Clinical Applications of Tendon Allografts

Abstract

Ligament injuries are common and potentially disabling. The healing of certain ligaments remains unpredictable for reasons that are still poorly understood. In recent years there has been an increase in the number of reconstructive procedures performed for different kinds of acute or chronic ligament injuries. For these reconstructive procedures many surgeons still use an autograft. The use of autografts bears some limitations. It is a mutilating surgery where one structure is sacrificed to replace another. This aspect not only limits the choice of tendon removal but also the amount of available graft material. It leads to extensive surgery, it is time consuming and may have adverse effects and complications due to the resection of a tendon or part of a tendon. These complications, such as a muscle hernia after Macintosh ligametoplasty, rupture of the patellar tendon [27] or tendonitis after Jones or Imbert plasty are inherent to the applied techniques. Consequently, various types of artificial ligaments and heterologous bioprostheses have been developed. Clinical trials of these materials have proved that they can provide neither a long-standing prosthetic substitute nor an innocuous scaffold which will induce thick fibrous tissue [12]. Problems relate to a lack of bone ingrowth at the osseous tunnels and also to biocompatibility, deformity and fatigue characteristics of the artificial ligament. In our center we revised several artificial ligaments that failed.