{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:50:51Z","timestamp":1792083051094,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"vor","delay-in-days":73,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:label\/>\n                    <jats:p>Anterior cruciate ligament (ACL) injury remains a major challenge in sports medicine because it affects a young and active population and is associated with instability, secondary meniscal and chondral damage, delayed return to sport and post\u2010traumatic osteoarthritis. This narrative review provides an ACL\u2010specific overview of orthobiologics, with an emphasis on the biologic rationale, current clinical applications and the strength of the available evidence. The biologic limitations of the native ACL, particularly its poor intrinsic healing capacity in the intra\u2010articular environment, have spurred interest in strategies to improve graft ligamentization, tendon\u2013bone healing, modulation of inflammation and preservation of native ligament tissue. Platelet\u2010rich plasma is the most widely investigated orthobiologic in ACL surgery; however, clinical findings remain inconsistent, largely because of substantial heterogeneity in preparation methods, leukocyte content, activation protocols and delivery sites. Bone marrow aspirate concentrate may provide a broader cellular and cytokine profile, but current studies suggest that any benefit is limited mainly to selective early imaging or functional recovery parameters, without consistent improvement in longer\u2010term patient\u2010reported outcomes. Other cell\u2010based approaches, including adipose\u2010 and synovium\u2010derived therapies, remain investigational and lack sufficient evidence to support routine clinical use. In contrast, scaffold\u2010based biologic repair, particularly bridge\u2010enhanced ACL repair, currently represents the most convincing example of successful biologic translation in this field, with prospective clinical studies demonstrating non\u2010inferior outcomes compared with autograft reconstruction in appropriately selected patients. The available literature remains difficult to interpret because of inconsistent product characterization, variable indications, heterogeneous surgical techniques, frequent reliance on surrogate imaging outcomes and underpowered clinical trials. Orthobiologics in ACL surgery should therefore be considered selective adjuncts rather than standard treatment. Future progress will depend on indication\u2010specific trial design, improved reporting of biologic composition and delivery methods and prioritization of clinically relevant outcomes such as graft failure, knee stability, return to sport and long\u2010term joint preservation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V, narrative review.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70905","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T19:25:16Z","timestamp":1789241116000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Orthobiologics in anterior cruciate ligament injuries"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6883-9486","authenticated-orcid":false,"given":"Marc 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