Abstract
The anterior cruciate ligament (ACL) of the knee joint is one of the strongest ligaments of the body and is often the target of traumatic injuries. Unfortunately, its healing potential is limited, and the surgical options for its replacement are frequently associated with clinical issues. A bioengineered ACL (bACL) was developed using a collagen matrix, seeded with autologous cells and successfully grafted and integrated into goat knee joints. We hypothesize that, in order to reduce the cost and simplify the model, an acellular bACL can be used as a substitute for a torn ACL, and bone plugs can be replaced by endobuttons to fix the bACL in situ. First, acellular bACLs were successfully grafted in the goat model with 18% recovery of ultimate tensile strength 6 months after implantation (94 N/mm2 vs. 520). Second, a bACL with endobuttons was produced and tested in an exvivo bovine knee model. The natural collagen scaffold of the bACL contributes to supporting host cell migration, growth and differentiation in situ post-implantation. Bone plugs were replaced by endobuttons to design a second generation of bACLs that offer more versatility as biocompatible grafts for torn ACL replacement in humans. A robust collagen bACL will allow solving therapeutic issues currently encountered by orthopedic surgeons such as donor-site morbidity, graft failure and post-traumatic osteoarthritis.
Highlights
High-pivoting sporting activities can result in a ruptured anterior cruciate ligament (ACL), with an annual incidence of 68.6 per 100,000 person years [1]
Injury, treatments range from nonoperative care to several surgical procedures, including autografts or allografts derived from the hamstring tendons, the quadriceps tendon or the gold-standard bone-patellar tendon-bone (BPTB) [5,6,7,8,9]
The first generation of bioengineered ACL (bACL) was designed according to the bone-patellar tendonbone (BPTB) graft, as it consists of tendon and bony attachments
Summary
High-pivoting sporting activities can result in a ruptured anterior cruciate ligament (ACL), with an annual incidence of 68.6 per 100,000 person years [1]. Affected people are mainly adolescents and young adults between 15 and 34 [3,4].Depending on the severity of the ACL injury, treatments range from nonoperative care to several surgical procedures, including autografts or allografts derived from the hamstring tendons (semitendinosus ± gracilis), the quadriceps tendon or the gold-standard bone-patellar tendon-bone (BPTB) [5,6,7,8,9]. Regardless of the cost of ACL reconstruction for healthcare systems, drawbacks of the current reconstruction method include the length of the recovery period [11], donor-site morbidity, frequent failure in the adolescent population [12,13,14] and a high rate of post-traumatic osteoarthritis a decade after ACL injury [15]. Better strategies to restore the stability of the knee are needed
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