Advancements in anterior cruciate ligament reconstruction based on weaving technology: current developments and future prospects

Abstract

Anterior cruciate ligament (ACL) reconstruction is a crucial surgical approach for rapidly restoring the function of an injured knee. Earlier approaches focused on repair techniques that often did not aim to replicate the native anatomy and function of the tissue (non-anatomical). In contrast, the field has shifted towards anatomic reconstruction methods, which prioritise restoring the native structure and biomechanics using autografts or synthetic materials. Textile technologies, especially weaving, have gained great attention for their capacity to create complex structures with the desired properties for various applications. By adjusting key parameters such as fibre arrangement, weave pattern, fibre/yarn linear density and warp/weft density, woven-based grafts can replicate the hierarchical structure, bioinspired morphology, anisotropic characteristics and mechanical properties of natural human tissues. This review examines the materials, structural designs, and functional outcomes of textile-based strategies for ACL reconstruction, with a particular focus on weaving technology. Key challenges for clinical translation are discussed, and future directions are explored. Weaving technology is highlighted as a promising strategy to address current limitations and guide future developments in ACL graft design.