Collagen type I fiber-based scaffolds for anterior cruciate ligament (ACL) replacement were evaluated for their mechanical properties and their ability to promote cellular proliferation. Prior to scaffold formation, two crosslinking methods were investigated on individual reconstituted collagen type I fibers, ultraviolet radiation, and 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC). Crosslinking with EDC for 4 hr yielded mechanical properties similar to the human ACL; therefore, scaffold crosslinking was done with EDC for 4 hr. A braid-twist scaffold design was used, and scaffolds were left uncrosslinked, crosslinked after the addition of gelatin, or crosslinked without gelatin. The ultimate tensile strength, Young's modulus, and viscoelastic properties of the scaffolds were then evaluated. In order to assess cellular response on the scaffolds, primary rat ligament fibroblast cells were seeded upon the scaffolds. Cell activity was evaluated at days 7, 14, and 21 using a Cell Titer 96(®) AQueous One Solution Cell Proliferation Assay (MTS Assay). The mechanical testing results showed that among the three scaffold groups, the crosslinked scaffolds without gelatin displayed an ultimate tensile strength, Young's modulus, and viscoelastic properties that were closest to the human ACL. Improvements are still desired to enhance the mechanical compliance and ductility of these scaffolds. Cell activity was observed on all cell-seeded scaffolds by day 7, but by day 21 only the crosslinked scaffolds without gelatin displayed increased cellular activity compared with the negative controls. Although improvement is still needed, the results suggest that these scaffolds have the potential to contribute toward an ACL replacement strategy.

Among the five ligaments in the knee the anterior cruciate ligament (ACL) is among the most important for stability and also the most commonly injured. Due to a lack of vascularization, the ACL has poor healing potential, therefore moderate to severe damage warrants medical intervention. Ligaments are complex, highly organized tissues; they are longitudinally arranged with a great deal of order that begins at the molecular level and carries through to the tissue level. The components of the ligament and their location and orientation heavily influence the tissue's mechanical behavior. ACL replacements have faced a variety of limitations that prevented their extensive use, including implant fatigue or fraying of the device. In the face of these problems, investigators have begun to examine a variety of matrix based techniques to create options for ACL repair, replacement, and regeneration. This article will discuss ACL structure and mechanics, past replacement options and their limitations, and recent tissue engineered options for ACL repair. These techniques employ a wide variety of designs, materials, and methods to heal damaged ACL tissue or regenerate lost tissue in order to regain full ACL strength and mechanics.