Biologic Approaches for the Treatment of Partial Tears of the Anterior Cruciate Ligament: A Current Concepts Review

Ignacio Dallo, Jorge Chahla, Justin J Mitchell, Cecilia Pascual-Garrido, John A Feagin, Robert F LaPrade, Ignacio Dallo, Jorge Chahla, Justin J Mitchell, Cecilia Pascual-Garrido, John A Feagin, Robert F LaPrade

Abstract

Background: Anterior cruciate ligament reconstruction (ACLR) has been established as the gold standard for treatment of complete ruptures of the anterior cruciate ligament (ACL) in active, symptomatic individuals. In contrast, treatment of partial tears of the ACL remains controversial. Biologically augmented ACL-repair techniques are expanding in an attempt to regenerate and improve healing and outcomes of both the native ACL and the reconstructed graft tissue.

Purpose: To review the biologic treatment options for partial tears of the ACL.

Study design: Review.

Methods: A literature review was performed that included searches of PubMed, Medline, and Cochrane databases using the following keywords: partial tear of the ACL, ACL repair, bone marrow concentrate, growth factors/healing enhancement, platelet-rich plasma (PRP), stem cell therapy.

Results: The use of novel biologic ACL repair techniques, including growth factors, PRP, stem cells, and bioscaffolds, have been reported to result in promising preclinical and short-term clinical outcomes.

Conclusion: The potential benefits of these biological augmentation approaches for partial ACL tears are improved healing, better proprioception, and a faster return to sport and activities of daily living when compared with standard reconstruction procedures. However, long-term studies with larger cohorts of patients and with technique validation are necessary to assess the real effect of these approaches.

Keywords: anterior cruciate ligament repair; bone marrow aspirate concentrate; healing enhancement; partial anterior cruciate ligament tear; platelet-rich plasma; stem cell therapy.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: R.F.L. is a consultant for and receives royalties from Arthrex, Ossur, and Smith & Nephew.

Figures

Figure 1.
Figure 1.
Magnetic resonance imaging (sagittal view) demonstrating a partial anterior cruciate ligament (ACL) tear. On the upper-right corner, the corresponding arthroscopic view (through the anterolateral portal) shows the posterolateral bundle tear of the ACL in a left knee.
Figure 2.
Figure 2.
Lateral view of a right knee with the medial femoral condyle removed to reveal the insertion of the anterior cruciate ligament (ACL) on the medial wall of the lateral femoral condyle. This image demonstrates the insertion of the ACL posterior to the lateral intercondylar ridge (resident’s ridge), and the positions of the posterolateral (PL) and anteromedial (AM) ACL bundles.
Figure 3.
Figure 3.
Arthroscopic view of partial tear of the anterior cruciate ligament (ACL) in a right knee treated with an injection of platelet-rich plasma (PRP) as viewed through the anteromedial portal.

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