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Dimitrios Kouroupis, Sarah M. Churchman, Peter V. Giannoudis and Elena Jones
Tendon and ligament injuries are the most common problems in adult health accounting for about half of all musculoskeletal injuries. Rupture of the anterior cruciate ligament (ACL) results in the loss of whole joint stability leading to meniscal rupture, cartilage damage and early osteoarthritis. Arthroscopic reconstruction using autografts or allografts has known drawbacks such as ligament laxity, donor site morbidity and long recovery periods. In addition to the appropriate mechanical environment, several biological factors have been implicated in the ACL healing process including specialised growth factors and mesenchymal stem cells (MSCs). However, in order to produce a superior molecular and biomechanical ACL there will be always the need to provide a suitable scaffold to ‘house’ MSCs and to provide adequate biomechanical properties in order for the regeneration process to proceed. Understanding the mechanisms of ACL healing following cellular therapy may lead to novel, more effective and biological-based tissue engineering strategies for ACL reconstruction. The focus of this review is the current knowledge of ACL reconstruction after joint trauma when combining MSC and tissue engineering technologies.