Ligaments and Ligamentoplasties

Despite a substantial amount of literature already accumulated on the subject, our understanding of the structure, function, and biology of the cruciate ligaments has yet to reach the point where we can repair this complicated structure. This volume does not attempt to address every aspect of cruciate ligament replacement, but rather chooses to concentrate on the neurological function of the ligaments. It adopts a pragmatic approach to fatigue testing in more physiological conditions, biomimetic designs, European surgical techniques and new approaches derived from tissue engineering. As such, it is the first volume to sufficiently emphasise the progress that has been made outside of North America and follows more closely the SICOT/SIROT philosophy. The first section provides an overview of the increasing amount of knowledge on natural ligaments, while the second one reviews - using a biomimetical approach - the different concepts and designs of artificial ligaments developed over the last few decades. The final section presents new directions to expand our present understanding and suggests future approaches. Prosthetic replacement of ligaments is a problem which still has not been solved. Despite the development of different synthetic implants and better knowledge of the ligament biomechanics, there is currently no prosthesis that shows satisfactory results. As a result, synthetic implants have either not been approved at all or approved by the FDA for limited use only as a replacement for the anterior cruciate ligament. The purpose of this book is to provide an overview of the growing knowledge of natural ligaments and to review, using a biomimetical approach, the different concepts and designs of artificial ligaments developed during the last decades. This approach is undertaken in an effort to better understand why artificial ligaments fail, to redefine design criteria, and stimulate the development of a new generation of more effective replacement devices.