Can An Emerging Synthetic Graft Have An Impact In Soft Tissue Repair?

Jason R. Miller, DPM, FACFAS, and Stanley Chen, DPM, AACFAS

Tendon and ligament pathologies are extremely common in the adult population. Eleven percent of runners experience Achilles tendinopathy with seven out of 100,000 people sustaining a rupture. There are 1 million ankle injuries per year, 85 percent of which are ankle sprains. The total cost of tendon and ligament treatment is approximately $30 billion per year in the United States alone.1 The medical community has actively sought the augmentation of these repairs and the response by orthobiologic companies has been great.

   There are two types of augmentation grafts, biologic and synthetic. Biologics have the advantage of being bioactive and creating induction of new tissue ingrowth at a faster rate.2,3 The disadvantages include low mechanical stamina often leading to structural failure; nonspecific induction leading to low quality tissue repair; an undefined degradation rate to assess healing time; and biocompatibility variations that may lead to rejection, and/or a significant inflammatory response.

   Synthetic grafts exhibit stronger mechanical strength and consistency in quality.4,5 Synthetic grafts are capable of acting as permanent replacement tissues in severely neglected repairs. The primary disadvantage may be poorer biocompatibility.

   Artelon (Artimplant) is a porous polyurethane urea, which performs as a scaffold allowing ingrowth of host tissue.6,7 This material has been in use in surgical procedures for over 30 years and more specifically in orthopedic type procedures for approximately 15 years. The implant maintains strength and elasticity over the long term to provide support. Artelon products retain approximately 50 percent of their strength after four years. They are designed to degrade over the course of five to seven years as the host tissue replaces the majority of the graft material.

   The applications of Artelon include joint resurfacing, tissue reinforcement and augmentation in tendon/ligament repairs. With Artelon being a biocompatible synthetic material, there is no risk of collagen rejection or disease transmission. Collagen patches have shown good initial strength but they degrade quickly and strength may not be maintained in the repair, which could lead to re-rupture.

   Artelon has properties that mimic tissue elasticity. With ingrowth of host tissue, the integrated implant will gradually take on more load, which is why it has been popular with general surgeons in hernia type of repairs.

A Closer Look At The Bioscaffold’s Indications And Usage

The intended use of this bioscaffold is reinforcement of soft tissue in which weakness is a concern. It is not intended to replace deficits in normal body structure or provide complete mechanical strength. The sutures surgeons use to repair a rupture or the ones they use with bone anchors provide the mechanical strength for tendon repair. Artelon reinforces the soft tissue in the repair and provides a biodegradable scaffold that incorporates into the patient’s native tissue. We have used porous polyurethane urea synthetic grafts for repairs in the following procedures.

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