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  Discussion on Research Summary: Collateral ligament repair using intestinal submucosa
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DrO

Posted on Thursday, Mar 6, 2008 - 11:59 am:

A ruptured collateral ligament of a horse's fetlock joint is a catastrophic event. For just a brief review the collateral ligaments arranged along the sides of a joint and connecting the two bones that come together in the joint act like hinges. They keep the joint cartilage of the two bones together but at the same time allow movement, flexion and extension, of the joint.

Usually the instability of a ruptured collateral joint has been treated with immobility (usually casting). Besides the inherent problems of casting equine limbs is a prolonged recovery with arthritis almost always a consequence. Here is a study that suggests there may be a better way. It is a preliminary study done on transected ligaments. Rupture will surely result in much more inflammation and then there is the period of instability before surgery can be preformed. I look forward to seeing reviews of the use of swine small intestinal submucosa in actual cases.
DrO


J Biomed Mater Res A. 2008 Jan;84(1):219-29.
Metacarpophalangeal collateral ligament reconstruction using small intestinal submucosa in an equine model.

Bertone AL, GoinS, Kamei SJ, Mattoon JS, Litsky AS, Weisbrode SE, Clarke RB, Plouhar PL, Kaeding CC.
Comparative Orthopaedic Research Laboratories, Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio 43210, USA.

Xenogeneic porcine small intestinal submucosa (SIS) is a natural, biodegradable matrix that has been successfully used as a scaffold for repair of tissue defects. The goal of this study was to compare a collateral ligament transection surgically reconstructed with an anchored SIS ligament to a sham-operated control procedure for the correction of joint laxity using an equine model. Ten metacarpophalangeal joints from 10 horses had complete transection of the lateral collateral ligament. In 6 horses, the collateral ligament was reconstructed with a multilaminate strip of SIS anchored with screws into bone tunnels proximal and distal to the joint. The sham controls had similar screws, but no SIS placed. Clinical compatibility and effectiveness were evaluated with lameness, incisional quality, and joint range of motion, circumference and laxity. Ligament structure and strength was quantified with serial high resolution ultrasound, histology, and mechanical testing at 8 weeks. Surgical repair with SIS eliminated joint laxity at surgery. SIS-treated joints had significantly less laxity than sham treatment at 8 weeks (p < 0.001). SIS-treated ligaments demonstrated a progressive increase in repair tissue density and fiber alignment that by week 8 were significantly greater than sham-treated ligament (p < 0.03). SIS-repaired ligament tended to have greater peak stress to failure than sham-treatment (p < 0.07). Cellularity within the ligament repair tissue and inflammation within the bone tunnel was significantly greater in the SIS-treated limbs (p < 0.017). Within the first 8 weeks of healing, SIS implanted to reinforce collateral ligament injury was biocompatible in the joint environment, restored initial loss of joint stability, and accelerated early repair tissue quality. SIS ligament reconstruction might provide benefit to early ligament healing and assist early joint stability associated with ligament injury. (c) 2007 Wiley Periodicals, Inc. J Biomed Mater Res, 2008.
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