Usage of synthetic tendons in tendon reconstruction

Abstract

Damaged tendons or loss of tendon poses a major surgical reconstructive problem. The conventional method is harvest donor tendons from palmaris longus, plantaris or tensor fasciae lata. Synthetic tendons has been used in Achilles tendon repair with studies on equine subjects. We present successful use in three patients with extensive tendon loss secondary to polytrauma. Additionally we have conducted an in-vitro study to analyse the ingrowth of tenocytes into the synthetic tendon. The synthetic tendon utilized in our study is Ortho-tape, a polyethylene terephthalate (polyester) (Neoligaments, Leeds, UK). Its construct is non-absorbable, woven with longitudinal and transverse fibres crossing at right angles. It has an “open structure” acting as a scaffold allowing bone and tissue ingrowth. It is not to be confused with the “permanent type” implant such as Gore-tex which is designed to last a lifetime with no contribution from the host tissue or new tissue growth. Artificial ligaments clinically available has been carbon (Johnson and Johnson), carbon and polyester (Surgicraft), Leeds-Keio polyester (Neoligaments), Dacron (Stryker-Meadox), bovine glutaraldehyde-fixed xenograft (Xenotech) and Gore-Tex polytetrafluoroethylene (WL Gore). Synthetic textile implants do not require donor harvesting shortening surgical procedural time and allows retention of initial strength whilst autografts undergo a necrotic stage before eventually recovering over a long period of time. Additionally, donor tendon grafts have varying properties and dimensions with limited availability. Textile implants has been utilized in ACL reconstruction and patellar ligament reconstruction [1-3] however there has been a decline in usage do to some concerns of synovitis after a prolonged duration 4. Hence some authors recommended usage only in low-activity patients or if donor harvesting was an issue.