Future challenges of anterior cruciate ligament reconstruction biological modulation using a growth factor application for enhancement of graft healing

Abstract

Although anterior cruciate ligament (ACL) reconstruction techniques using tendon autograft have improved markedly over the last couple of decades, the slow graft maturation may result in graft failure or elongation during the postoperative rehabilitation period. To improve the problems after ACL reconstruction in the near future, we should challenge to develop a new strategy to promote graft healing using biological modulation. Preclinical animal studies need scrutiny to see if further clinical trials are worthwhile. If a plurispecies approach is taken to confirm the findings, animal studies convey useful information for a better understanding on the effectiveness of biological modulation on ACL reconstruction. Our recent experimental findings using a plurispecies approach suggested that biological modulation by a TGF-beta1 application inhibits the deterioration of mechanical properties of the grafted tendon after ACL reconstruction. However, intraarticular administration of TGF-beta may be unsuitable for clinical application with an ACL reconstruction procedure, since recent studies reported that intraarticular administration of TGF-beta1 induced arthritic changes of the articular cartilage in the knee joint. The cell-based therapy with cellular activation by TGF-beta1 may be a potential solution against this problem. Translational research should be conducted to put biological modulation by a TGF-beta1 application into clinical use for the enhancement of graft healing after ACL reconstruction in the future.