Osteointegration of soft tissue grafts within the bone tunnels in anterior cruciate ligament reconstruction can be enhanced.
Anterior cruciate ligament reconstruction with a soft tissue autograft (hamstring autograft) has grown in popularity in the last 10 years. However, the issues of a relatively long healing time and an inferior histological healing result in terms of Sharpey-like fibers connection in soft tissue grafts are still unsolved. To obtain a promising outcome in the long run, prompt osteointegration of the tendon graft within the bone tunnel is essential. In recent decades, numerous methods have been reported to enhance osteointegration of soft tissue graft in the bone tunnel. In this article, we review the current literature in this research area, mainly focusing on strategies applied to the local bone tunnel environment. Biological strategies such as stem cell and gene transfer technology, as well as the local application of specific growth factors have been reported to yield exciting results. The use of biological bone substitute and physical stimulation also obtained promising results. Artificially engineered tissue has promise as a solution to the problem of donor site morbidity. Despite these encouraging results, the current available evidence is still experimental. Further clinical studies in terms of randomized control trial in the future should be conducted to extrapolate these basic science study findings into clinical practice.
Kuang
Guan-Ming
GM
Department of Orthopaedics and Traumatology, LKS Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. kuanggm@gmail.com
Yau
W P
WP
Lu
William W
WW
Chiu
K Y
KY
D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001843:Bone Cements; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D005346:Fibroblast Growth Factors; D015316:Genetic Therapy; D006085:Graft Survival; D019220:High-Energy Shock Waves; D006801:Humans; D018836:Inflammation Mediators; D016348:Osseointegration; D010521:Periosteum / Q000637:transplantation; D033581:Stem Cell Transplantation; D013710:Tendons / Q000473:pathology / Q000637:transplantation; D023822:Tissue Engineering; D015291:Transforming Growth Factors; D014182:Transplantation, Autologous; D014464:Ultrasonic Therapy
D001843:Bone Cements; D019485:Bone Morphogenetic Proteins; D018786:Bone Substitutes; D018836:Inflammation Mediators; D005346:Fibroblast Growth Factors; D015291:Transforming Growth Factors