Application of internal brace ligament augmentation technology in repair and reconstruction of cruciate ligament injuries_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Hongmai , SHI ZhengLiang , RUAN Zhaohui , LI Kaiquan , ZHANG Minyuan ,  LI Yanlin

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

LI Yanlin, Email: liyanlin@kmmu.edu.cn

Keywords：

Internal brace ligament augmentation technology; anterior cruciate ligament; posterior cruciate ligament; ligament reconstruction; ligament repair

DOI：

10.7507/1002-1892.202509051

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the application progress of internal brace ligament augmentation (IBLA) technology in the repair and reconstruction of anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, and to clarify the development trends of IBLA technology. Methods A comprehensive review of recent domestic and international in vitro and in vivo biomechanical studies, animal experiments, and clinical research on IBLA technology was conducted. The effects of this technology on postoperative biomechanics, histological changes, and clinical outcomes following ACL and PCL repair and reconstruction were analyzed and summarized. Results IBLA technology provides enhanced knee stability in the early postoperative period after ACL and PCL repair and reconstruction. It promotes healing at the ligament injury site and increases the biomechanical strength of tendon grafts, thereby reducing postoperative failure rates. IBLA demonstrates good histocompatibility in vivo. Clinical follow-up shows that IBLA improves early postoperative knee stability, range of motion, and functional scores. Patients undergoing rapid rehabilitation achieve more satisfactory outcomes, with no reported serious complications. Conclusion The combination of IBLA with ACL and PCL repair and reconstruction promotes rapid early postoperative recovery and shows promising application prospects. However, further optimization of IBLA material properties and related surgical techniques is needed. Additionally, the long-term effectiveness, structural remodeling of the grafts and repaired ligaments, and the underlying biomechanical functional mechanisms require further clarification.

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1. Vermeijden HD, van der List JP, DiFelice GS. Arthroscopic posterior cruciate ligament primary repair. Sports Med Arthrosc Rev, 2020, 28(1): 23-29.
2. 哈斯魯, 劉利國, 張謝卓, 等. 膝關節后交叉韌帶損傷的修復與重建. 中國組織工程研究, 2015, 19(51): 8322-8326.
3. 趙正呂, 李彥林, 王旭, 等. 后交叉韌帶重建移植物的特點與選擇. 中國組織工程研究, 2022, 26(10): 1615-1619.
4. van der Graaff SJA, Meuffels DE, Bierma-Zeinstra SMA, et al. Why, when, and in which patients nonoperative treatment of anterior cruciate ligament injury fails: An exploratory analysis of the COMPARE trial. Am J Sports Med, 2022, 50(3): 645-651.
5. Kennedy JC, Roth JH, Mendenhall HV, et al. Presidential address. Intraarticular replacement in the anterior cruciate ligament-deficient knee. Am J Sports Med, 1980, 8(1): 1-8.
6. Ahmad SS, Schreiner AJ, Hirschmann MT, et al. Dynamic intraligamentary stabilization for ACL repair: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2019, 27(1): 13-20.
7. Endre? F, H?rner R, Hauth W, et al. Early complication analysis of dynamic intraligamentary stabilization versus anterior cruciate ligament reconstruction. J Pers Med, 2023, 13(7): 1022. doi: 10.3390/jpm13071022.
8. Eggli S, Kohlhof H, Zumstein M, et al. Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc, 2015, 23(4): 1215-1221.
9. Heusdens CHW, Zazulia K, Roelant E, et al. Study protocol: a single-blind, multi-center, randomized controlled trial comparing dynamic intraligamentary stabilization, internal brace ligament augmentation and reconstruction in individuals with an acute anterior cruciate ligament rupture: LIBRE study. BMC Musculoskelet Disord, 2019, 20(1): 547. doi: 10.1186/s12891-019-2926-0.
10. Murray MM, Forsythe B, Chen F, et al. The effect of thrombin on ACL fibroblast interactions with collagen hydrogels. J Orthop Res, 2006, 24(3): 508-515.
11. Zhang M, Zhen J, Zhang X, et al. Effect of autologous platelet-rich plasma and gelatin sponge for tendon-to-bone healing after rabbit anterior cruciate ligament reconstruction. Arthroscopy, 2019, 35(5): 1486-1497.
12. Shah AK, Neijna AG, Retzky JS, et al. Indications, techniques, and outcomes of bridge-enhanced ACL restoration (BEAR). Curr Rev Musculoskelet Med, 2025, 18(4): 140-148.
13. Shah AK, Rizy ME, Neijna AG, et al. A preliminary study of post-market bridge-enhanced ACL restoration (BEAR) suggests non-inferior short-term outcomes and low complications. HSS J, 2024, 21(4): 404-413.
14. Murray MM, Spindler KP, Ballard P, et al. Enhanced histologic repair in a central wound in the anterior cruciate ligament with a collagen-platelet-rich plasma scaffold. J Orthop Res, 2007, 25(8): 1007-1017.
15. Lubowitz JH, MacKay G, Gilmer B. Knee medial collateral ligament and posteromedial corner anatomic repair with internal bracing. Arthrosc Tech, 2014, 3(4): e505-e508.
16. McIntyre V, Hopper GP, Mackay GM. Anterior cruciate ligament repair in a professional soccer player using internal brace ligament augmentation: A case report focusing on rehabilitation. Surg Technol Int, 2019, 35: 341-348.
17. Wilson WT, Hopper GP, Banger MS, et al. Anterior cruciate ligament repair with internal brace augmentation: A systematic review. Knee, 2022, 35: 192-200.
18. 盧曉君. 新型ACL內減張增強系統輔助重建食蟹猴ACL的功效分析. 昆明: 昆明醫科大學, 2024.
19. Cook JL, Luther JK, Beetem J, et al. Clinical comparison of a novel extracapsular stabilization procedure and tibial plateau leveling osteotomy for treatment of cranial cruciate ligament deficiency in dogs. Vet Surg, 2010, 39(3): 315-323.
20. 徐飛, 李彥林, 王國梁, 等. 內減張技術在輔助前交叉韌帶重建中的研究進展. 中國修復重建外科雜志, 2021, 35(12): 1630-1636.
21. Bachmaier S, Smith PA, Bley J, et al. Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: A biomechanical full construct model. Arthroscopy, 2018, 34(2): 490-499.
22. Soreide E, Denbeigh JM, Lewallen EA, et al. In vivo assessment of high-molecular-weight polyethylene core suture tape for intra-articular ligament reconstruction: an animal study. Bone Joint J, 2019, 101-B(10): 1238-1247.
23. Massey P, Parker D, McClary K, et al. Biomechanical comparison of anterior cruciate ligament repair with internal brace augmentation versus anterior cruciate ligament repair without augmentation. Clin Biomech (Bristol), 2020, 77: 105065. doi: 10.1016/j.clinbiomech.2020.105065.
24. 陳思奇. 新型內支架結構伴脛骨過線固定在后交叉韌帶重建術中的生物力學研究. 沈陽: 中國醫科大學, 2024.
25. Trasolini NA, Hatch GF, Wright D, et al. Posterior cruciate ligament reconstruction with internal brace augmentation reduces posterior tibial translation under cyclic loading. Orthopedics, 2021, 44(4): 235-240.
26. Malige A, Carbone A, Huang DT, et al. Biomechanical evaluation of posterolateral corner reconstruction with suture augmentation in a posterolateral corner and posterior cruciate ligament deficient knee model. Clin Biomech (Bristol), 2025, 123: 106461. doi: 10.1016/j.clinbiomech.2025.106461.
27. Grotting JA, Nelson TJ, Banffy MB, et al. Biomechanical evaluation of PCL reconstruction with suture augmentation. Knee, 2020, 27(2): 375-383.
28. Cook JL, Smith P, Stannard JP, et al. A canine arthroscopic anterior cruciate ligament reconstruction model for study of synthetic augmentation of tendon allografts. J Knee Surg, 2017, 30(7): 704-711.
29. Conzemius MG, Evans RB, Besancon MF, et al. Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs. J Am Vet Med Assoc, 2005, 226(2): 232-236.
30. 熊波涵, 王國梁, 余洋, 等. 內減張技術輔助前交叉韌帶重建促進滇南小耳豬跟腱移植物韌帶化. 中國組織工程研究, 2025, 29(4): 713-720.
31. 熊波涵, 盧曉君, 薛文強, 等. 內減張技術輔助前交叉韌帶重建對滇南小耳豬關節軟骨的保護作用. 中國組織工程研究, 2024, 28(14): 2221-2226.
32. Murray MM, Martin SD, Martin TL, et al. Histological changes in the human anterior cruciate ligament after rupture. J Bone Joint Surg (Am), 2000, 82(10): 1387-1397.
33. Murray MM. Current status and potential of primary ACL repair. Clin Sports Med, 2009, 28(1): 51-61.
34. Takahashi T, Kondo E, Yasuda K, et al. Effects of remnant tissue preservation on the tendon graft in anterior cruciate ligament reconstruction: A biomechanical and histological study. Am J Sports Med, 2016, 44(7): 1708-1716.
35. Amini M, Venkatesan JK, Liu W, et al. Advanced gene therapy strategies for the repair of ACL injuries. Int J Mol Sci, 2022, 23(22): 14467. doi: 10.3390/ijms232214467.
36. Murray MM. Optimizing outcomes of ACL surgery—Is autograft reconstruction the only reasonable option? J Orthop Res, 2021, 39(9): 1843-1850.
37. Jabara J, Trotter M, Confino JE, et al. Anterior cruciate ligament repair with suture tape augmentation using self-tapping knotless anchors. Arthrosc Tech, 2025, 14(6): 103532. doi: 10.1016/j.eats.2025.103532.
38. Hopper GP, Aithie JMS, Jenkins JM, et al. Combined anterior cruciate ligament repair and anterolateral ligament internal brace augmentation: Minimum 2-year patient-reported outcome measures. Orthop J Sports Med, 2020, 8(12): 2325967120968557. doi: 10.1177/2325967120968557.
39. Zhao L, Lu M, Deng M, et al. Arthroscopy primary double-bundle repair of anterior cruciate ligament with internal brace augmentation and a knotless anchor implant. Arthrosc Tech, 2020, 9(12): e1927-e1935.
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