Reconstruction of the anterior cruciate ligament with cryopreserved allogeneous anterior tibia tendon graft
Authors:   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Budaev A.A. , Bondarev V.B. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Borovkova N.V. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Fine A.M. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru; MD, Head of the Scientific Department; Professor of A.I. Evdokimov Moscow State Medical University, Ministry of Health of the Russian Federation, Makarov M.S. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Vaza A.Yu. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Evdokimova O.L. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Neznanova M.V. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Storozheva M.V. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Mironov A.S. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Nikolaev A.Yu. ,   Cand. Sc., senior researcher, A. N. Nesmeyanov Institute of Organoelement Compounds of Russian Academy of Sciences, Andreev Yu.V. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru, Ponomarev I.N. ,   N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Ru;
Published: December 2024

Aim of study. To evaluate the effectiveness of allogeneic tendon, sterilized with supercritical carbon dioxide, in restoration of the anterior cruciate ligament (ACL) during clinical example.
Material and methods. The patient was admitted at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the diagnosis: an old rupture of the anterior cruciate ligament of the right knee joint, rupture of the internal meniscus, chondromalacia of the inner condyle of the right femur 2-3 art., according to the ICRS classification. From the anamnesis, it became known about the previous 2 operations for ruptures of the ligaments of the right knee joint and the use of autologous tendons as a plastic material.
A conversation was held with the patient about all possible methods of ACL repair and a choice was made in favor of using a cryopreserved allogeneic tibialis anterior tendon graft as a graft due to a shortage of autologous tissues. Allogeneic tendons were taken from tissue donors, treated with 10% dimethyl sulfoxide, sterilized with supercritical carbon dioxide and frozen at -80°C. After confirming the absence of toxicity, as well as the results of bacteriological examination, the allogeneic tendon graft was used for ACL repair.
Results. The early postoperative period was uneventful. On the 12th day postoperative wounds healed by primary intention. An MRI examination revealed a graft of the anterior cruciate ligament in the formed bone canals; the graft was not thickened and had a homogeneous structure.
After 28 days, the patient gradually began active and passive development of movements in the knee joint. After 6 weeks the range of motion and strength in the right knee joint was comparable to the left knee joint. After 4 months, according to magnetic resonance imaging, ligamentation of the allogenic graft and "synovial sleeve" formation were observed.
Conclusion. According to the clinical course and time of rehabilitation, the technique of using allogeneic tendons during ACL plastic surgery was comparable to the use of an autologous graft. The clinical experience of using allogeneic tendons at the early postoperative stage could be assessed as successful. Further observation is necessary to fully assess the reconstruction and integration of the tendon.
Keywords: anterior cruciate ligament, arthroscopic repair, graft, tendons, allogeneic, sterilization.