Long-term effects of knitted silk–collagen sponge scaffold on anterior cruciate ligament reconstruction and osteoarthritis prevention

Abstract Anterior cruciate ligament (ACL) is difficult to heal after injury due to the dynamic fluid environment of joint. Previously, we have achieved satisfactory regeneration of subcutaneous tendon/ligament with knitted silk–collagen sponge scaffold due to its specific “internal-space-preservation” property. This study aims to investigate the long-term effects of knitted silk–collagen sponge scaffold on ACL regeneration and osteoarthritis prevention. The knitted silk–collagen sponge scaffold was fabricated and implanted into a rabbit ACL injury model. The knitted silk–collagen sponge scaffold was found to enhance migration and adhesion of spindle-shaped cells into the scaffold at 2 months post-surgery. After 6 months, ACL treated with the knitted silk–collagen sponge scaffold exhibited increased expression of ligament genes and better microstructural morphology. After 18 months, the knitted silk–collagen sponge scaffold-treated group had more mature ligament structure and direct ligament-to-bone healing. Implanted knitted silk–collagen sponge scaffolds degraded much more slowly compared to subcutaneous implantation. Furthermore, the knitted silk–collagen sponge scaffold effectively protected joint surface cartilage and preserved joint space for up to 18 months post-surgery. These findings thus demonstrated that the knitted silk–collagen sponge scaffold can regenerate functional ACL and prevent osteoarthritis in the long-term, suggesting its clinical use as a functional bioscaffold for ACL reconstruction.