Chinese Journal of Tissue Engineering Research ›› 2024, Vol. 28 ›› Issue (9): 1457-1463.doi: 10.12307/2024.013

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Strategies for repairing injured anterior cruciate ligament and promoting graft healing

Bai Chen1, Yang Wenqian1, Meng Zhichao1, Wang Yuze2   

  1. 1Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2Department of Orthopedics of Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China      
  • Received:2023-02-20 Accepted:2023-03-23 Online:2024-03-28 Published:2023-07-26
  • Contact: Wang Yuze, MD, Chief physician, Department of Orthopedics of Second Affiliated Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Bai Chen, Master candidate, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • Supported by:
    Shanxi Provincial Youth Science and Technology Research Fund, No. 201901D211505 (to WYZ)

Abstract: BACKGROUND: In recent years, the treatment of anterior cruciate ligament injury has become more and more mature. However, there are still disputes about the timing of surgery, the choice of surgical methods, the choice of grafts, and the methods to promote graft healing after anterior cruciate ligament injury.
OBJECTIVE: To summarize the latest research progress of surgical timing, surgical methods, graft selection and methods to promote graft healing after anterior cruciate ligament injury, and to find new treatment directions for anterior cruciate ligament injury. 
METHODS: Relevant articles concerning anterior cruciate ligament injury were retrieved from PubMed, CNKI, WanFang Date, VIP, SinoMed, ScienceDirect, Springer and Cochrane Library. After the screening, 72 related articles were finally included.
RESULTS AND CONCLUSION: (1) Surgical timing: Compared with delayed anterior cruciate ligament reconstruction, early reconstruction can reduce meniscus injury, elevate quality of life, and improve functional recovery. However, it is still uncertain whether the different operation timing will accelerate cartilage injury. (2) Surgical methods: Arthroscopic anterior cruciate ligament reconstruction is a common surgical method for anterior cruciate ligament injury. Dynamic internal stabilization repair of anterior cruciate ligament can bring similar results to traditional anterior cruciate ligament reconstruction in short-term and long-term effects. (3) Graft selection: Autogenous hamstring tendon is the first choice of anterior cruciate ligament graft, while bone-patellar tendon-bone grafts and allografts are the secondary choices. (4) Among the methods to promote graft healing, suture band strengthening can increase knee joint stability and ensure graft healing. Stem cells promote the tendon-bone healing of grafts through anti-inflammatory action, angiogenesis, inhibition of osteolysis and promotion of chondrocyte differentiation. Preserving the residual end of the anterior cruciate ligament can maintain the stability of the knee joint, promote the recovery of proprioception, and provide a prerequisite for the healing of the graft. The effectiveness of platelet-rich plasma in promoting graft healing remains to be discussed. However, biomaterials, gene therapy, stem cell application and other methods to promote tendon healing remain in the stage of molecular and animal researches. Clinical transformation is also needed in the future.

Key words: anterior cruciate ligament injury, anterior cruciate ligament reconstruction, graft, graft healing, delayed reconstruction, LARS, quadriceps femoris tendon, stem cell, gene, biomaterial

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