Background: The incidence of knee ligament injury is increasing and represents a significant
cost to healthcare providers. Current interventions include tissue grafts, suture repair and non-surgical
management. These techniques have demonstrated good patient outcomes but have been associated
graft rejection, infection, long term immobilization and reduced joint function. The limitations of traditional
management strategies have prompted research into tissue engineering of knee ligaments.
Objective: This paper aims to evaluate whether tissue engineering of knee ligaments offers a viable
alternative in the clinical management of knee ligament injuries. A search of existing literature was
performed using OVID Medline, Embase, AMED, PubMed and Google Scholar, and a manual review
of citations identified within these papers.
Results: Silk, polymer and extracellular matrix based scaffolds can all improve graft healing and collagen
production. Fibroblasts and stem cells demonstrate compatibility with scaffolds, and have been
shown to increase organized collagen production. These effects can be augmented using growth factors
and extracellular matrix derivatives. Animal studies have shown tissue engineered ligaments can provide
the biomechanical characteristics required for effective treatment of knee ligament injuries.
Conclusion: There is a growing clinical demand for a tissue engineered alternative to traditional management
strategies. Currently, there is limited consensus regarding material selection for use in tissue
engineered ligaments. Further research is required to optimize tissue engineered ligament production
before clinical application. Controlled clinical trials comparing the use of tissue engineered ligaments
and traditional management in patients with knee ligament injury could determine whether they can
provide a cost-effective alternative.