1 Introduction</h5> Anterior cruciate ligament (ACL) reconstruction is usually performed by the transfer of a free tendon graft into a bone tunnel. The functional outcome of ligament reconstruction relies on the firm healing of tendon to bone in the bone tunnel. The phenomenon of ligamentization after free autograft ACL reconstruction remains controversial  . Previous studies showed conflicting results [2–9] . Some studies demonstrated the phenomenon of ligamentization after implantation of tendon autograft into a bone tunnel [2,5,7–9] . However, other studies showed the opposite results and concluded that metaphyseal bone and tendon do not heal together [3,4,6] .</P>Many factors may influence the healing of tendon to bone in ACL surgery. Some studies demonstrated that bone morphogenic protein is effective in promoting bone formation and the healing of tendon to bone in a bone tunnel [10–13] . Other studies attempted to improve the healing of tendon to bone with different modalities including periosteum augmentation, calcium phosphate cement, tricalcium phosphate, calcium phosphate–hybridized tendon, granulocyte colony–stimulating factor, magnesium-based adhesive, hyperbaric oxygen therapy, and gene transfer [14–21] . Some reported limited success, but none showed consistent results. In animal experiment, extracorporeal shockwave therapy (ESWT) was shown to induce the ingrowth of
Journal of Surgical Research – Elsevier
Published: May 1, 2014
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