Advancements for artificial ligaments: enhancing biological activity and antibacterial performance

Anterior cruciate ligament (ACL) reconstruction is one of the most frequently performed orthopedic procedures, particularly for athletes seeking to restore knee stability and function. Polyethylene terephthalate (PET) is widely used for artificial ligaments due to its durability and chemical stability. However, PETs inherent limitations, including poor osteoconductivity and biocompatibility, contribute to graft failure and postoperative infections. Recent advancements in surface functionalization, including the incorporation of hydroxyapatite (HAp) and bioactive glass, have significantly improved PET's osteoconductive and osteoinductive properties, promoting enhanced bone integration and healing. Additionally, innovations in antibacterial coatings, such as silver nanoparticles and polydopamine, have demonstrated potential in reducing infection rates and improving the longevity of implants. This review highlights these technological advances, emphasizing how biomaterials and surface modifications are transforming the performance of PET-based artificial ligaments, leading to more successful ACL reconstructions and improved patient outcomes.