Anterior cruciate ligament (ACL) ruptures represent a common pathology, especially in young and active patients. Spontaneous repair, although reported in some studies, is altered by local conditions, thus emerges the need to perform reconstruction of the ACL. It is reported that 3,430 primary reconstructions and around 267 revisions are performed yearly in Sweden. Some reconstructions result in biological failure, which represents the inability of the graft to incorporate and remodel in order to perform its role as a knee stabilizer. Orthobiology, a new concept that includes growths factors, stem cells, and different scaffolds, could represent a solution to a better outcome of this procedure. This manuscript is a review of different therapeutic strategies used for enabling ACL regeneration, including in vitro ACL-bio-enhanced repair that is currently being developed. Substantial progress is to be expected in the area of ACL surgery.
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