included.Twenty-five included studies were regarded as good quality, with a methodological score ≥5.This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background: Whether biological modulation is effective to promote healing in anterior cruciate ligament (ACL) reconstruction remains unclear.

Purpose: To perform a systematic review of both clinical and experimental evidence of preclinical animal studies on biological modulation to promote healing in ACL reconstruction.

Study design: Systematic review; Level of evidence, 2.

Methods: A systematic search was performed using the PubMed, Ovid, and Scopus search engines. Inclusion criteria were clinical and animal studies involving subjects with ACL injury with the use of biological modulation to promote healing outcomes. Methodological quality of clinical studies was evaluated using the Critical Appraisal Skill Programme (CASP) appraisal tool, and animal studies were evaluated by a scoring system based on a published checklist of good animal studies.

Results: Ten clinical studies and 50 animal studies were included. Twenty-five included studies were regarded as good quality, with a methodological score ≥5. These studies suggested that transforming growth factor-beta (TGF-β), mesenchymal stem cells, osteogenic factors, and modalities that reduce local inflammation may be beneficial to promote graft healing in ACL reconstruction.

Conclusion: This systematic review suggests that biological modulation is able to promote healing on top of surgical treatment for ACL injuries. This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation.

No MeSH data available.


Related in: MedlinePlus

Flowchart showing results of database search, article elimination, and final inclusion performed in January 2013. Results of the updated search performed in January 2014 are reported separately in the Results section.
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fig1-2325967114526687: Flowchart showing results of database search, article elimination, and final inclusion performed in January 2013. Results of the updated search performed in January 2014 are reported separately in the Results section.

Mentions: Systematic searches were carried out in January 2013 using PubMed, Ovid, and Scopus databases. The keywords in combination with search operants were as follows: (ACL OR anterior cruciate ligament) AND (growth factor OR stem cell OR drug OR biomaterial OR biophysical intervention). A postsearch filtering with keywords reconstruction, reconstructive, and healing in the titles was used to facilitate the identification of relevant studies. Studies with biological modulation on ACL lesion without reconstructive surgery were also identified by screening the titles. The search results from 3 different databases were merged, and duplicate studies were removed. Application of inclusion/exclusion criteria on the search results was started by screening the title and then the abstracts. The full text of the filtered articles was then obtained for data extraction, such as publication years, first author, type of modulation, animal model, sample size, follow-up time, key outcome measures, and major findings. A flowchart of the search results is shown in Figure 1. After the original search in January 2013, an updated search was conducted in January 2014 to cover publications from January 2013 to January 2014. The search criteria remained the same as the original search.


Systematic Review of Biological Modulation of Healing in Anterior Cruciate Ligament Reconstruction.

Fu SC, Cheuk YC, Yung SH, Rolf CG, Chan KM - Orthop J Sports Med (2014)

Flowchart showing results of database search, article elimination, and final inclusion performed in January 2013. Results of the updated search performed in January 2014 are reported separately in the Results section.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555564&req=5

fig1-2325967114526687: Flowchart showing results of database search, article elimination, and final inclusion performed in January 2013. Results of the updated search performed in January 2014 are reported separately in the Results section.
Mentions: Systematic searches were carried out in January 2013 using PubMed, Ovid, and Scopus databases. The keywords in combination with search operants were as follows: (ACL OR anterior cruciate ligament) AND (growth factor OR stem cell OR drug OR biomaterial OR biophysical intervention). A postsearch filtering with keywords reconstruction, reconstructive, and healing in the titles was used to facilitate the identification of relevant studies. Studies with biological modulation on ACL lesion without reconstructive surgery were also identified by screening the titles. The search results from 3 different databases were merged, and duplicate studies were removed. Application of inclusion/exclusion criteria on the search results was started by screening the title and then the abstracts. The full text of the filtered articles was then obtained for data extraction, such as publication years, first author, type of modulation, animal model, sample size, follow-up time, key outcome measures, and major findings. A flowchart of the search results is shown in Figure 1. After the original search in January 2013, an updated search was conducted in January 2014 to cover publications from January 2013 to January 2014. The search criteria remained the same as the original search.

Bottom Line: Ten clinical studies and 50 animal studies were included.Twenty-five included studies were regarded as good quality, with a methodological score ≥5.This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. ; Lui Che Woo Institute of Innovative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background: Whether biological modulation is effective to promote healing in anterior cruciate ligament (ACL) reconstruction remains unclear.

Purpose: To perform a systematic review of both clinical and experimental evidence of preclinical animal studies on biological modulation to promote healing in ACL reconstruction.

Study design: Systematic review; Level of evidence, 2.

Methods: A systematic search was performed using the PubMed, Ovid, and Scopus search engines. Inclusion criteria were clinical and animal studies involving subjects with ACL injury with the use of biological modulation to promote healing outcomes. Methodological quality of clinical studies was evaluated using the Critical Appraisal Skill Programme (CASP) appraisal tool, and animal studies were evaluated by a scoring system based on a published checklist of good animal studies.

Results: Ten clinical studies and 50 animal studies were included. Twenty-five included studies were regarded as good quality, with a methodological score ≥5. These studies suggested that transforming growth factor-beta (TGF-β), mesenchymal stem cells, osteogenic factors, and modalities that reduce local inflammation may be beneficial to promote graft healing in ACL reconstruction.

Conclusion: This systematic review suggests that biological modulation is able to promote healing on top of surgical treatment for ACL injuries. This treatment strategy chiefly works through promotion of healing at the tunnel-graft interface, but the integrity of the intra-articular midsubstance of the graft would be another target for biological modulation.

No MeSH data available.


Related in: MedlinePlus