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

Author(s): 
Jason R. Miller, DPM, FACFAS, and Stanley Chen, DPM, AACFAS

• Achilles tendon repair
• Plantar plate repair
• Modified Brostrom lateral ankle reconstruction
• Painful os peroneum excision
• Peroneal tendon reconstruction
• Tibialis posterior tendon reconstruction
• Extensor hallucis longus repair
• Spring ligament repair/augmentation

   Contraindications include patients with active or latent infection, decreased vascularity or pathologic soft tissue disorders that would prevent secure attachment. It is also not advised to use the product in patients for whom rolling, layering or folding of the graft is required as it may lead to impermeability of fluid, cells and vascular ingrowth. This could potentially lead to excessive inflammation, drainage, extrusion and infection.

   Potential complications of the implant include infection, acute or chronic inflammation, tissue erosion and graft extrusion.

   The implant comes in patch form and is easy to handle and shape to the application once it is rehydrated in normal sterile saline solution. It is packaged sterile with a minimum dose 25 kGy electron beam radiation. The shelf life is five years. One can store the product at room temperature and normal relative humidity is advised. Prior to using the implant, one should submerge it into sterile saline at room temperature for at least five minutes. The senior author frequently hydrates the implant in platelet rich plasma as a substitute to the normal sterile saline solution for an equivalent timeframe.

Case Studies In The Use Of Artelon

A 57-year-old female presented eight weeks after dropping large scissors on her foot. She had a laceration and flexion contracture of the first metatarsophalangeal joint (MPJ) and hallux. The patient reported loss of push-off strength in normal gait. Surgeons retrieved the extensor hallucis longus tendon both proximally and distally with the proximal portion split longitudinally to span the defect. Surgeons then augmented repair with an Artelon strip, which was anchored at each end with non-absorbable suture and along its course with Vicryl (see photo at left). The patient went on to bear weight at four weeks and reported gradual increases in first MPJ dorsiflexory power after eight weeks during physical therapy.

   A 62-year-old squash player presented 10 weeks after injuring his Achilles tendon. Surgeons secured the Artelon patch proximally and distally with non-absorbable sutures while securing the graft to itself in a tubular fashion with Vicryl sutures, ensuring minimal to no overlap (see photo at right). The patient returned to full weightbearing at three to four weeks postoperatively and started full physical therapy by week six. After 12 weeks, the patient returned to reduced activity squash and by six months was competing again.

In Conclusion

The question remains as to whether graft augmentation precludes re-rupture. Key factors surrounding this issue include patient education, adequate physical rehabilitation, home exercise programs, a gradual return to activity, patient awareness of the injury severity, the postoperative course, and seeking early intervention if the patient recognizes any problems in the healing course.

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