Ligaments & Tendons

The current standard for ACL reconstruction involves grafting either autologous (patient's own) or allogeneic (cadaveric) tendons. Both methods have disadvantages: autograft harvest creates a second surgical site with increased pain and morbidity, while many allogeneic tendons come from elderly individuals with reduced biomechanical capacity.

Our research has explored two alternatives: using stronger allograft quadriceps tendon with a reproducible 3-incision technique, and—more experimentally—"humanizing" porcine tissue through enzymatic treatment to create unlimited supply of strong, young tissue.

The 2023 xenograft study represents a proof of principle for one of the most ambitious goals in orthopaedic tissue engineering: creating unlimited, strong, young tissue from animal sources.

The processing technique eliminates α-gal epitopes (which trigger immune rejection) and uses partial glutaraldehyde crosslinking to slow macrophage infiltration. This allows the porcine tissue to gradually remodel into autologous human tissue.

While 5 of 10 patients experienced failure (3 from subsequent trauma, 1 from arthrofibrosis, 1 from technical error), the remaining patients demonstrated stable, fully athletic knees at 20 years with MRIs showing mature remodeling of the device.

If supported by additional clinical trials, this approach could eliminate the tissue supply limitations that currently constrain orthopaedic reconstruction.