OrthoPure™ XT Pilot Clinical Study

The OrthoPure™ XT device is a decellularized, sterile, single use biological scaffold for use
in the treatment of patients with a partial or complete tear of the Anterior Cruciate
Ligament (ACL) who require surgical reconstruction of the ACL.

This is a Pilot Safety Study. The primary objective of this study is to evaluate the clinical
safety of the OrthoPure™ XT device in a small group of patients that require reconstruction
of the Anterior Cruciate Ligament (ACL) due to partial or complete tear of the ACL.

Clinical safety will be analyzed through measurement of immune response (alpha-Gal IgG),
blood and urine analysis, incidence of secondary surgical interventions with the treated
knee, and the incidence of individual adverse events.

The second objectives of this study are to assess the efficacy endpoints, specifically:
improvement in knee stability, function and pain; improvement in patient quality of life and
radiographic analysis.

Inclusion Criteria:

1. Patients who are skeletally mature, as evidenced by closed tibial and femoral
epiphyses on x-rays at baseline.

2. Patients who have been diagnosed with a partial or complete tear of the ACL as
determined by MRI, require surgical reconstruction of the ACL, and are candidates for
ACL surgery.

3. Patients who have passive flexion ≥ 120°, and passive extension on the target knee is
the same as the contralateral knee, in the judgment of the Investigator.

4. Patients who have Medial Collateral Ligament (MCL) injury of Grade 2 or less.

5. Patients with osteoarthritis of Grade 2 or less as defined radiographically on the
Kellgren-Lawrence (K-L) scale.

6. Patients who are able to give voluntary, written informed consent to participate and
have signed an Informed Consent Form specific to this study.

7. Patients who are willing and able to comply with all study procedures including all
pre-operative, post-operative and rehabilitation requirements.

8. If female and of child-bearing potential, patients who have a negative urine pregnancy
test at Visit 2 and have no intention to become pregnant in the next 24 months.

Exclusion Criteria:

1. Patients with Body Mass Index (BMI) greater than 35 kg/m2.

2. Patients presenting with osteoarthritis of the target knee e.g. International
Cartilage Repair Society (ICRS) Grade III or higher as determined by their baseline
MRI scan.

3. Patients who have had previous ACL reconstruction on the target knee.

4. Patients who have had any other type of surgical procedure on the target knee in the 3
months prior to Visit 1.

5. Patients with ligament instability, osteoarthritis greater than Grade 2 or a current
ACL injury in the contralateral knee.

6. Patients with a complete or partial Lateral Collateral Ligament (LCL) tear or
Posterior Cruciate Ligament (PCL) tear on the target knee.

7. Patients with meniscal repairs and tears requiring more than one third (1/3) removal
of the meniscus on the target knee as determined during knee arthroscopy.

8. Patients who have an active systemic infection, or an active local infection in or
near the target knee, or have a previous history of joint infection.

9. Patients who are participating concurrently in another clinical trial, or have
participated in a clinical trial within the last 90 days, or intend to during the
course of the study.

10. Patients who have previously been implanted with any type of xenograft device.

11. Patients with known immunodeficiency including patients who are receiving or have
received corticosteroids, immunosuppressants, immunostimulating agents or radiation
therapy within 6 months of Visit 1.

12. Patients who have conditions that may be exacerbated by, or may interfere with the
results of the skin prick test.

13. Patients with significant comorbidities or conditions associated with high risk for
surgical or anesthetic survival (e.g. renal failure, peripheral vascular disease,
unstable cardiac disease, poorly controlled diabetes, immunosuppression, etc.).

14. Patients with active neoplastic disease.

15. Patients with known allergy to mammalian meat, porcine products or a religious
objection to the use of implanted porcine material.

16. Patients with current drug or alcohol abuse, or a history of the same within the last
6 months.

17. Patients with local circulatory problems, (e.g. thrombophlebitis and lymphedema).

18. Patients with any mental or psychological disorder that would impair their ability to
complete the study questionnaires.

19. Patients with any medical condition or other circumstances that might interfere with
their ability to return for follow-up visits in the judgment of the Investigator,
including any systemic illness, neuromuscular, neurosensory, or musculoskeletal
deficiency that would render the patient unable to perform appropriate postoperative
rehabilitation.

20. Any condition which, in the judgment of the Investigator, would preclude adequate
evaluation of device's safety and performance.