Safety of Intra-Articular Use of Atelocollagen for Enhanced Tissue Repair

Abstract

<jats:p>Collagen is an important biomaterial in intra-articular tissue engineering, but there are unanswered questions about its safety. We hypothesize that the addition of type-I-collagen for primary repair of the Anterior Cruciate Ligament (ACL) might result in a local and systemic reaction in a porcine model after 15 weeks as demonstrated by joint effusion, synovial thickening, elevated intraarticular and systemic leukocyte counts. Further, this reaction might be aggravated by the addition of a platelet concentrate. Eighteen porcine ACLs were transected and repaired with either sutures (n=6), a collagen sponge (n=6), or a collagen-platelet-composite (CPC; n=6). Twelve intact contralateral knees served as controls (n=12). No significant synovial thickening or joint effusion was seen in the collagen-treated knees. Synovial fluid leukocyte counts showed no significant differences between surgically treated and intact knees, and no differences were seen in leukocyte counts of the peripheral blood. The addition of a platelet concentrate to the knee joint resulted in lower serum levels of IL-1β, but serum levels of TNF-α were not significantly different between groups. In conclusion, the presence of collagen, with or without added platelets, did not increase the local or systemic inflammatory reactions following surgery, suggesting that Type I collagen is safe to use in the knee joint.</jats:p>

Primary Repair of the Anterior Cruciate Ligament: A Systematic Review

“…[20][21][22][23] Furthermore, other studies stressed the importance of providing a suitable biological environment by adding a collagen matrix sponge [25][26][27][28][29] or PRP to stimulate healing. [30][31][32][33] The literature suggests a mutually inclusive relation between collagen matrix sponge and PRP.…”

“…In addition to mechanical augmentation, several groups have investigated the role of biologics in primary ACL repair including the use of a collagen scaffold [25][26][27][28][29] and platelet-rich plasma (PRP). [30][31][32][33] Fleming et al 25 reported that augmentation with a bovine collagen scaffold alone did not improve the biomechanical properties of a repaired porcine ACL.…”

“…Magarian et al 29 looked at markers of systemic and local inflammatory response in 18 skeletally immature Yorkshire pigs that were divided into 3 experimental groups: suture repair alone, suture repair augmented with a collagen sponge, and suture repair augmented with a CPC. No significant differences were found regarding synovial thickening, joint effusion, synovial leukocyte counts, or peripheral leukocyte counts among the 3 experimental groups when compared with contralateral control knees.…”

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

“…The BEAR scaffold softens when blood is added to it, making it conformable to the intra-articular notch and able to fill in the irregular contours of the gap between the torn ligament ends. The scaffold material has been tested in preclinical large animal studies 15,16,22,38 in which the healing ACL was found to have similar mechanical properties to a bone–patellar tendon–bone allograft at 3, 6, and 12 months after surgery. 21,33 In addition, pigs treated with the BEAR scaffold had a significantly lower rate of osteoarthritis than those treated with ACL reconstruction.…”

Autologous Collagen-Induced Chondrogenesis Using Fibrin and Atelocollagen Mixture

“…Collagen is the connective tissue protein which has a key role in maintaining tissue morphology, and atelocollagen is a highly purified type I collagen obtained following the treatment of pepsin from skin dermis [Magarian et al, 2012]. This atelocollagen is obtained following the removal of telopeptide which is immunologically problematic and is used for a number of purposes such as wound healing, vessel prosthesis, bone substitute and hemostatic agent [Kojima et al, 2007].…”