Stem Cells and Ligament Repair: Translational Aspects in Dogs and Humans

CCL/ACL rupture is a common injury with high prevalence in dogs and humans. It results in a spectrum of secondary symptoms including stifle laxity, locomotory dysfunction, meniscus and cartilage damage and mild to severe osteoarthritis. It is generally accepted that the CCL in dogs ruptures as part of a degenerative pathway (CCL disease), with partial CCL rupture being diagnosed frequently. In humans, a traumatic injury is considered the classic ACL rupture pathway in sports medicine. However partial ruptures and degenerative ruptures are also seen. The common denominator for both species is that the intraarticular ligaments of the stifle have poor intrinsic regenerative properties. Conservative treatment in veterinary medicine and surgical suture techniques in human medicine often fail, which has shifted the treatment approach to osteotomies and extraarticular stabilization techniques in dogs and ACL reconstruction using autologous intraarticular grafts in humans. Superior clinical safety over primary reconstruction of the ligament is the driver for this development.

With improved knowledge of ligament healing and development of biological strategies for treatment, novel repair approaches such as bio-enhanced repair and dynamic intraligamentary stabilization have been introduced and are currently being tested in clinical and in translational studies.

Although joint stabilization appears to be adequately achieved with current techniques, there remain issues in the preoperative, postoperative and long-term treatment of CCL/ACL rupture.

Preoperative aspects include the optimal preparation of an injured/inflamed joint to surgical therapy or conservative management.  [...]