Biologics for ACL Injuries
How are biologics used in ACL tears?
The idea behind biologics in ACL reconstruction is that their use can help to facilitate improved tissue healing, incorporation of the graft in the tunnels drilled in the knee, as well as to help minimize any potential graft failure after surgery. Compared to injury of some of the other ligaments in the knee, the ACL has limited ability to heal on its own. One of the key points is that biologics have the potential to offer the most benefit when used together with a surgical procedure. Biologics can be used in patients who have acute or chronic tears to the ACL. Popular biologics used in orthopedic sports medicine include platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC). In regard to PRP, blood is taken from the arm of the patient and placed into a machine, spun down to concentrate a large amount of platelets to be applied to the tissue. For BMAC, a sample of bone marrow from the patient’s own body can be taken under local anesthesia from the tibia or iliac crest. The concentrate of cells contains a significant number of pluripotent cells, including growth factors, to aid in healing of the ACL. These forms of treatment may have additional benefit in those with only partial tears to the ACL as localized delivery of biologics can result in tissue repair without the need for surgery. If a patient requires surgery, the biologics can be injected directly to the ACL chosen to focus healing properties to the ligament (See Picture). Biologics are usually not used in isolation for complete tears as they cannot regenerate the ligament.