title: A novel silk-TCP-PEEK construct for anterior cruciate ligament reconstruction: an off-the shelf alternative to a bone-tendon-bone autograft.
abstract: Bone-tendon-bone autograft represents a gold-standard for anterior cruciate ligament (ACL) reconstruction but at the cost of a secondary surgical site that can be accompanied by functional impairment and discomfort. Although numerous in vitro and in vivo studies have investigated tissue engineering alternatives to autografting, the achievement of a functional histological transition between soft and hard tissue has remained elusive. To bridge this gap we developed and tested a novel multiphase scaffold of silk, tricalcium phosphate (TCP) and polyether ether ketone for ACL reconstruction. We present in vitro biomechanical tests demonstrating that the construct recapitulates native ACL function under typical physiological loads. A pilot in vivo experiment in two pigs with a three-month follow-up showed a robust histological transition between regenerated fibrous tissue and the margins of the bone tunnel, with histological features similar to the native ACL to bone insertion. These histological observations suggest that the construct was stably anchored until TCP incorporation to the host tissues. On the strength of these preliminary results, we conclude that the described approach may offer a promising alternative to autograft for ACL reconstruction. This study thus provides proof for a concept that warrants further development.
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Switzerland. Institute for Biomechanics, ETH Zurich, Switzerland.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.forename: Jiankang
authors.initials: J
authors.lastname: He
authors.forename: Weiguo
authors.initials: W
authors.lastname: Bian
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.forename: Dichen
authors.initials: D
authors.lastname: Li
authors.forename: Jess G
authors.initials: JG
authors.lastname: Snedeker
mesh_terms: D000818:Animals; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction; D064592:Autografts; D001577:Benzophenones; D001672:Biocompatible Materials / Q000737:chemistry*; D012831:Bombyx; D001842:Bone and Bones / Q000601:surgery*; D002130:Calcium Phosphates / Q000737:chemistry*; D006801:Humans; D007659:Ketones / Q000737:chemistry*; D008297:Male; D011092:Polyethylene Glycols / Q000737:chemistry*; D011108:Polymers; D047011:Silk / Q000737:chemistry*; D013552:Swine; D013710:Tendons / Q000601:surgery*; D054457:Tissue Scaffolds / Q000737:chemistry*
chemical_list: D001577:Benzophenones; D001672:Biocompatible Materials; D002130:Calcium Phosphates; D007659:Ketones; D011108:Polymers; D047011:Silk; C063834:polyetheretherketone; D011092:Polyethylene Glycols; C018392:tricalcium phosphate