Acl Primary Repair with Bone Marrow Stimulation and Growth Factors

The incidences of ligament around the knee have been steadily increasing following an increase in participation in recreational and competitive sporting activities. According to an ongoing study in the United States, an estimated 200,000 anterior cruciate ligament (ACL) reconstructions are performed annually, and the incidence of ACL injury is roughly 1 in 3000 per year. The treatment of acute rupture of ACL is an area of considerable controversy despite many advances in the sports medicine. ACL reconstruction with tendon graft is considered as a gold standard treatment with a high success rate of 80%, but has some disadvantages like poor proprioception, postoperative muscular weakness, inability to restore normal kinematics, and possible premature osteoarthritis. Many long-term follow-up studies have showed that suture repair of partially torn ACL without any biological stimulation presented failure rates of up to 90% and were therefore abandoned. Despite reports of the poor healing potential of the ACL in the past, 18 recent investigations showed the possibility of ACL healing after primary suture of the ligament augmented with the use of growth factors from PRP preparation and bone marrow–derived multipotent mesenchymal stem cells (BMSCs). Considering the fact that ACL injury and associated chondral injury mostly affects young sports population, leading to considerable morbidity, newer biological therapeutic options should be investigated to address these knee injuries effectively.