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Xenograft Ligaments

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

Xenograft ligaments for anterior cruciate ligament (ACL) offer the promise of an off-the-shelf graft for the treatment of ligament ruptures. Made from young healthy animal donor tissue, these grafts have the potential to give surgeons an alternative option to allograft and autograft tissue grafts. The major barrier to the use of xenograft tissues has been immunological rejection to a carbohydrate antigen found on donor animal tissue called the “α-Gal epitope.” This chapter starts with a discussion of the design of an animal model to test for xenograft rejection and follows with a description of an enzymatic cleavage technique to strip this epitope from porcine grafts. The grafts produced using this method were tested for biomechanical strength and for implantability in a primate ACL model. Following successful results of the primate ACL model, a 10 patient FDA pilot safety trial was successfully completed followed by a double-blind, randomized, controlled, clinical trial of xenograft compared to allograft ACL reconstruction. The data from the study was reviewed leading to a 2014 CE mark permitting sale of the devices outside the USA. At the time of writing this chapter, the paper reporting this study is under peer review. Over the next few years, widespread clinical use of xenograft ligaments will reveal their true place in the options for ACL reconstruction.

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Author information

Authors and Affiliations

  1. Stone Research Foundation, San Francisco, CA, USA

    Kevin R. Stone

  2. The Stone Clinic, San Francisco, CA, USA

    Kevin R. Stone

  3. Department of Surgery (retired), University of Massachusetts Medical School, Worcester, MA, USA

    Uri Galili

Authors
  1. Kevin R. Stone
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  2. Uri Galili
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Corresponding author

Correspondence to Kevin R. Stone .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Stone, K.R., Galili, U. (2017). Xenograft Ligaments. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_32

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_32

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-52740-5

  • Online ISBN: 978-3-662-52742-9

  • eBook Packages: MedicineMedicine (R0)

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