Biological enhancement of ACL Reconstruction: Are we there yet?

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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.

IMPORTANT: This event takes place at 8:30pm HKST/8:30am EDT


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

Recorded Video/Audio of Presentation

Recorded Video/Audio of Discussion

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Date And Time

2020-06-24 @ 08:30 PM


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