Immunoregulative coating for scarless healing in anterior cruciate ligament reconstruction

Shuang Wang; Chao Xu; Yuanman Yu; Jie Li; Tianwu Chen; Jing Wang; Changsheng Liu

Bioactive Materials (Mar 2025)

Immunoregulative coating for scarless healing in anterior cruciate ligament reconstruction

Shuang Wang,
Chao Xu,
Yuanman Yu,
Jie Li,
Tianwu Chen,
Jing Wang,
Changsheng Liu

Affiliations

Shuang Wang: Key Laboratory for Ultrafine Materials of Ministry of Education, Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, PR China
Chao Xu: College of Materials Science and Engineering, Wuhan Textile University, Wuhan, 430200, PR China
Yuanman Yu: Key Laboratory for Ultrafine Materials of Ministry of Education, Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, PR China
Jie Li: Key Laboratory for Ultrafine Materials of Ministry of Education, Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, PR China
Tianwu Chen: Sports Medicine Department, Huashan Hospital, Fudan University, Shanghai, 200040, PR China; Corresponding author.
Jing Wang: Key Laboratory for Ultrafine Materials of Ministry of Education, The State Key Laboratory of Bioreactor Engineering, East China University of Science and Technology, Shanghai, 200237, PR China; Corresponding author.
Changsheng Liu: Key Laboratory for Ultrafine Materials of Ministry of Education, Engineering Research Center for Biomedical Materials of the Ministry of Education, East China University of Science and Technology, Shanghai, 200237, PR China; Corresponding author.

Journal volume & issue: Vol. 45
pp. 71 – 87

Abstract

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Polyethylene terephthalate (PET) artificial ligaments are widely used in anterior cruciate ligament (ACL) reconstruction due to their high tensile strength. However, bone tunnel enlargement around PET ligaments poses a risk for surgical failure. PET's inert surface, lower bioactivity, and mechanical abrasion trigger an M1 macrophage-mediated inflammatory response, leading to excessive, disorganized scar tissue. This scar tissue creates a space-occupying effect at the interface, obstructing graft-bone integration and contributing to bone tunnel enlargement. To address this issue, we developed a multi-layered immune-regulating hydrogel coating for scar-free PET-bone integration. Comprising gelatin methacrylate (GelMA), polyethyleneglycol diacrylate (PEGDA), and sulfated polysaccharide (SCS), the hydrogel forms a hydrogen-bonded lubricating layer to reduce friction. The sustained release of SCS also down-regulates M1 macrophage polarization, inhibiting early scar formation. By eliminating the space-occupying effect of scar tissue, SCS subsequently promotes M2 macrophage polarization. This shift releases endogenous factors that enhance blood vessel formation and new bone growth, ultimately achieving high-quality graft-bone integration. The application of this multi-layered, inflammation-modulating hydrogel coating not only removes scar tissue barriers but also improves graft-bone integration through enhanced angiogenesis and osteogenesis. Moreover, it avoids the overuse of exogenous growth factors and potential complications, offering a more convenient and feasible therapeutic strategy.

Published in Bioactive Materials

ISSN: 2452-199X (Online)
Publisher: KeAi Communications Co., Ltd.
Country of publisher: China
LCC subjects: Technology: Electrical engineering. Electronics. Nuclear engineering: Materials of engineering and construction. Mechanics of materials; Science: Biology (General)
Website: https://www.keaipublishing.com/en/journals/bioactive-materials/

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