Abstract
Reliable soft tissue attachment to prosthetic implants remains a great clinical challenge in adult reconstruction and oncology. Past efforts using tendon alone have been universally disappointing. With the introduction of trabecular metals, new possibilities present them selves in dealing with this problem. Using an established canine supraspinatus tendon model, reliable and physiologic soft tissue attachment to a trabecular metal prosthesis was achieved, with near normal strength and function. This suggests that this new genre of material can possibly provide better options in dealing with this difficult problem.
Direct attachment of tendon to an endoprothesis has applications throughout the field of orthopaedics. The purpose of this study was to devise a soft-tissue attachment device using tantalum foam metal which would allow for early soft tissue reconstruction strength and long term biologic in-growth fixation.
A foam metal tendon attachment prosthesis was designed. Using a validated tendon attachment model, twenty-three skeletally-mature canine supraspinatus tendons were sharply detached and then reattached to the greater tuberosity. Ultimate strength, stiffness and gross morphological changes were recorded immediately after surgery and at three and six weeks.
Tendon-implant strength as percent of normal rose from thirty-nine percent at surgery, to sixty-seven percent at three weeks, and ninety-nine percent at six weeks (standard deviations thirteen, nineteen, and eighteen percent). Stiffness of construct also approached normal tendon: forty-seven percent at surgery, sixty-two percent at three weeks, and ninety-four percent at six weeks (standard deviations seventy-seven, nineteen, and eighteen percent). Supraspinatus muscle volume decreased from ninety seven (percent of normal) at surgery, to seventy-nine percent at three weeks. By six weeks, the muscle had recovered to ninety percent of normal volume. Gross and histologic analysis revealed complete tendon in-growth and attachment to the prosthesis with the formation of Sharpey’s fibers
This study suggests that tendon attachment to a metallic endoprothesis is possible. Near normal physiologic strength and stiffness was achieved six weeks post surgery. Future study should ascertain the micro-anatomy of this attachment and delineate the mechanical conditions necessary for soft tissue in-growth.
Funding: Zimmer, Inc., Warsaw, IN
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Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
