[...]... noncollagenous, bovine bone proteins containing various BMPs and purified rhBMP-7 also can improve tendon-to-bone healing, based on histologic analysis and biomechanical testing [22,26] Further insight into the role of BMPs in tendon-to-bone healing was gained through studies in which BMP was inhibited Ma and colleagues [24] delivered noggin, a potent inhibitor of BMP activity, in an injectable calcium... during ACL reconstruction in a rabbit Noggin significantly inhibited new bone formation in the tendon–bone interface and increased the width of the fibrous scar tissue at the graft–tunnel interface These results verified the important role of BMP in bone formation around the tendon graft in a bone tunnel In addition to osteoinductive materials, osteoconductive materials also may play a role in improving... patellofemoral pain also has been reported in 22% of ACL-deficient knees and in 20% of hamstring reconstructions [1,56] Shelbourne and Trumper [57] found no difference in the incidence of patellofemoral pain in 602 BPTB autograft ACL reconstructions and 122 control knees with no surgical intervention They concluded that patellofemoral pain is not inherent to BPTB harvest and that the incidence of pain can be minimized... important stabilizing and biomechanical function for the knee Reconstruction of the ACL remains one of the most commonly performed procedures in the field of sports medicine Restoration of normal knee function and protection from further intra-articular injury, particularly injuries resulting from abnormal pivoting, drive continued research and development of new techniques for reconstruction In preparation... begin gait training as part of the initial regimen At 5 to 6 weeks after surgery conventional weight machines are used, and the patient begins to use an elliptical trainer Plyometric exercise is started 8 weeks after surgery and is continued until the end of rehabilitation Patients may start jogging 12 weeks postoperatively and return to sports- specific training as progression with the therapist indicates... Am J Sports Med 2001;29(6): 689–98 [23] Rodeo SA, Suzuki K, Deng XH, et al Use of recombinant human bone morphogenetic protein-2 to enhance tendon healing in a bone tunnel Am J Sports Med 1999;27(4): 476–88 [24] Ma C, Kawamura S, Deng X, et al Bone morphogenetic protein-signaling plays a role in tendon-to-bone healing: a study of rhBMP-2 and noggin Am J Sports Med 2002;35(4): 597–604 [25] Martinek... neurapraxia in longer surgeries The operative leg then is prepped and draped using standard sterile technique The leg is exsanguinated with a rubber bandage The tourniquet is in ated to 300 mm Hg and remains in ated until the postoperative dressing is in place Diagnostic Arthroscopy A diagnostic arthroscopy should be performed first if any findings on MRI, physical examination, or examination under anesthesia indicate... healing Relative graft-tunnel micromotion may contribute to sustained in ammation caused by repetitive microinjury at the healing interface In a clinical study, Hantes and colleagues [30] found that patients who underwent an aggressive 516 GULOTTA & RODEO rehabilitation regimen following ACL reconstruction with a hamstring graft showed more radiographic evidence of tibial tunnel widening than seen in. .. preliminary data suggest that excessive vascularity may have detrimental effects on the healing ACL graft Matrix metalloproteinases (MMPs) play a central role in the degradation and remodeling of the extracellular matrix during healing and graft remodeling Demirag and colleagues [41] performed bilateral ACL reconstruction with semitendinosus grafts in rabbits Postoperatively, one knee joint was injected... performed bilateral ACL reconstructions in a rabbit and coated one graft with rabbit-derived mesenchymal stem cells (MSCs) in a fibrin glue carrier in one limb and used the fibrin glue alone in the other limb They reported healing by fibrocartilage formation with positive staining for type II collagen in the MSC-treated animals, as opposed to disorganized collagen seen in the control animals At 8 weeks, the . Elsevier Inc. All rights reserved. doi:10.1016/j.csm.2007.07.001 sportsmed.theclinics.com Clin Sports Med 26 (2007) xiii CLINICS IN SPORTS MEDICINE Preface Jon. Elsevier Inc. All rights reserved. doi:10.1016/j.csm.2007.06.007 sportsmed.theclinics.com Clin Sports Med 26 (2007) 509–524 CLINICS IN SPORTS MEDICINE Autologous