Biological considerations of tendon graft incorporation within the bone tunnel

Boris A. Zelle, Christian Lattermann, Anikar Chhabra, Freddie H. Fu, Johnny Huard

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Incorporation of the tendon graft within the bone tunnel is crucial for a successful outcome after anterior cruciate ligament reconstruction. Previous studies demonstrated that the incorporation of the tendon graft may take up to several months. Thus, it is of concern whether the early tendon-bone interface is strong enough to tolerate accelerated early postoperative rehabilitation. Biological solutions to enhance tendon healing within the bone tunnel may allow further advances in anterior cruciate ligament surgery. Previous studies emphasized the important role of bone growth factors. In animal models, successful stimulation of graft incorporation has been achieved by the application of bone morphogenetic protein-2. Moreover, periosteal enveloping of the tendon graft has shown to improve the healing response of the tendon graft within the bone tunnel, and preliminary clinical results appear promising. Further advances may be achieved by the use of tissue-engineered ligaments. Successful tissue engineering of ligaments requires optimized structural scaffolds, tissue specific cells, biological stimulation by growth factors, and mechanical stimulation by cyclic stretching.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalOperative Techniques in Orthopaedics
Issue number1
StatePublished - Jan 2005


  • Gene therapy
  • Growth factor
  • Ligament replacement
  • Tissue engineering

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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