Achilles tendon replacement by a collagen fiber prosthesis: morphological evaluation of neotendon formation

Reconstituted type I collagen was processed into fibers which were subsequently severely dehydrated and cyanamide cross-linked. Fibers prepared by this method were stronger and more resistant to degradation than uncrosslinked fibers. When used as a tendon replacement prosthesis, morphological events occurred which were observed by light, scanning, transmission electron microscopy and electron histochemistry. Resorption was the initial host response to the prosthesis and involved gradual biodegradation. Formation of a host-replacement tendon was the second response. Increased collagen fibril diameters and a transition in the proteoglycan/collagen fibril interactions occurred in the newly developing connective tissue between 3 and 10 weeks postimplantation. These extracellular matrix transitions were major events occurring during wound healing and led to the assembly of a mature connective tissue. When used as a tendon prosthesis, these collagen fibers rapidly resorb while allowing simultaneous formation of aligned connective tissue. The fibers may have other applications in the fields of Orthopaedic Surgery, Neurosurgery and Biomaterials Research.