Biologics, Stem Cells, Growth Factors, Platelet-Rich Plasma, Hemarthrosis, and Scaffolds May Enhance Anterior Cruciate Ligament Surgical Treatment

Arthroscopy. 2023 Feb;39(2):166-175. doi: 10.1016/j.arthro.2022.11.006. Epub 2022 Nov 9.


Biologics including mesenchymal stem cells (MSCs), growth factors, and platelet-rich plasma may enhance anterior cruciate ligament (ACL) reconstruction and even ACL primary repair. In addition, hemarthrosis after acute ACL injury represents a source of biologic factors. MSCs can differentiate into both fibroblasts and osteoblasts, potentially providing a transition between the ligament or graft and bone. MSCs also produce cytokines and growth factors necessary for cartilage, bone, ligament, and tendon regeneration. MSC sources including bone marrow, synovium, adipose tissue, ACL-remnant, patellar tendon, and umbilical cord. Also, scaffolds may represent a tool for ACL tissue engineering. A scaffold should be porous, which allows cell growth and flow of nutrients and waste, should be biocompatible, and might have mechanical properties that match the native ACL. Scaffolds have the potential to deliver bioactive molecules or stem cells. Synthetic and biologically derived scaffolds are widely available. ACL reconstruction with improved outcome, ACL repair, and ACL tissue engineering are promising goals. LEVEL OF EVIDENCE: Level V, expert opinion.

MeSH terms

  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries* / surgery
  • Biological Factors
  • Biological Products* / therapeutic use
  • Hemarthrosis
  • Humans
  • Mesenchymal Stem Cells*
  • Platelet-Rich Plasma*
  • Tissue Scaffolds


  • Biological Products
  • Biological Factors