ArticleJournal of experimental orthopaedics2023
Xenograft bone-patellar tendon-bone ACL reconstruction: a case series at 20-year follow-up as proof of principle.
Article in Journal of experimental orthopaedics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed, 3 citations in OpenAlex.
- Decellularized Porcine Tendon Xenografts Provide a Viable Option in Anterior Cruciate Ligament Reconstruction.Cureus · 2026Article
- Low failure rates and satisfactory PROMs in ACL reconstruction with decellularized porcine xenograft: Short-term results in middle-aged adults.Journal of experimental orthopaedics · 2026Article
- Five-year clinical study of a novel porcine xenograft for anterior cruciate ligament reconstruction: Positive safety and performance outcomes.Journal of experimental orthopaedics · 2025Article
- Graft Selection in Anterior Cruciate Ligament Reconstruction: A Comprehensive Review of Current Trends.Medicina (Kaunas, Lithuania) · 2024Review
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeACL reconstruction has a significant failure rate. To address the need for inexpensive strong tissue, a treatment process to "humanize" porcine tissue was developed and tested in primates and humans. This report describes the long-term outcomes from the first human clinical trial using a porcine xenograft ACL reconstruction device.
methodsThe study was performed with Z-Lig™ xenograft ACL device in 2003 as a pilot clinical feasibility study. This device was processed to slow its immune-mediated destruction by enzymatic elimination of α-gal epitopes and by partial crosslinking to slow the infiltration of macrophages into the biotransplant.
resultsTen patients underwent reconstruction with the Z-Lig™ device. Five of 10 patients failed due to subsequent trauma (n = 3), arthrofibrosis (n = 1), and surgical technical error (n = 1). One patient was lost to follow-up after the 12-year evaluation. Each remaining patient reported a stable fully athletic knee. Physical exams are consistent with a score of less than one on the ACL stability tests. MRIs demonstrate mature remodeling of the device. There is no significant degradation in patient-reported outcome scores, physical exams, or MRI appearance from 12 to 20-year follow-ups.
conclusionsThe studies in a small group of patients have demonstrated that implantation of porcine ligament bioprosthesis into patients with torn ACLs can result in the reconstruction of the bioprosthesis into autologous ACL that remains successful over 20 years. The possibility of humanizing porcine tissue opens the door to unlimited clinical material for tissue reconstructions if supported by additional clinical trials. LEVEL OF EVIDENCE: IV, case series.
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