Arthroscopy: The Journal of Arthroscopic & Related Surgery
Current conceptTissue Engineering for Anterior Cruciate Ligament Reconstruction: A Review of Current Strategies
Section snippets
Ligament healing
An appreciation of the physiology underlying ligament healing is necessary to efficiently formulate a system for ex vivo ligament engineering. In many extra-articular ligaments, such as the medial collateral ligament (MCL), healing occurs in 3 phases: hemostasis and inflammation, cellular proliferation and matrix deposition, and long-term remodeling.27, 28, 29 During the initial 72 hours following ligament injury, a hematoma develops within the soft tissue surrounding the ligament. This area is
Ligament engineering
The development of a functional engineered ligament is predicated on a system that uses (1) reparative cells with the capacity for proliferation and matrix synthesis, (2) a structural scaffold that facilitates cell adaptation, and (3) an environment that provides sufficient nutrient transport and appropriate regulatory stimuli (Fig 1). These constituents may be applied in either an in vivo or ex vivo system. In vivo ligament engineering uses a scaffold that is designed to be implanted into the
The UCLA experience
The aforementioned investigations represent the foundation of knowledge of ligament engineering. Collectively, the data suggest that fibroblasts and mesenchymal stem cells can be cultured on natural and synthetic ligament scaffolds, and that these cells respond to a number of biochemical and mechanical stimuli by proliferation, differentiation, and elaboration of ECM. However, the goal of synthesizing a functional ligament, or simply a tissue that can withstand biomechanical testing, has yet to
Summary
The current strategies applied to ACL reconstruction are satisfactory. However, the goal of improving this procedure and eliminating its associated complications is a practical one. With the heightened emphasis on fitness and athleticism in the United States, the prevalence of ACL injuries will likely continue to rise. A suitable tissue-engineered ACL replacement may obviate many of the current shortcomings of current autograft and allograft techniques, while allowing patients to promptly
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