Uchida Ryohei, Jacob George, Shimomura Kazunori, Horibe Shuji, Nakamura Norimasa
Sports Orthopedic Center, Yukioka Hospital.
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita.
Sports Med Arthrosc Rev. 2020 Jun;28(2):49-55. doi: 10.1097/JSA.0000000000000266.
Historically, anterior cruciate ligament (ACL) suture repair mostly resulted in failure because of intra-articular hypovascularity and poor intrinsic healing capacity of ACL. ACL reconstruction was therefore deemed the gold standard with a high success rate because of more evolved surgical technique. There are, however, clinical and subclinical disadvantages of reconstruction; low rate in full recovery to sports, donor harvest morbidity, tunnel enlargement, and incomplete microscopic healing of the graft. Recent experimental and clinical studies on biological augmentation of mesenchymal stem cells, platelet-rich plasma, or the other biologic agents with scaffold suggested potential feasibility of positive effects by such bio-therapies for both ACL repair and reconstruction. Biological augmentation of ACL surgery is still in the exploratory stages and more evidence from preclinical and clinical studies is required for implementation in clinical practice.
从历史上看，由于关节内血管分布少以及前交叉韧带（ACL）自身愈合能力差，ACL缝合修复大多以失败告终。因此，由于手术技术的不断发展，ACL重建被视为成功率高的金标准。然而，重建存在临床和亚临床方面的缺点；完全恢复运动的比例低、供体取材部位的并发症、隧道扩大以及移植物微观愈合不完全。最近关于间充质干细胞、富血小板血浆或其他生物制剂与支架进行生物增强的实验和临床研究表明，这种生物疗法对ACL修复和重建都有积极作用的潜在可行性。ACL手术的生物增强仍处于探索阶段，临床实践中实施还需要更多来自临床前和临床研究的证据。
