Strategies to enhance biological tendon-bone healing in anterior cruciate ligament reconstruction

Abstract

Tissue engineering techniques to enhance tendon-bone healing in anterior cruciate ligament (ACL) reconstruction, including stem cells and growth factors/cytokines, are gaining wide acceptance, and their clinical feasibility has also been recognized. Among them, vascular stem cells at the site of ruptured ACL, which have high proliferation and multi-differentiation potential, accelerate tendon-bone healing by enhancing angiogenesis and osteogenesis in human-rat xenotransplantation and canine autologous transplantation model of ACL reconstruction. A pilot clinical study, which used ruptured tissue for ACL reconstruction, indicated reduction of tunnel enlargement despite no improvement in clinical scores. However, for effective clinical application in future, detailed analysis is required regarding enrolled patient demographic parameters, such as age, sex, surgical timing, and type of ACL injury. This chapter highlights effectiveness of vascular stem cells application for early tendon-bone healing in ACL reconstruction, providing an insight for future strategies.