Decellularized Porcine Tendon Xenografts Provide a Viable Option in Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments, and ACL reconstruction (ACLR) is projected to steadily increase. While autografts are the gold standard, the limited harvest volume and donor site morbidity have spurred the search for viable alternatives. A decellularized porcine xenograft is currently available; therefore, we have investigated patient outcomes in a series of patients who have received this graft for ACLR.

Patients were eligible for inclusion in this study if they had undergone ACLR, either primary or revision, and had received a decellularized tendon xenograft (Orthopure XT, Tissue Regenix, Leeds, UK) as the ACL graft. All patients underwent surgery by the same surgeon at the same hospital (IRCCS Ospedale Galeazzi, Milan, Italy) and followed standardized care for ACLR, including surgery and post-operative rehabilitation. The outcome data collected were the International Knee Documentation Committee (IKDC) score, Tegner-Lysholm, and visual analog scale (VAS) for pain. Outcome data were analysed using a repeated measures ANOVA, with α=0.05.

Of the 29 patients who underwent ACLR, 24 (83%) were male. The mean age at surgery for male patients was 43.6 ± 9.8 years, while for women, it was 40.8 ± 15.1 years. The mean BMI was 25.8 ± 3.4 for men and 25.4 ± 2.9 for women. Follow-up was collected at a mean of 27.4 ± 9.6 months after surgery. The mean post-operative IKDC score was 94.9 ± 2.6 (95% CI: 93.9-95.9). The Tegner-Lysholm score improved from a pre-operative mean of 43.3 ± 5.7 (95% CI: 41.1-45.4) to a post-operative mean of 92.7 ± 3.6 (95% CI: 91.3-94; p<0.001). The VAS pain improved from a mean of 3.0 ± 1.4 to a post-operative mean of 0.4 ± 0.7 (p < 0.001). During the follow-up period, there was one traumatic failure (3%) and one acute infection (3%). The positive responder rate was 97%.

The short-term follow-up outcomes in this small, retrospective cohort indicate that this decellularized xenogeneic graft, processed from porcine tendon, can provide a viable option in ACL reconstruction.