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A severely injured anterior cruciate ligament (ACL) does not heal well, and can cause knee
instability, meniscal damage, and osteoarthritis. Patellar tendon autografts and allografts are
widely used but are not suited for an ACL reconstruction. The problems associated with an
autograft include lengthy rehabilitation as well as persistent patellar pain. Allografts carry the risk of disease transmission, and their procurement is difficult and costly. Permanent synthetic ACL prostheses, including the Gore Tex prosthesis, Stryker-Dacoron ligament, and Kennedy ligament augmentation device, may show satisfactory performance in the short term but they tend to break down and fail in the long term. Recently, a tissue engineering strategy has been attempted for an ACL reconstruction. The ideal ACL replacement scaffold should be biodegradable, porous, biocompatible, show adequate mechanical strength, and be able to promote the formation of ligament tissue. Several groups have reported the potential ACL scaffold using collagen, silk, and biodegradable polymers such as polyglycolic acid (PGA) and polylactic acid (PLA). Over the past 20 years, silk and a variety of degradable synthetic materials including PGA have been used as biomedical suture materials. In addition, silk and PGA fibers were studied to regenerate tendon and ligament defects. The biocompatibility of implant materials is of major concern in orthopedic surgery. After implantation, host-material interactions occurring at the implant site can be cause adverse inflammatory reactions.