Advancements in Understanding and Techniques for Enhancing Bone Tunnel Healing Following Anterior Cruciate Ligament Reconstruction: A Comprehensive Review

This review synthesizes recent advancements in surgical innovations and biological augmentation strategies aimed at enhancing bone tunnel healing after ACL reconstruction. Anterior cruciate ligament (ACL) reconstruction remains the gold standard for restoring knee function, yet suboptimal bone tunnel healing impedes graft integration and functional recovery; this biologically complex process-involving osteoblast activation, fibrovascular tissue formation, and endochondral/intramembranous ossification-is critically modulated by biomechanical and biochemical factors. We critically evaluate emerging surgical techniques (e.g., tunnel positioning optimization, fixation methods) and biological interventions (e.g., growth factor delivery, stem cell therapy), highlighting their mechanistic roles in accelerating osteointegration and mitigating healing failure risks. Evidence-based integration of these innovations demonstrates significant potential to improve graft stability, accelerate rehabilitation, and optimize long-term patient outcomes. (Level of Evidence: Level V).