Orthobiologics in anterior cruciate ligament (ACL) reconstruction: A narrative review

Anterior cruciate ligament (ACL) injury is one of the most frequent injuries in sports medicine. Despite advancements in surgical techniques, suboptimal results in terms of delayed graft incorporation into bone tunnels and ligamentization, as well as inferior clinical outcomes, still present significant challenges in treating these injuries. Orthobiological modalities such as platelet-rich plasma (PRP) and stem cells have emerged as a potential adjunct to ACL treatment, with a theoretical advantage in enhancing local biological processes and subsequent improvements in clinical outcomes. Embase, Cochrane, and PubMed databases were searched for relevant literature. The aim of this narrative review was to summarize the currently available evidence on the efficacy of orthobiologics, or the lack thereof, in ACL repair and reconstruction (ACLR), with emphasis on graft incorporation into bone tunnels, ligamentization, and overall clinical outcomes. These modalities exert their theoretical effect by delivering growth factors, anti-inflammatory cytokines, and regenerative cells to the target site, which enhance local biological processes. Although some research has shown positive effects of orthobiologics in ACLR, clinical outcomes remain inconsistent, without consensus on preparation methods and administration protocols. The lack of homogeneous, high-quality methodology in existing studies limits the possibility of drawing definitive conclusions on the efficacy of orthobiologics in ACLR. Although orthobiological modalities provide theoretical benefits in improving outcomes, until more robust evidence is available regarding their efficacy and optimal application methods, their routine use warrants caution and cannot yet be recommended. Future research should focus on improving and standardizing clinical and research protocols before drawing any definitive conclusions on this matter.