Looney Austin MacFarland, Leider Joseph Daniel, Horn Andrew Ryan, Bodendorfer Blake Michael
Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, USA.
SAGE Open Med. 2020 May 12;8:2050312120921057. doi: 10.1177/2050312120921057. eCollection 2020.
Injuries involving the anterior cruciate ligament are among the most common athletic injuries, and are the most common involving the knee. The anterior cruciate ligament is a key translational and rotational stabilizer of the knee joint during pivoting and cutting activities. Traditionally, surgical intervention in the form of anterior cruciate ligament reconstruction has been recommended for those who sustain an anterior cruciate ligament rupture and wish to remain active and return to sport. The intra-articular environment of the anterior cruciate ligament makes achieving successful healing following repair challenging. Historically, results following repair were poor, and anterior cruciate ligament reconstruction emerged as the gold-standard for treatment. While earlier literature reported high rates of return to play, the results of more recent studies with longer follow-up have suggested that anterior cruciate ligament reconstruction may not be as successful as once thought: fewer athletes are able to return to sport at their preinjury level, and many still go on to develop osteoarthritis of the knee at a relatively younger age. The four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) combined in various methods of bioaugmentation have been increasingly explored in an effort to improve outcomes following surgical treatment of anterior cruciate ligament injuries. Newer technologies have also led to the re-emergence of anterior cruciate ligament repair as an option for select patients. The different biological challenges associated with anterior cruciate ligament repair and reconstruction each present unique opportunities for targeted bioaugmentation strategies that may eventually lead to better outcomes with better return-to-play rates and fewer revisions.
涉及前交叉韧带的损伤是最常见的运动损伤之一，也是涉及膝关节的最常见损伤。前交叉韧带是膝关节在旋转和变向活动时的关键平移和旋转稳定器。传统上，对于那些前交叉韧带断裂且希望保持活跃并重返运动的人，建议采用前交叉韧带重建的手术干预方式。前交叉韧带的关节内环境使得修复后实现成功愈合具有挑战性。从历史上看，修复后的结果很差，前交叉韧带重建成为治疗的金标准。虽然早期文献报道重返运动的比例很高，但近期随访时间更长的研究结果表明，前交叉韧带重建可能并不像曾经认为的那样成功：能够恢复到受伤前运动水平的运动员减少，而且许多人仍会在相对年轻时患上膝关节骨关节炎。组织工程的四项原则（细胞、生长因子、支架和机械刺激）以各种生物增强方法相结合，已被越来越多地探索，以改善前交叉韧带损伤手术治疗后的效果。新技术也使前交叉韧带修复重新成为部分患者的一种选择。与前交叉韧带修复和重建相关的不同生物学挑战，为有针对性的生物增强策略提供了独特的机会，这些策略最终可能带来更好的效果、更高的重返运动率和更少的翻修手术。
