Use of a bioscaffold to improve healing of a patellar tendon defect after graft harvest for ACL reconstruction: A study in rabbits

Abstract

Following harvest of a bone-patellar tendon-bone (BPTB) autograft, the central third of the patellar tendon (PT) does not heal well. The healing tissues also form adhesions to the fat pad and can cause abnormal patellofemoral joint motion. The hypotheses were that a bioscaffold could enhance patellar tendon healing through contact guidance and chemotaxis, and the scaffold could serve as a barrier to decrease adhesion formation between the neo-PT and infrapatellar fat pad. In 20 New Zealand White rabbits, a central-third PT defect was created. One strip of porcine small intestinal submucosa (SIS) was attached to both the anterior and posterior sides of the PT defect of the SIS-treated group (n ¼ 10). For comparison, a central defect was left nontreated (n ¼ 10). At 12 weeks, histomorphology was examined using Masson's trichrome staining. The cross-sectional area (CSA) was determined with a laser micrometer, and the central BPTB complexes were tested in uniaxial tension. SIS-treated samples showed a greater amount of healing tissue with denser and well-oriented collagen fibers and more spindle-shaped cells. There was no noticeable adhesion formation in the SIS-treated group. For the nontreated group, there were significantly more and diffuse adhesive formations. The SIS-treated group also had a 68% increase in neo-PT CSA, 98% higher stiffness, and 113% higher ultimate load than that in the nontreated group. SIS treatment increased the quantity of healing tissue, improved the histological appearance and biomechanical properties of the neo-PT, and prevented adhesion formation between the PT and fat pad. ß

Alpha1,3-galactosyltransferase knockout does not alter the properties of porcine extracellular matrix bioscaffolds

“…The urinary bladder matrix (UBM), another ECM bioscaffold that arouses interests in its potential applications, has also been characterized and tested in pre-clinical studies [3,13,14]. In our research center, we have demonstrated that porcine SIS bioscaffolds can improve the morphological, biochemical and biomechanical properties of healing ligaments and tendons in different animal models [15][16][17][18].…”

A multi-step method for preparation of porcine small intestinal submucosa (SIS)

“…SIS from swine displays very low immunogenicity without provoking immune-mediated inflammatory reactions when transplanted. To date, SIS has been extensively used as scaffolds for tissue engineering applications of artery [7], bladder [8], intestinal tract [9,10], and tendon [11]. The US FDA has approved its use in human for urogenital procedures, such as hernia repair, cystoplasties, ureteral reconstructions, stress incontinence, peyronie's disease, penile chordee, even urethral reconstruction for hypospadias and strictures [12e16].…”

Ligament-Derived Matrix Stimulates a Ligamentous Phenotype in Human Adipose-Derived Stem Cells

“…45,46 Other investigators have evaluated biologic scaffolds, such as small intestinal submucosa, dermis, fascia lata, pericardium, and decellularized tendon or tendon slices for repair of tendon and ligament. 5,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] While these other tissue matrices have shown some ability to induce tendon or ligament formation, the ECM components from native tendon appear to be critical for differentiation because depletion of key ECM components from tendon impairs tendon formation by tendon progenitor cells. 4 Decorin inhibits type I collagen fibrillogenesis during repair, but is critical for normal fibrillogenesis in tendon development when expression increases rapidly and then decreases to a steady state.…”