The future of anterior cruciate ligament restoration

Advancements in the understanding of anatomy, kinematics, and physiology should improve future treatment of anterior cruciate ligament injured knees. The ultimate goal of full restoration of an anterior cruciate ligament injured knee to preinjury status, may be possible in the distant future through genetic manipulation inducing regeneration of tissues. In the midterm future, resorbable stents with incorporated bioactive growth factors have the potential of inducing normal anterior cruciate ligament anatomy without the need for detrimental harvesting of the patient's tissues, or risk of microbial transmission with the use of an allograft. In the near future, the development of more benign autografts and allografts is possible along with methods of resorbable fixation of the graft to bone. Future development of 3-dimensional arthroscopic visualization and robotic surgical techniques have the potential for improvement in graft placement. Advancements in treatment of anterior cruciate ligament deficient knees also can be expected from nonsurgical areas, such as control of muscle atrophy, enhancing cerebellar-proprioceptive rehabilitation, and better bracing techniques. The basic principle of therapy should be to maximize the functional load acceptance and transference capacity of the knee with the least degree of risk to the patient.