Soft tissue-to-bone healing in anterior cruciate ligament reconstruction

The anterior cruciate ligament (ACL) of the knee acts as the primary restraint to anterior translation of the tibia and is a secondary restraint to varus and valgus stress. It is estimated that 800,000 ACL tears occur annually, leading to high levels of knee instability as well as meniscal and cartilage injuries. The most common treatment for ACL tears is reconstruction with intra-articular grafts. This chapter reviews reconstruction strategies for ACL repair, with an emphasis on graft choices and repair techniques. Successful ACL reconstruction relies on incorporation of the graft into the bone tunnel. Poor healing at the interface between the graft and the bone can lead to loosening and potential failure of the reconstruction. The slow and variable outcome of current reconstruction approaches has generated strong interest in biologic, mechanical, and tissue engineering strategies for improving ACL repair.