Biological Enhancement of ACL Reconstruction: Are we there yet?

ACL reconstruction (ACLR) is successful to restore knee stability, but the surgical outcomes are always compromised by poor biological healing responses. These healing responses include inflammation, re-population of healing cells into the tendon graft, bone tendon junction healing inside tunnels, and re-organization of collagen matrix at graft mid-substance (ligamentization). In fact, the graft does not “heal”, but subject to matrix remodeling processes influenced by regional responses to grafting. At peri-graft regions inside tunnel, bone healing and graft incorporation are compromised by unfavorable mechanical environment, presence of fixation device and unnatural alignment of tendon-to-bone attachment. Collagenous matrix of the tendon graft is unweaving by infiltrated cells for potential graft incorporation and ligamentization, thereby weakening the mechanical properties of the graft. Thus a comprehensive biological enhancement of ACLR should target on: 1) graft deterioration associated with matrix remodeling and 2) poor peri-graft bone quality that compromises graft fixation and incorporation. Numerous animal studies revealed positive effects of biological enhancement in peri-graft region inside bone tunnels, but seldom are working on the graft mid-substance. Clinical trials are limited to relatively harmless modalities like PRP and biophysical intervention. Delivery of bioactive agents in surgeon- and patient-friendly ways are necessary, and imaging modalities to monitor matrix remodeling in graft and inside tunnels are essential.


Patrick Yung MBChB(HK), FRCS(Edin),
FRCS(Edin Ortho Surg), FCSHK, FHKAM(Ortho), FHKCOS
Professor and Chairman of the Department of Orthopaedics & Traumatology
Head of Sports Medicine Team
The Chinese University of Hong Kong


Bruma Fu, MD
Research Technician
Department of Orthopaedics & Traumatology
The Chinese University of Hong Kong


Hong Kong, China

Date and Time

2020-06-24 @ 08:30 PM
* All event times are in EST (Toronto)

Recorded Video/Audio Presentation

Recorded Video/Audio Discussion

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