Abstract
Donor site morbidity, poor graft site integration, and incorrect mechanical performance are all common problems associated with autografts for anterior cruciate ligament (ACL) reconstructions. A tissue-engineered (TE) ligament has the potential to overcome these problems. We produced an online questionnaire relating to tissue engineering of the ACL to obtain input from practising clinicians who currently manage these injuries. 300 British orthopaedic surgeons specialising in knee surgery and soft tissue injury were invited to participate. 86% of surgeons would consider using a TE ACL if it were an option, provided that it showed biological and mechanical success, if it significantly improved the patient satisfaction (63%) or shortened surgical time (62%). 76% felt that using a TE ACL would be more appropriate than a patellar tendon, hamstring, or quadriceps autograft. Overall, most surgeons would be prepared to use a TE ACL if it were an improvement over the current techniques.
Highlights
Some of the most frequently ruptured ligaments occur in the knee joint, often through sporting activities such as skiing, football, and basketball
300 British orthopaedic surgeons specialising in knee surgery and soft tissue injury were invited to participate. 86% of surgeons would consider using a TE anterior cruciate ligament (ACL) if it were an option, provided that it showed biological and mechanical success, if it significantly improved the patient satisfaction (63%) or shortened surgical time (62%). 76% felt that using a TE ACL would be more appropriate than a patellar tendon, hamstring, or quadriceps autograft
It is important to include a dialogue with the end users of these products during their development to ensure the correct criteria are being addressed. This survey was targeted at surgeons who performed ACL reconstruction to gain their views on how satisfied they are with the current methods for ACL reconstruction, whether there is a need for an alternative method, and how they would feel about using a tissue-engineered ACL if it were an option
Summary
Some of the most frequently ruptured ligaments occur in the knee joint, often through sporting activities such as skiing, football, and basketball. 75–90% of patients have good or excellent long-term success rates from the current reconstruction techniques regarding functional stability and symptomatic relief upon return to normal activities, but many patients experience unsatisfactory results, which could be attributed to graft failure [7] Some of these patients continue to endure pain, suffer from loss of motion secondary to the procedure, and their instability is not corrected [7]. Surgical reconstruction techniques have limitations and do not always provide completely satisfactory longterm results in a high proportion of patients, affecting their quality of life [7, 11] Because of this dilemma, regenerative medicine could be an option, whereby in vitro tissue engineering of ligaments could offer a solution to the problems associated with the current surgical methods [4, 6]. Tissue-engineered ligaments could provide better performance in the long run by improved biocompatibility, better integration into host tissue, and the ability to remodel their own extracellular matrix [12]
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