Current Advances of Artificial Ligaments for Anterior Cruciate Ligament Reconstruction: From Biocompatibility to Bioactivity

Anterior cruciate ligament (ACL) injuries are frequently caused by sports injuries and trauma. In cases involving complete tears, ACL reconstruction (ACLR) surgery is the only way to restore the ligament’s integrity. When selecting a graft, both the potential complications and the mechanical properties and healing efficacies should be considered. Artificial ligaments have been widely applied in clinical ACLR, and most have exhibited satisfactory biocompatibility and short-term follow-up results. Compared with autografts and allografts, however, the lack of bioactivity of currently available artificial ligaments is a major disadvantage. In addition, some long-term follow-up results have revealed other drawbacks of artificial ligaments, such as graft failure and other complications. Here, we summarize attempts to enhance the bioactive performance of artificial ligaments, as such modifications may have good potential for clinical translation and could improve the long-term outcomes of existing products.