A new biological enhancement therapy for anterior cruciate ligament reconstruction: the preclinical proof of anterior cruciate ligament reconstruction with tendon graft reseeded with autologous anterior cruciate ligament

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background The current standard of care to treat a ruptured anterior cruciate ligament (ACL) is ACL reconstruction (ACLR), which involves replacing the torn ligament with a tendon graft. The implanted tendon graft undergoes a graft-maturation process known as ligamentization. However, the synthesis of type III collagen, which is typically found in weaker scar tissue, continues at higher concentrations, and the heterogeneous composition of collagen fibers of varying diameters of native ACL is never restored. Culture-expanded ACL-derived cells reseeded to tendon graft have shown the potential for enhanced ligamentization. We performed in vitro and in vivo studies of the outcomes of ACLR with decellularized tendon grafts reseeded with ACL-derived cells combined with acellularized cruciate ligament matrix (ACLM) powder as a biological scaffold. We hypothesized that this tissue-engineered construct would enhance the graft maturation process and mechanical properties of the graft following ACLR. Methods ACL-derived cells were harvested and isolated from remnants of ruptured ACLs within 4 weeks of injury in patients who had undergone ACLR. An ACLM was prepared from human ACL and posterior cruciate ligament tissues. Forty-five Sprague Dawley rats were randomly divided into 3 groups: a standard allograft group, an ACLM powder-only injection group, and an ACL-derived cells and ACLM powde

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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