Nanocoating Strategies for Enhancing Traditional PET Anterior Cruciate Ligament Grafts

Abstract

Anterior cruciate ligament (ACL) injuries are becoming increasingly common nowadays. Anterior cruciate ligament replacement (ACLR) is the surgery people turn to in most cases. Autografts are often the first choice for ACLR, but harvesting autografts prolongs recovery time and damage the healthy tendon in the other area. For artificial ligaments, polyethylene terephthalate (PET) ACL is mostly used; they do not have autograft’ s drawbacks but are constrained by their lack of bone integration, low wear resistance, and infection risk. Recent advances in nanocoatings provide insight into improving the PET ACL surface’s properties. Nanocoatings made of bone morphogenetic protein (BMP)-2-loaded ligament, triple-nano-coated ligament, and hydroxyapatite (HAp) have shown significant promise in improving bone integration. The nano-TiN composite exhibits excellent wear resistance. Metal-based and carbonbased nanocoatings have also proven to be effective in preventing infection risks. Despite its advantages, there are still issues, such as the toxicity of nanoparticles, the gap between humans and small animals, and the neglect of soft tissue integration. This review suggests nanocoating techniques for enhancing conventional PET ACLs and provides direction for future ACLR development.