Design and testing of external fixator bone screws

In external fixation, bone screw loosening still presents a major clinical problem. For this study, the design factors influencing the mechanics of the bone-screw interface were analysed and various experimental screws designed with the intention of maximizing the strength and stiffness of the inserted screw. Push-in, pull-out and bending tests were then carried out on the three experimental screws, and on two commercially available screws in both a synthetic material and in cadaveric bone; photoelastic tests on different screw threadforms were also performed. The results of the push-in and pull-out tests indicate that both the screw threadform and cutting head have a significant effect on the holding strength of the screw. The photoelastic tests show that most of the applied load is distributed over the first few threads closest to the load, and that the area between the thread crests is subjected to high shear stresses.     

Osteochondral graft fixation using a bioresorbable bone cement

Multiple osteochondral grafts can be used to resurface large joint defects in both humans and horses. In humans, immediate postoperative weight bearing can be prevented, however in the equine, it is unavoidable. Early weight bearing can create detrimental graft micromotion. The aim of this study was to investigate the role of a bioresorbable cement in improving the initial stability of multiple osteochondral graft repairs of large subchondral cystic lesions in the horse. Configurations employed for filling a 20mm diameter cylindrical defect included: (A) twelve 4.5mm diameter grafts with cement, (B) five 6.5mm diameter grafts with cement, (C) four each of 4.5mm and 6.5mm grafts with cement and (D) cement only. Intact bone slices (E) were also tested. Push-out tests were used to quantify construct to host sidewall interface fixation. Configuration (A) proved clinically impractical (n=3). Configurations (B) (n=6), and (C) (n=4) had statistically similar interface stiffnesses and failure stresses (43+/-8 and 30+/-12 MPa and 0.96+/-0.1 and 1.2+/-0.3 Mpa, respectively) suggesting that they are equally susceptible to interface movement in the immediate postoperative period. By way of comparison, defects filled only with cement had an average stiffness of 53+/-7MPa and failure stress of 1.8+/-0.3 MPa (n=6) while the intact femoral condyle demonstrated a stiffness of 108+/-7 MPa and failure stress of 18+/-0.4 MPa (n=6). Cement augmentation improved immediate postoperative stability of multiple osteochondral graft constructs over uncemented constructs, although in all cases the observed moduli of elasticity and yield stress values were lower than those observed for cement only and intact bone test specimens. (all numbers are mean+/-SEM).     

Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts

We developed an experimental model to compare the efficacy of free vascularized bone grafts, conventional segmental autografts, matchstick autografts, and fresh segmental allografts in terms of their ability to reconstruct a 7-cm segmental diaphyseal defect created in the canine femur. Forty-five adult mongrel dogs were studied and followed for 6 to 12 months prior to sacrifice. Evaluation included radiologic assessment of graft incorporation and hypertrophy, histology, and biomechanical testing. These studies indicated that microsurgically revascularized autografts were superior to all other groups in terms of early incorporation, hypertrophy, and the highest mechanical strength to failure. Union of the bone graft to the recipient femur was achieved by 6 months in 25 of 26 autografts, and no difference in union rate was seen within the autograft group. However, only two of five allografts achieved bony union during this time interval. Arteriography, microangiography, fluorochrome, and histologic studies all supported the concept that microsurgically revascularized grafts, when successful, maintain their viability. However, the premise that all osteocytes survive in a successfully revascularized bone graft is open to question. While decalcified sections showed that all microsurgically revascularized grafts maintained normal viability in the central marrow and cancellous portions compared with the other three groups, the viability of cortical bone in the vascularized autografts was less clear. Undecalcified fluorochrome sections suggested that circulation was not preserved in all portions of the cortex. Revascularization of the nonvascularized autografts was complete at 3 months, while, in the avascular allografts, the process was not complete at 6 months.     

An approximate model for cancellous bone screw fixation

This paper presents a finite element (FE) model to identify parameters that affect the performance of an improved cancellous bone screw fixation technique, and hence potentially improve fracture treatment. In cancellous bone of low apparent density, it can be difficult to achieve adequate screw fixation and hence provide stable fracture fixation that enables bone healing. Data from predictive FE models indicate that cements can have a significant potential to improve screw holding power in cancellous bone. These FE models are used to demonstrate the key parameters that determine pull-out strength in a variety of screw, bone and cement set-ups, and to compare the effectiveness of different configurations. The paper concludes that significant advantages, up to an order of magnitude, in screw pull-out strength in cancellous bone might be gained by the appropriate use of a currently approved calcium phosphate cement.     

A laboratory simulation for morselized bone graft fusion: apparent modulus under operatively based femoral impaction kinetics

The purpose of this study was to determine the apparent modulus changes accompanying a novel procedure for simulating in situ fusion of morselized cancellous bone femoral impaction grafts. An experienced surgeon's habitual intra-operative impaction grafting protocol was first quantified in human cadaver femurs, using a customized impulse force hammer. A corresponding standardized impaction procedure was then defined, and was used to prepare impaction grafts in axisymmetric metallic fixturing designed to replicate the nominal geometry of femoral canal confinement. Impaction graft fusion was simulated by mixing morselized cancellous bone with an amine-based epoxy adhesive before the impaction, then allowing the mixture to fuse after the impaction (J. Biomech. 34 (2001) 811). Force/deflection behavior of the unfused and fused impaction grafts was measured for both the (tapered) proximal and (untapered) distal portions of the grafts. Apparent modulus was then calculated from force/deflection stiffness. The impaction graft fusion simulation increased apparent modulus by an order of magnitude over the unfused state, for mixture parameters appropriate to have the fused graft apparent modulus be comparable to the compressive modulus of intact femoral cancellous bone.     

Micro-CT and micro-FE analysis of pedicle screw fixation under different loading conditions

Anchorage of pedicle screw instrumentation in the elderly spine with poor bone quality remains challenging. In this study, micro finite element (µFE) models were used to assess the specific influence of screw design and the relative contribution of local bone density to fixation mechanics. These were created from micro computer tomography (µCT) scans of vertebras implanted with two types of pedicle screws, including a full region-or-interest of 10 mm radius around each screw, as well as submodels for the pedicle and inner trabecular bone of the vertebral body. The local bone volume fraction (BV/TV) calculated from the µCT scans around different regions of the screw (pedicle, inner trabecular region of the vertebral body) were then related to the predicted stiffness in simulated pull-out tests as well as to the experimental pull-out and torsional fixation properties mechanically measured on the corresponding specimens. Results show that predicted stiffness correlated excellently with experimental pull-out strength (R² > 0.92, p < .043), better than regional BV/TV alone (R2 = 0.79, p = .003). They also show that correlations between fixation properties and BV/TV were increased when accounting only for the pedicle zone (R² = 0.66–0.94, p ≤ .032), but with weaker correlations for torsional loads (R² < 0.10). Our analyses highlight the role of local density in the pedicle zone on the fixation stiffness and strength of pedicle screws when pull-out loads are involved, but that local apparent bone density alone may not be sufficient to explain resistance in torsion.     

Changes of the dermal-fascial autograft after transplantation on the vascular-nervous connections using a microsurgical technique

In 56 dogs 86 microsurgical operations on transplantation of free dermal-facial autografts from the internal knee surface have been performed on the hidden vascular-nervous bundle. The animals have been observed for 1 day up to 1 year. The implanted grafts (63) have been studied, using a complex of anatomical, histological and roentgenological methods. During early time (up to 7 days) after the operation in the flap signs of edema, dystrophy and inflammatory infiltration of tissues predominate. The graft gets blood at the expense of the restored main artery and has no vascular connections with the surrounding tissues. Its nervous conductors are fragmented. During 2 weeks--1 month epidermis completely regenerates along the line of the dermal suture. In the flap bed mature granulations result in vascular connections with its surrounding tissues. These connections become stable by the end of the first month, this means that the graft has implanted. Its nervous fibers are also restored. Long-term observations demonstrate that the adaptive changes of the flap and its vascular bed are near to completion. By the end of the 1st year restoration of the main innervational connections of the graft takes place. According to the data obtained, the nervous conductors grow into it along the sewed hidden nerve and along the course of paravasal nerve plexuses. Across the scar from the surrounding tissues the dermal-fascial autograft does not reinnervate.     

Mechanical behavior of a new biphasic calcium phosphate bone graft

The aim of this study was to create a new porous calcium phosphate implant for use as a synthetic bone graft substitute. Porous bioceramic was fabricated using a foam-casting method. By using polyurethane foam and a slurry containing hydroxyapatite-dicalcium phosphate powder, water, and additives, a highly porous structure (66 ± 5%) was created. The porous specimens possess an elastic modulus of 330 ± 32 MPa and a compressive strength of 10.3 ± 1.7 MPa. The X-ray diffraction patterns show hydroxyapatite and beta-pyrophosphate phases after sintering. A rabbit model was developed to evaluate the compressive strength and elastic modulus of cancellous bone defects treated with these porous synthetic implants. The compressive mechanical properties became weaker until the second month post implantation. After the second month, these properties increased slightly and remained higher than control values. New bone formed on the outside surface and on the macropore walls of the specimens, as osteoids and osteoclasts were evident two months postoperatively. Considering these properties, these synthetic porous calcium phosphate implants could be applicable as cancellous bone substitutes.     

Influence of aspect ratios on the creep behaviour of articular cartilage in indentation

Indentation tests are commonly used to determine the mechanical behaviour of articular cartilage with varying properties, thickness, and geometry. This investigation evaluated the effect of changing geometric parameters on the properties determined from creep indentation tests. Finite element analyses simulated the indentation behaviour of two models, an excised cylindrical specimen of cartilage with either normal and repair qualities and an osteochondral defect represented as a cylindrical region of repair cartilage integrated with a surrounding layer of normal tissue. For each model, the ratios of indenter radius to cartilage height (a/h=0.5,1.5) and cartilage radius to indenter radius (r/a=2,5) were varied. The vertical displacement of the cartilage under the indenter obtained through finite element analysis was fitted to a numerical algorithm to determine the aggregate modulus, permeability, and Poisson's ratio. Indentation behaviours of cartilage specimens for either model with a/h=1.5 were not affected by r/a for values of 2 and 5. Aggregate modulus was not greatly affected by the geometric changes studied. Permeability was affected by changes in the ratio of specimen to indenter radii for a/h=0.5. These findings suggest that experimental configurations of excised cylindrical specimens, also representing osteochondral defects with no or unknown degree of integration, where the cartilage layer has a/h=0.5 should not have r/a values on the order of 2 for confidence in the mechanical properties determined. Indentation of osteochondral defects where the repair cartilage is fully integrated to the surrounding cartilage can be performed with confidence for all cases tested.     

Free bone graft reconstruction of irradiated facial tissue: experimental effects of basic fibroblast growth factor stimulation

A study was undertaken to evaluate the potential utility of basic fibroblast growth factor in the induction of angiogenesis and osseous healing in bone previously exposed to high doses of irradiation. Thirty New Zealand rabbits were evaluated by introducing basic fibroblast growth factor into irradiated mandibular resection sites either prior to or simultaneous with reconstruction by corticocancellous autografts harvested from the ilium. The fate of the free bone grafts was then evaluated at 90 days postoperatively by microangiographic, histologic, and fluorochrome bone-labeling techniques. Sequestration, necrosis, and failure to heal to recipient osseous margins was observed both clinically and histologically in all nontreated irradiated graft sites as well as those receiving simultaneous angiogenic stimulation at the time of graft placement. No fluorescent activity was seen in these graft groups. In the recipient sites pretreated with basic fibroblast growth factor prior to placement of the graft, healing and reestablishment of mandibular contour occurred in nearly 50 percent of the animals. Active bone formation was evident at cortical margins adjacent to the recipient sites but was absent in the more central cancellous regions of the grafts.     

Biomechanical assessment of tissue retrieved after in vivo cartilage defect repair: tensile modulus of repair tissue and integration with host cartilage

Failure to restore the mechanical properties of tissue at the repair site and its interface with host cartilage is a common problem in tissue engineering procedures to repair cartilage defects. Quantitative in vitro studies have helped elucidate mechanisms underlying processes leading to functional biomechanical changes. However, biomechanical assessment of tissue retrieved from in vivo studies of cartilage defect repair has been limited to compressive tests. Analysis of integration following in vivo repair has relied on qualitative histological methods. The objectives of this study were to develop a quantitative biomechanical method to assess (1) the tensile modulus of repair tissue and (2) its integration in vivo, as well as determine whether supplementation of transplanted chondrocytes with IGF-I affected these mechanical properties. Osteochondral blocks were obtained from a previous 8 month study on the effects of IGF-I on chondrocyte transplantation in the equine model. Tapered test specimens were prepared from osteochondral blocks containing the repair/native tissue interface and adjacently located blocks of intact native tissue. Specimens were then tested in uniaxial tension. The tensile modulus of repair tissue averaged 0.65 MPa, compared to the average of 5.2 MPa measured in intact control samples. Integration strength averaged 1.2 MPa, nearly half the failure strength of intact cartilage samples, 2.7 MPa. IGF-I treatment had no detectable effects on these mechanical properties. This represents the first quantitative biomechanical investigation of the tensile properties of repair tissue and its integration strength in an in vivo joint defect environment.     

Direct Lentiviral-Cyclooxygenase 2 Application to the Tendon-Bone Interface Promotes Osteointegration and Enhances Return of the Pull-Out Tensile Strength of the Tendon Graft in a Rat Model of Biceps Tenodesis

This study sought to determine if direct application of the lentiviral (LV)-cyclooxygenase 2 (COX2) vector to the tendon-bone interface would promote osteointegration of the tendon graft in a rat model of biceps tenodesis. The LV-COX2 gene transfer strategy was chosen for investigation because a similar COX2 gene transfer strategy promoted bony bridging of the fracture gap during bone repair, which involves similar histologic transitions that occur in osteointegration. Briefly, a 1.14-mm diameter tunnel was drilled in the mid-groove of the humerus of adult Fischer 344 rats. The LV-COX2 or βgal control vector was applied directly into the bone tunnel and onto the end of the tendon graft, which was then pulled into the bone tunnel. A poly-L-lactide pin was press-fitted into the tunnel as interference fixation. Animals were sacrificed at 3, 5, or 8 weeks for histology analysis of osteointegration. The LV-COX2 gene transfer strategy enhanced neo-chondrogenesis at the tendon-bone interface but with only marginal effect on de novo bone formation. The tendon-bone interface of the LV-COX2-treated tenodesis showed the well-defined tendon-to-fibrocartilage-to-bone histologic transitions that are indicative of osteointegration of the tendon graft. The LV-COX2 in vivo gene transfer strategy also significantly enhanced angiogenesis at the tendon-bone interface. To determine if the increased osteointegration was translated into an improved pull-out mechanical strength property, the pull-out tensile strength of the LV-COX2-treated tendon grafts was determined with a pull-out mechanical testing assay. The LV-COX2 strategy yielded a significant improvement in the return of the pull-out strength of the tendon graft after 8 weeks. In conclusion, the COX2-based in vivo gene transfer strategy enhanced angiogenesis, osteointegration and improved return of the pull-out strength of the tendon graft. Thus, this strategy has great potential to be developed into an effective therapy to promote tendon-to-bone healing after tenodesis or related surgeries.     

Porous hydroxyapatite as a bone graft substitute in cranial reconstruction: a histometric study

To assess the potential of a porous hydroxyapatite matrix to serve as a bone graft substitute, bilateral 15 X 20 mm craniectomy defects were reconstructed in 17 dogs with blocks of implant and split-rib autografts. Specimens were retrieved at 3, 6, 12, 24, and 48 months, and undecalcified sections were prepared for microscopy and histometry. The implant and graft cross-sectional areas did not change with time, documenting their equivalent ability to maintain cranial contour. Bone ingrowth extended across the implant from one cranial shelf to the other in 15 specimens. Little apparent bone ingrowth was seen in most graft specimens. Two implants and three grafts were nonunited, possibly due to lack of fixation or the orientation of the histology sections. The implant specimens were composed of 39.3 percent hydroxyapatite matrix, 17.2 percent bone ingrowth, and 43.5 percent soft-tissue ingrowth. The graft specimens were composed of 43.7 percent bone and 56.3 percent soft tissue. This study supported the thesis that a porous hydroxyapatite matrix may function in part as a bone graft substitute. The brittle hydroxyapatite matrix undoubtedly became stronger with bone ingrowth, but the degree of cranial protection achieved was not measured in this study. The size of the cranial defect used in this study did not permit estimation of the distance over which bone ingrowth may be reliably expected. There remains a need for greater understanding of the causes of nonunion, the extent of predictable ingrowth depth, and the strength of the resultant implant-bone composite.     

Cell-free xenogenic vascular grafts fixed with glutaraldehyde or genipin: in vitro and in vivo studies

Chronic rejection of arterial xenografts results in aneurysmal dilation, due to immune mediated processes. To minimize the immunologic degradation of the graft, a cell-extraction process employing sodium dodecyl sulfate (SDS) was used in the study to remove the cellular components in bovine carotid arteries. To further reduce their immunogenicity, the acellular arteries were fixed with glutaraldehyde (A-GA) or genipin (A-GP). The in vitro properties of all test samples were analyzed. Additionally, the in vivo performance of the heparinized A-GA and A-GP grafts (H-A-GA and H-A-GP) was evaluated in a canine model. It was found that the SDS treatment effectively removed cells from the arterial wall, but the main structures of the extracellular matrix were preserved with a portion of the water-soluble glycosaminoglycans removed. After cell extraction, the elastic lamellae in the media became straightened, and thus made the tissue less extensile. The heparinized tissues significantly reduced platelet adhesion. At retrieval, all implanted grafts were patent and not dilated. Chronic inflammatory response surrounding the implants was observed. However, fixation of acellular tissues by glutaraldehyde or genipin inhibited immune cell penetration into the media and limited tissue degradation, and therefore prevented the arterial wall from dilation. Nevertheless, the H-A-GP graft was superior to the H-A-GA graft in completeness of endothelialization on its luminal surface, and thus precluded thrombus formation.     

Articular cartilage reconstruction using xenogeneic epiphyses slices

Reconstruction of articular cartilage defects using adult osteochondral allografts is an established clinical procedure, whose principal drawback is lack of lateral integration of the grafts to the surrounding tissue. Autologous chondrocytes transplantation is a sophisticated technique requiring cell culture and a staged operation. Its main draw back is the lack of mechanical strength early on. This study was conducted in order to evaluate the possibility of using embryonal epiphyses as a cartilage reconstruction tissue. A xenogeneic human to rabbit sub-acute osteochondral defect model was designed to evaluate the possibility of allogeneic implantation in humans. The following procedures were perfomed (n = 5): transplantation of 1. live epiphyses 2. live epiphyses with autogeneic periosteum 3. de-vitalized epiphyses and 4. devitalized epiphyses with autogeneic articular chondrocytes. A fifth control group did not receive any implant. Animals in groups 1 and 2 had a viable reconstruction of the articular surface with little evidence of rejection and without pannus formation. Animals in groups 3 and 4 became severely arthritic and the graft was resorbed. Nitric oxide synthase accumulation was reduced in group 1 and 2 as compared to groups 3, 4, and 5, indicating a joint preserving function of the epiphyseal grafts. Epiphyseal grafts appear to be a feasible procedure for reconstruction of articular cartilage defects even in a xenogeneic model. This revised version was published online in July 2006 with corrections to the Cover Date.     

Biomechanical measurements on scaphoid bone screws in an experimental model

A number of screws commonly used for internal fixation in scaphoid bone fractures and nonunions are compared regarding biomechanical properties and clinical applicability. The experiments were carried out on models made of ash-wood, representing a reconstruction and fixation as is performed in a cortico-cancellous inlay bone graft for scaphoid non-union. For fixation use was made of 2.7 and 3.5 AO/ASIF cortical screws respectively, 4.0 AO/ASIF cancellous screws, Herbert screws, and a newly designed screw called the three components screw (D.K.S.). The models with implanted screws were tested for bending strength, tensile strength and torsion stability. No large differences between the various screws were found regarding the measured parameters, so that a small intra-osteal implant such as the Herbert screw and the D.K.S., which can be inserted easily and which gives a certain amount of interfragmentary compression, will be sufficient for osteosynthesis of the scaphoid bone. In case an intra-osteal implant is not available a single 3.5 AO/ASIF cortical screw, inserted following lag-screw principles, is recommended.     

Tissue engineering of peripheral nerves: A comparison of venous and acellular muscle grafts with cultured Schwann cells

Bioengineering is considered to be the laboratory-based alternative to human autografts and allografts. It ought to provide "custom-made organs" cultured from patient's material. Venous grafts and acellular muscle grafts support axonal regeneration only to a certain extent because of the lack of viable Schwann cells in the graft. We created a biologic nerve graft in the rat sciatic nerve model by implanting cultured Schwann cells into veins and acellular gracilis muscles, respectively. Autologous nerve grafts and veins and acellular muscle grafts without Schwann cells served as controls. After 6 and 12 weeks, regeneration was assessed clinically, histologically, and morphometrically. The polymerase chain reaction analvsis showed that the implanted Schwann cells remained within all the grafts. The best regeneration was seen in the control; after 12 weeks the number of axons was increased significantly compared with the other grafts. A good regeneration was noted in the muscle-Schwann cell group, whereas regeneration in both of the venous grafts and the muscle grafts without Schwann cells was impaired. The muscle-Schwann cell graft showed a systematic and organized regeneration including a proper orientation of regenerated fibers. The venous grafts with Schwann cells showed less fibrous tissue and disorganization than the veins without Schwann cells, but failed to show an excellent regeneration. This might be attributed to the lack of endoneural-tube-like components serving as scaffold for the sprouting axon. Although the conventional nerve graft remains the gold standard, the implantation of Schwann cells into an acellular muscle provides a biologic graft with basal lamina tubes as pathways for regenerating axons and the positive effects of Schwann cells producing neurotrophic and neurotropic factors, and thus, supporting axonal regeneration.     

Solvent-dehydrated calvarial allografts in craniofacial surgery

Craniofacial surgery almost always requires the use of bone grafting. Although autografts are the standard procedure for bone grafting, it is sometimes not possible to harvest bone, and autografts have particular risks. The use of allograft bone provides a reasonable alternative to meet the need for graft material. Solvent dehydration is a multistage procedure in which human cadaveric bone is processed by osmotic exchange baths and gamma sterilization. This processing avoids the risk of infection transmission, decreases antigenicity, and does not weaken the mechanical properties of the bone. Solvent-dehydrated, gamma-irradiated human calvarial bone allografts were used for reconstruction of craniofacial deformities in 24 patients between 1988 and 2002. Resorption of the allografts and results of the surgical intervention were evaluated with plain radiographs and three-dimensional computed tomography 12 months after surgery, in 21 patients. Serologic tests for human immunodeficiency virus-1 antibody, hepatitis B surface antigen, and hepatitis C antigen were also performed. Biopsy specimens were taken from the allografts. Average follow-up in this group was 30 months (range, 8 to 60 months), and results of serologic tests were negative in all patients. Seventy-one percent of the patients (15 of 21) showed no resorption, with partial and complete allograft fusion. One patient had nearly total graft loss and the remaining five patients had 10 to 25 percent graft resorption. Rigid fixation of the allograft, contact with the dura and periosteum, and prevention of dead spaces around the allograft are the most important factors in achieving a satisfactory result. In solvent-dehydrated bone allografts, sterilization and antigenic tissue cleaning are achieved after several steps with a minimal dose of radiation. The result is a nonantigenic, sterile mechanical scaffold that can tolerate external forces. Although autografts are the standard in craniofacial surgery, solvent-dehydrated calvarial bone allografts produced successful results in selected cases.     

Injectable calcium phosphate cement for augmentation around cancellous bone screws. In vivo biomechanical studies

In lower cancellous apparent bone density, it can be difficult to achieve adequate screw fixation and hence stable fracture fixation. Different strategies have been proposed, one of them is through augmentation using calcium phosphate cement in the region at or close to the screw thread itself. To support the hypothesis of an improved screw fixation technique by augmentation of the bone surrounding the implanted screw, in vivo biomechanical and densitometric studies are performed on rabbit specimen where normal and simulated weak bone quality are considered. In particular, the evolution of screw stability till 12 weeks following the implantation is quantified. A statistical significance in the pull out force for augmented versus non-augmented screws was found for the shorter time periods tested of ≤ 5 days whilst the pull out force was found to increase with time for both augmented and non-augmented screws during the 12 week course of the study. The results of the study demonstrate that the use of an injectable calcium phosphate cement which sets in vivo can significantly improve screw pull out strength at and after implantation for normal and simulated weak bone quality.     

Functional properties of palmaris longus muscles of rhesus monkeys transplanted as index finger flexors

This experiment with skeletal muscle autografts in monkeys was designed to retest previous findings that transplanted skeletal muscle can regenerate to a functional degree in primates without predenervation and to test a new hypothesis that increased functional demands on regenerated muscle grafts in monkeys may result in improved functional capacity of the grafts. Rhesus monkey index flexors were replaced with free palmaris longus muscle autografts with microneural anastomoses between the graft motor nerve and the severed profundus motor nerve. One monkey was taught selective index flexion before grafting and continued with this program after grafting to test the effect of training on the graft. Mature grafts were evaluated for in vivo contractile properties and by histology and histochemistry and were compared with a group of normal Rhesus palmaris longus muscles. The results reconfirm the capacity of nonpredenervated monkey skeletal muscle grafts to regenerate and to achieve some contractile ability and suggest that training of free muscle grafts may enhance recovery of their functional and structural properties.