Anterior cruciate ligament: 3-D fiber anatomy, fluorescence arthroscopy & healing

One of the current emphases in optimizing anterior cruciate ligament (ACL) reconstructions is closer mimicking the anatomy of the ACL. The aim of Chapter 2 and Chapter 3 is to develop and validate a methodology to quantify the 3-D collagen fiber orientation of ligaments, accurately and at a high resolution. The clinical research question is: how many bundles are present in the human ACL and what should the amount of bundles to be reconstructed. Another current emphasis in improving the ACL reconstruction is graft placement at the original insertion sites of the torn ACL also called - anatomical ACL reconstruction. The aim of Chapter 4 is to develop a new arthroscopic imaging methodology based on fluorescence of collagen molecules to localize the original insertion sites. Another strategy to improve the patient outcome is by healing the torn ACL. In Chapter 5 the aim is to evaluate the effect of the small intestine submucosa bioscaffold (SIS) on the collagen fibrillogenesis in the healing medial collateral ligament. Chapter 6 describes the investigation that aims to improve the efficacy of SIS by remodeling its collagen fibers. The research question was whether this can be achieved through cell-seeding and cyclic stretch. Chapter 7 is a pre-translational study and investigates whether the human ACL has a healing potential by histologic analysis of reattached ACL remnants from patients. The aim in Chapter 8 is to heal the ACL in a goat model and biomechanically evaluate the result. Chapter 9 aims to histologically evaluate the healing ACLs. The final Chapter 10 discusses the findings and implications of this thesis and proposes future studies.