Abstract
The purpose of this study is to review the surgical methods of enhancing anterior cruciate ligament (ACL) graft maturation. Several methods of ACL maturation enhancement were identified through research of the literature available in the PubMed database. ACL remnant preservation was the most extensively investigated technique. ACL reconstruction with a pedunculated hamstring graft provides superior revascularization of the graft along with higher mechanical strength. The usage of a graft enveloped with a periosteum was proposed to enhance the tendon-bone unit formation, and consequently, to prevent the bone tunnel widening. The muscle tissue on the graft is a potential source of stem cells. However, an excessive amount may weaken whole graft strength despite its enhanced remodeling. Similarly, amniotic tissue may augment the ACL reconstruction with stem cells and growth factors. Despite the existence of several surgical techniques that utilize amnion, the outcomes of these augmentation methods are lacking. Lastly, the intra-articular transplantation of the synovium on the surface of an ACL was proposed to augment the graft with synovial tissue and blood vessels. In conclusion, diverse approaches are being developed in order to enhance the maturation of an ACL reconstruction graft. Although these approaches have their foundation in on well-established scientific research, their outcomes are still equivocal. Clinical trials of high quality are needed to evaluate their utility in clinical practice.
Highlights
Recent decades have witnessed progress in the management of anterior cruciate ligament (ACL) tears
Several emerging techniques for ACL reconstruction surgical enhancement have been reported in the literature
ACL remnant preservation was the most extensively investigated technique, but its beneficial effect differs depending on the assessed outcomes
Summary
Recent decades have witnessed progress in the management of anterior cruciate ligament (ACL) tears. Despite the favorable outcomes, still up to 9% of reconstructed ACLs fail at 25 years of follow-up, with young, active patients being especially at risk [1]. These factors have laid the groundwork for increased interest in methods of ACL graft maturation enhancement. The evidence supporting their use is constantly growing, their influence on the outcomes of ACL reconstruction remains a matter of debate. Besides these augmentative techniques, several other surgical methods have been proposed to boost ACL graft maturation. The purpose of this narrative review is to provide an insight into the scientific background of alternative “biosurgical” methods for ACL graft maturation enhancement, outline their premises and report their clinical outcomes
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