保留自体ACL：临床前及临床模型中桥接增强修复术的范围综述
简介
一篇关于桥接增强ACL修复（BEAR）的范围综述，纳入6项临床前及20项临床研究。BEAR技术通过负载自体全血的牛胶原支架促进韧带愈合，动物实验显示其机械强度与重建相当且软骨退变更轻；临床研究随访2年，BEAR在膝关节稳定性及患者报告结局上与重建术无差异，但早期腘绳肌力量恢复更优。作为首个经临床评估的ACL中段撕裂生物修复策略，BEAR为中青年患者提供了保留…
英文摘要
CONTEXT: Bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR) is a biologically based surgical alternative to reconstruction that seeks to restore the native ligament using a bioengineered bovine collagen-based extracellular matrix scaffold saturated with autologous whole blood. This technique has generated growing interest for its potential to preserve proprioception, minimize graft morbidity, and protect long-term joint health. EVIDENCE ACQUISITION: A scoping review was performed following Joanna Briggs Institute (JBI) guidelines. PubMed, Embase, and MEDLINE were searched systematically through June 2025 using the terms "bridge-enhanced," "ACL repair," and "BEAR." Eligible studies included preclinical animal models and human clinical investigations evaluating BEAR outcomes. Data were synthesized thematically across preclinical and clinical domains and analyzed separately within mechanistic, biomechanical, and clinical frameworks. STUDY DESIGN: Scoping review of preclinical and clinical studies. LEVEL OF EVIDENCE: Level 5. RESULTS: A total of 26 studies (6 preclinical, 20 clinical) met inclusion criteria. Preclinical investigations demonstrated that BEAR restores ligament continuity and mechanical strength comparable with that of reconstruction while reducing cartilage degeneration in large-animal models. Human trials demonstrated comparable knee stability and patient-reported outcomes relative to reconstruction at 2 years, with superior early hamstring strength. Quantitative magnetic resonance imaging studies revealed progressive ligament maturation and signal normalization over time. Long-term durability and chondroprotection in humans remain under investigation. CONCLUSION: BEAR represents the first clinically evaluated biologic repair strategy for midsubstance ACL tears, with current evidence suggesting functional outcomes comparable with those of reconstruction while preserving native anatomy. Further high-quality, long-term studies are needed to define patient selection, optimize surgical timing, and to determine durability of biologic healing.Strength-of-Recommendation Taxonomy (SORT):Level B: consistent limited-quality patient-oriented evidence.