Metacarpophalangeal collateral ligament reconstruction using small intestinal submucosa in an equine model.

Xenogeneic porcine small intestinal submucosa (SIS) is a natural, biodegradable matrix that has been successfully used as a scaffold for repair of tissue defects. The goal of this study was to compare a collateral ligament transection surgically reconstructed with an anchored SIS ligament to a sham-operated control procedure for the correction of joint laxity using an equine model. Ten metacarpophalangeal joints from 10 horses had complete transection of the lateral collateral ligament. In 6 horses, the collateral ligament was reconstructed with a multilaminate strip of SIS anchored with screws into bone tunnels proximal and distal to the joint. The sham controls had similar screws, but no SIS placed. Clinical compatibility and effectiveness were evaluated with lameness, incisional quality, and joint range of motion, circumference and laxity. Ligament structure and strength was quantified with serial high resolution ultrasound, histology, and mechanical testing at 8 weeks. Surgical repair with SIS eliminated joint laxity at surgery. SIS-treated joints had significantly less laxity than sham treatment at 8 weeks (p < 0.001). SIS-treated ligaments demonstrated a progressive increase in repair tissue density and fiber alignment that by week 8 were significantly greater than sham-treated ligament (p < 0.03). SIS-repaired ligament tended to have greater peak stress to failure than sham-treatment (p < 0.07). Cellularity within the ligament repair tissue and inflammation within the bone tunnel was significantly greater in the SIS-treated limbs (p < 0.017). Within the first 8 weeks of healing, SIS implanted to reinforce collateral ligament injury was biocompatible in the joint environment, restored initial loss of joint stability, and accelerated early repair tissue quality. SIS ligament reconstruction might provide benefit to early ligament healing and assist early joint stability associated with ligament injury.

[1]  S. Badylak,et al.  Human helper T cell activation and differentiation is suppressed by porcine small intestinal submucosa. , 2002, Tissue engineering.

[2]  J. Gastel,et al.  Meniscal tissue regeneration using a collagenous biomaterial derived from porcine small intestine submucosa. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  D. Rosenbaum,et al.  Reconstruction of the Lateral Ligaments: Do the Anatomical Procedures Restore Physiologic Ankle Kinematics? , 2004, Foot & ankle international.

[4]  W. Lineaweaver,et al.  Porcine Small Intestinal Submucosa as a Carrier for Skin Flap Prefabrication , 2003, Annals of plastic surgery.

[5]  J. Iannotti,et al.  Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. , 2006, The Journal of bone and joint surgery. American volume.

[6]  Joy C MacDermid,et al.  The effectiveness of rehabilitation for nonoperative management of shoulder instability: a systematic review. , 2004, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[7]  A. Farron,et al.  Grade I and II acromioclavicular dislocations: results of conservative treatment. , 2003, Journal of shoulder and elbow surgery.

[8]  Volker Musahl,et al.  The use of porcine small intestinal submucosa to enhance the healing of the medial collateral ligament—a functional tissue engineering study in rabbits , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  S. Badylak,et al.  XENOGENEIC EXTRACELLULAR MATRIX GRAFTS ELICIT A TH2-RESTRICTED IMMUNE RESPONSE1 , 2001, Transplantation.

[10]  R. Marx,et al.  Osteoarthritis following shoulder instability. , 2005, Clinics in sports medicine.

[11]  L. Teoh,et al.  Anatomic Reconstruction of the Distal Radioulnar Ligaments: Long-Term Results , 2005, Journal of hand surgery.

[12]  Thomas W. Gilbert,et al.  A quantitative method for evaluating the degradation of biologic scaffold materials , 2007 .

[13]  T. B. Edwards,et al.  Glenohumeral Arthrosis in Anterior Instability before and after Surgical Treatment , 2004, The American journal of sports medicine.

[14]  J. Paul Robinson,et al.  Tensile mechanical properties of three-dimensional type I collagen extracellular matrices with varied microstructure. , 2002, Journal of biomechanical engineering.

[15]  J. T. Winkler,et al.  The effect of a porcine-derived small intestinal submucosa product on wounds with exposed bone in dogs. , 2002, Veterinary surgery : VS.

[16]  S. Woo,et al.  Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future. , 2004, The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.

[17]  S. Woo,et al.  The healing medial collateral ligament following a combined anterior cruciate and medial collateral ligament injury—a biomechanical study in a goat model , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  R. Arora,et al.  Dorsolateral dislocation of the proximal interphalangeal joint: closed reduction and early active motion or static splinting; a retrospective study , 2004, Archives of Orthopaedic and Trauma Surgery.

[19]  S. Arnoczky,et al.  Kinetic study of the replacement of porcine small intestinal submucosa grafts and the regeneration of meniscal-like tissue in large avascular meniscal defects in dogs. , 2001, Tissue engineering.

[20]  M. Sacks,et al.  The role of MMP-I up-regulation in the increased compliance in muscle-derived stem cell-seeded small intestinal submucosa. , 2006, Biomaterials.

[21]  C. Pellegrini,et al.  The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. , 2003, American journal of surgery.

[22]  M. Abe,et al.  The effect of medial collateral ligament insufficiency on the reconstructed anterior cruciate ligament: A study in the rabbit , 2003, Acta orthopaedica Scandinavica.

[23]  E. Elson,et al.  Cellular and Matrix Mechanics of Bioartificial Tissues During Continuous Cyclic Stretch , 2006, Annals of Biomedical Engineering.

[24]  S. Badylak,et al.  The use of xenogeneic small intestinal submucosa as a biomaterial for Achilles tendon repair in a dog model. , 1995, Journal of biomedical materials research.

[25]  J. Kreeger,et al.  Induction of Meniscal Regeneration in Dogs Using a Novel Biomaterial , 1999, The American journal of sports medicine.

[26]  M. Sawant,et al.  Valgus knee injuries: evaluation and documentation using a simple technique of stress radiography. , 2004, The Knee.

[27]  I. Vesely,et al.  Novel geometries for tissue-engineered tendonous collagen constructs. , 2006, Tissue engineering.

[28]  T. Brown,et al.  Incongruity versus Instability in the Etiology of Posttraumatic Arthritis , 2004, Clinical orthopaedics and related research.

[29]  Shelbourne Kd,et al.  Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment. , 2003, Instructional course lectures.

[30]  Jiake Xu,et al.  Porcine small intestine submucosa (SIS) is not an acellular collagenous matrix and contains porcine DNA: possible implications in human implantation. , 2005, Journal of biomedical materials research. Part B, Applied biomaterials.

[31]  S. Piva,et al.  Reports of joint instability in knee osteoarthritis: its prevalence and relationship to physical function. , 2004, Arthritis and rheumatism.

[32]  S. Weisbrode,et al.  Instability-induced osteoarthritis in the metacarpophalangeal joint of horses. , 1999, American journal of veterinary research.

[33]  C. Kaeding,et al.  Intra-articular findings in the reconstructed multiligament-injured knee. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[34]  S. Badylak,et al.  The Th2-restricted immune response to xenogeneic small intestinal submucosa does not influence systemic protective immunity to viral and bacterial pathogens. , 2002, Tissue engineering.

[35]  M. Holzman,et al.  Physiologic properties of small intestine submucosa1 , 2005 .

[36]  S. Badylak,et al.  The Use of Extracellular Matrix as an Inductive Scaffold for the Partial Replacement of Functional Myocardium , 2006, Cell transplantation.

[37]  C. Sheehan,et al.  A pilot study to evaluate the effectiveness of small intestinal submucosa used to repair spinal ligaments in the goat. , 2002, The spine journal : official journal of the North American Spine Society.

[38]  M. Otto,et al.  Small intestinal submucosa for pubourethral sling suspension for the treatment of stress incontinence: first histopathological results in humans. , 2004, The Journal of urology.

[39]  S. Badylak,et al.  Enhanced bone regeneration using porcine small intestinal submucosa. , 1999, Journal of investigative surgery : the official journal of the Academy of Surgical Research.

[40]  G. Lantz,et al.  Morphologic study of three collagen materials for body wall repair. , 2004, The Journal of surgical research.

[41]  Thore Zantop,et al.  Extracellular matrix scaffolds are repopulated by bone marrow‐derived cells in a mouse model of achilles tendon reconstruction , 2006, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[42]  M. Sacks,et al.  Quantification of the fiber architecture and biaxial mechanical behavior of porcine intestinal submucosa. , 1999, Journal of biomedical materials research.

[43]  J. Deprest,et al.  Comparison of host response to polypropylene and non‐cross‐linked porcine small intestine serosal‐derived collagen implants in a rat model , 2005, BJOG : an international journal of obstetrics and gynaecology.

[44]  R. Haut,et al.  Tissue-Engineered Rotator Cuff Tendon Using Porcine Small Intestine Submucosa , 2001, The American journal of sports medicine.