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Tendon re-attachment to metal prostheses in an in vivo animal model using demineralised bone matrix

¹ Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
² University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK.

Correspondence should be sent to Dr J. C. Pendegrass; e-mail: c.pendegrass{at}ucl.ac.uk

We used demineralised bone matrix (DBM) to augment re-attachment of tendon to a metal prosthesis in an in vivo ovine model of reconstruction of the extensor mechanism at the knee. We hypothesised that augmentation of the tendon-implant interface with DBM would enhance the functional and histological outcomes as compared with previously reported control reconstructions without DBM. Function was assessed at six and 12 weeks postoperatively, and histological examination was undertaken at 12 weeks.

A significant increase of 23.5% was observed in functional weight-bearing at six weeks in the DBM-augmented group compared with non-augmented controls (p = 0.004). By 12 weeks augmentation with DBM resulted in regeneration of a more direct-type enthesis, with regions of fibrocartilage, mineralised fibrocartilage and bone. In the controls the interface was predominantly indirect, with the tendon attached to the bone graft-hydroxyapatite base plate by perforating collagen fibres.