Biology of anterior cruciate ligament injury and repair: Kappa delta ann doner vaughn award paper 2013

Anterior cruciate ligament (ACL) injuries are currently treated by removing the injured ligament and replacing it with a tendon graft. Recent studies have examined alternative treatment methods, including repair and regeneration of the injured ligament. In order to make such an approach feasible, a basic understanding of ACL biology and its response to injury is needed. Identification of obstacles to native ACL healing can then be identified and potentially resolved using tissue engineering strategies - first, with in vitro screening assays, and then with in vivo models of efficacy and safety. This Perspectives paper outlines this path of discovery for optimizing ACL healing using a bio-enhanced repair technique. This journey has required constructing indices of functional tissue response, pioneering physiologically-based methods of biomechanical testing, developing and validating clinically relevant animal models, and creating and optimizing translationally feasible scaffolds, surgical techniques and biologic additives. Using this systematic translational approach, “bio-enhanced” ACL repair has been advanced to the point where it may become an option for future treatment of acute ACL injuries and the prevention of subsequent post-traumatic osteoarthritis associated with this injury.