Biologic attachment of an allograft bone and tendon transplant to a titanium prosthesis

An Achilles tendon allograft with its bony insertion was used to bridge a Titanium implant, containing an endoprosthetic tendon anchor, and the sheep biceps muscle. Twelve sheep were operated on unilaterally and followed up clinically and histologically for 2, 4 (n = 2), 8, and 12 months (n = 4). Full function of the front limb was regained after 8 to 12 weeks. There were no signs of mechanical loosening at all times. The morphologic changes at the bone block and implant fixation site were an initial revascularization of the allograft bone, which was observed at 2 months and enhanced at 4 months but occurred without any evidence of bone remodeling. This was changed in all specimens taken at 8 and 12 months where intensive new bone development, remodeling, and bone ingrowth in the titanium implant was found. Bone mass was shifted significantly to the tendon insertion half of the bone block because of a creeping substitution of the cancellous allograft bone and bone ingrowth to the implant. Overall bone mass slightly decreased with time but resorption of allograft bone outweighed new bone development only at lesser loaded areas. Transplantation of a bone and tendon allograft to an implant resulted in a revitalized, mechanically stable, and biologically anchored compound.