Biological augmentation of graft healing in anterior cruciate ligament reconstruction

Abstract

There is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271-84.

Amplifying Bone Marrow Progenitors Expressing α‐Smooth Muscle Actin Produce Zonal Insertion Sites During Tendon‐to‐Bone Repair

“…As seen in this study (Figs. , , and ), ligament reconstructions where a tendon is passed through a bone tunnel, such as the femoral and tibial tunnels in an ACL reconstruction procedure, can yield zonal attachments of the tendon graft to the adjacent bone . Therefore, ligament reconstructions can be used to study the mechanisms of zonal tendon‐to‐bone repair.…”

“…Moreover, healing following tendon‐to‐bone repair results in disorganized scar formation rather than re‐establishment of zonal tendon‐to‐bone attachments. In contrast, when a tendon is placed through a bone tunnel, zonal attachments with collagen fibers spanning across unmineralized and mineralized fibrocartilage occur . While direct tendon repairs typically are not performed through a bone tunnel (due to anatomic constraints), ligament reconstructions often utilize a tendon graft placed though bone tunnels.…”

“…A staged repair response ensues after tendon grafts are passed through bone marrow tunnels in the femur and tibia following the ACL reconstruction that ultimately leads to zonal tendon‐to‐bone attachments at the interface of the tendon graft and adjacent bone marrow . The cellular origin of these attachments is not from tenocytes within the tendon graft but instead from external populations as demonstrated by studies using green fluorescent protein (GFP) allografts or physical barriers around the tendon graft .…”

Posterior cruciate ligament reconstruction implemented by the Ligament Advanced Reinforcement System over a minimum follow-up of 10 years

“…These findings remind us that whether it is synovitis or infection, graft failure may occur. Hexter et al reviewed a great deal of preclinical research that supported the use of biological augmentation in ACLR [24], and the biologic augmentation might be beneficial in a graft such as LARS that depends on ingrowth tissue. This may be the direction of future research.…”

Are orthobiologics the next chapter in clinical orthopedics? A literature review

“…There are studies that show no difference in clinical outcomes by addition of PRP. [41,42] In a very recent systematic review investigating the usage of PRP, bone substitutes, calcium phosphate-hybridized grafts, and autologous stem cells, Hexter et al, [43] concluded that most of the studies are preclinical and there is still a need for extensive clinical studies to support their use.…”