Cruciate ligament healing and injury prevention in the age of regenerative medicine and technostress: homeostasis revisited

Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):777-789. doi: 10.1007/s00167-019-05458-7. Epub 2019 Mar 19.


Purpose: This clinical concepts paper discusses the essential elements of cruciate ligament recuperation, micro-trauma repair, and remodeling.

Methods: Cruciate ligament mechanobiology and tissue heterogeneity, anatomy and vascularity, and synovial membrane and fluid functions are discussed in relationship to deficiency-induced inflammatory responses, nervous and immune system function, recuperation, repair and remodeling, and modern threats to homeostasis.

Results: Cruciate ligament surgical procedures do not appreciate the vital linked functions of the central, peripheral, and autonomic nervous systems and immune system function on knee ligament injury recuperation, micro-trauma repair, and remodeling. Enhanced knowledge of these systems could provide innovative ways to decrease primary non-contact knee injury rates and improve outcomes following reconstruction or primary repair.

Conclusions: Restoration of knee joint homeostasis is essential to cruciate ligament recuperation, micro-trauma repair, and remodeling. The nervous and immune systems are intricately involved in this process. Varying combinations of high-intensity training, under-recovery, technostress, and environmental pollutants (including noise) regularly expose many athletically active individuals to factors that abrogate the environment needed for cruciate ligament recuperation, micro-trauma repair, and remodeling. Current sports training practice, lifestyle psychobehaviors, and environmental factors combine to increase both primary non-contact knee injury risk and the nervous and immune system dysregulation that lead to poor sleep, increased anxiety, and poorly regulated hormone and cytokine levels. These factors may create a worst-case scenario leading to poor ligament recuperation, micro-trauma repair, and remodeling. Early recognition and modification of these factors may decrease knee ligament injury rates and improve cruciate ligament repair or reconstruction outcomes.

Level of evidence: V.

Keywords: Biology; Inflammation; Osteoarthritis; Vascularity.

Publication types

  • Review

MeSH terms

  • Anterior Cruciate Ligament / anatomy & histology
  • Anterior Cruciate Ligament / blood supply
  • Anterior Cruciate Ligament Injuries / physiopathology*
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction* / adverse effects
  • Anterior Cruciate Ligament Reconstruction* / methods
  • Homeostasis
  • Humans
  • Immune System / physiopathology
  • Inflammation / physiopathology
  • Nervous System / physiopathology
  • Postoperative Complications / prevention & control*
  • Regenerative Medicine
  • Synovial Membrane / physiology
  • Wound Healing / physiology*