Review ArticlesBiological Augmentation of ACL Repair and Reconstruction: Current Status and Future PerspectiveUchida, Ryohei MD, PhD*; Jacob, George MBBS, MS Ortho†; Shimomura, Kazunori MD, PhD†; Horibe, Shuji MD, PhD‡; Nakamura, Norimasa MD, PhD, FRCS§Author Information *Sports Orthopedic Center, Yukioka Hospital §Institute for Medical Science in Sports, Osaka Health Science University, Osaka †Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita ‡Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan Disclosure: The authors declare no conflict of interest. Reprints: Norimasa Nakamura, MD, PhD, FRCS, Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka City, Osaka 530-0043, Japan. Sports Medicine and Arthroscopy Review: June 2020 - Volume 28 - Issue 2 - p 49-55 doi: 10.1097/JSA.0000000000000266 Buy Metrics Abstract Historically, anterior cruciate ligament (ACL) suture repair mostly resulted in failure because of intra-articular hypovascularity and poor intrinsic healing capacity of ACL. ACL reconstruction was therefore deemed the gold standard with a high success rate because of more evolved surgical technique. There are, however, clinical and subclinical disadvantages of reconstruction; low rate in full recovery to sports, donor harvest morbidity, tunnel enlargement, and incomplete microscopic healing of the graft. Recent experimental and clinical studies on biological augmentation of mesenchymal stem cells, platelet-rich plasma, or the other biologic agents with scaffold suggested potential feasibility of positive effects by such bio-therapies for both ACL repair and reconstruction. Biological augmentation of ACL surgery is still in the exploratory stages and more evidence from preclinical and clinical studies is required for implementation in clinical practice. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.