Beyond The Graft: Synthetic Scaffolds For Soft-Tissue Reconstruction

Silver wire and carbon fiber; polyethylene, Dacron, and Gor-Tex: these are just some among the synthetic materials device makers have fashioned into ropes, cuffs, and straps to replace torn and ruptured ligaments and tendons. These prosthetic anterior cruciate ligaments, Achilles and elbow tendons, rotator cuffs, and more have often failed or sometimes set off such serious biomechanical, health, or immunogenic complications that surgeons needed to remove them. After a century of efforts to fashion synthetic implants, every attempt so far has fallen short of human tissue’s particular combination of biology, strength, flexibility, stability, and endurance. Surgeons must still rely either on transplanting human tissue harvested from a patient’s own body – autografts – or a cadaver – allografts – to rebuild seriously damaged soft connective tissue.

Surgeons fix ankle, knee, shoulder, and other soft-tissue tears and ruptures more than a million times a year, yet autografts and allografts, too, have important drawbacks. Autografts require cutting as much as a third of a patient’s tendon, weakening it, causing site pain and potential morbidity, biomechnical insufficiency, extended surgery time, and long recovery; allografts obviate the need to cut and damage the patient’s own tissue, but raise red flags from concerns about possible disease transmission – along with the potential for failure due to structural weakness in the allograft caused by sterilization processes