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Meyer M. Processing of collagen based biomaterials and the resulting materials properties. Biomed Eng Online 2019; 18:24. [PMID: 30885217 PMCID: PMC6423854 DOI: 10.1186/s12938-019-0647-0] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/12/2019] [Indexed: 02/07/2023] Open
Abstract
Collagen, the most abundant extracellular matrix protein in animal kingdom belongs to a family of fibrous proteins, which transfer load in tissues and which provide a highly biocompatible environment for cells. This high biocompatibility makes collagen a perfect biomaterial for implantable medical products and scaffolds for in vitro testing systems. To manufacture collagen based solutions, porous sponges, membranes and threads for surgical and dental purposes or cell culture matrices, collagen rich tissues as skin and tendon of mammals are intensively processed by physical and chemical means. Other tissues such as pericardium and intestine are more gently decellularized while maintaining their complex collagenous architectures. Tissue processing technologies are organized as a series of steps, which are combined in different ways to manufacture structurally versatile materials with varying properties in strength, stability against temperature and enzymatic degradation and cellular response. Complex structures are achieved by combined technologies. Different drying techniques are performed with sterilisation steps and the preparation of porous structures simultaneously. Chemical crosslinking is combined with casting steps as spinning, moulding or additive manufacturing techniques. Important progress is expected by using collagen based bio-inks, which can be formed into 3D structures and combined with live cells. This review will give an overview of the technological principles of processing collagen rich tissues down to collagen hydrolysates and the methods to rebuild differently shaped products. The effects of the processing steps on the final materials properties are discussed especially with regard to the thermal and the physical properties and the susceptibility to enzymatic degradation. These properties are key features for biological and clinical application, handling and metabolization.
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Affiliation(s)
- Michael Meyer
- Research Institute for Leather and Plastic Sheeting, Meissner Ring 1-5, 09599, Freiberg, Germany.
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Barboni B, Russo V, Berardinelli P, Mauro A, Valbonetti L, Sanyal H, Canciello A, Greco L, Muttini A, Gatta V, Stuppia L, Mattioli M. Placental Stem Cells from Domestic Animals: Translational Potential and Clinical Relevance. Cell Transplant 2019; 27:93-116. [PMID: 29562773 PMCID: PMC6434480 DOI: 10.1177/0963689717724797] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The field of regenerative medicine is moving toward clinical practice in veterinary science. In this context, placenta-derived stem cells isolated from domestic animals have covered a dual role, acting both as therapies for patients and as a valuable cell source for translational models. The biological properties of placenta-derived cells, comparable among mammals, make them attractive candidates for therapeutic approaches. In particular, stemness features, low immunogenicity, immunomodulatory activity, multilineage plasticity, and their successful capacity for long-term engraftment in different host tissues after autotransplantation, allo-transplantation, or xenotransplantation have been demonstrated. Their beneficial regenerative effects in domestic animals have been proven using preclinical studies as well as clinical trials starting to define the mechanisms involved. This is, in particular, for amniotic-derived cells that have been thoroughly studied to date. The regenerative role arises from a mutual tissue-specific cell differentiation and from the paracrine secretion of bioactive molecules that ultimately drive crucial repair processes in host tissues (e.g., anti-inflammatory, antifibrotic, angiogenic, and neurogenic factors). The knowledge acquired so far on the mechanisms of placenta-derived stem cells in animal models represent the proof of concept of their successful use in some therapeutic treatments such as for musculoskeletal disorders. In the next future, legislation in veterinary regenerative medicine will be a key element in order to certify those placenta-derived cell-based protocols that have already demonstrated their safety and efficacy using rigorous approaches and to improve the degree of standardization of cell-based treatments among veterinary clinicians.
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Affiliation(s)
- B Barboni
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - V Russo
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - P Berardinelli
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - A Mauro
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - L Valbonetti
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - H Sanyal
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - A Canciello
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - L Greco
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - A Muttini
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - V Gatta
- 1 Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - L Stuppia
- 2 Medical Genetics, University "G. d'Annunzio" of Chieti Pescara, Chieti, Italy
| | - M Mattioli
- 3 Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise "G. Caporale," Teramo, Italy
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Cole W, Samsell B, Moore MA. Achilles Tendon Augmented Repair Using Human Acellular Dermal Matrix: A Case Series. J Foot Ankle Surg 2019; 57:1225-1229. [PMID: 29779989 DOI: 10.1053/j.jfas.2018.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Indexed: 02/03/2023]
Abstract
Achilles tendon ruptures are common in the general population, especially among members of the older demographic occasionally active in sports. Operative treatments provide a lower incidence of rerupture than do nonoperative treatments, although surgical complications remain a concern. The use of a human acellular dermal matrix to augment Achilles tendon repair might reduce the incidence of complications. In the present case series, we describe the outcomes of 9 patients who underwent Achilles tendon repair with acellular dermal matrix augmentation. Functional outcomes were evaluated using the Foot Function Index-Revised long form, and the clinical results were recorded. After a mean average follow-up period of 14.4 (range 12.0 to 20.0) months, the mean Foot Function Index-Revised long form score was 33.0% ± 4.2%. No cases of rerupture or complications that required additional treatment occurred during the observation period. The outcomes we have presented support further evaluation beyond this case series for using a human acellular dermal matrix to augment Achilles tendon repairs.
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Affiliation(s)
- Windy Cole
- Adjunct Faculty and Director, Wound Care Research, Kent State University College of Podiatric Medicine, Independence, OH; Medical Director, Wound Care Center, University Hospitals Ahuja Medical Center, Beachwood, OH.
| | - Brian Samsell
- Scientific Writer, Scientific Affairs, LifeNet Health, Virginia Beach, VA
| | - Mark A Moore
- Global Senior Director, Scientific Affairs, LifeNet Health, Virginia Beach, VA
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Li Z, Zhang Y. Efficacy of bone marrow stimulation in arthroscopic repair of full thickness rotator cuff tears: a meta-analysis. J Orthop Surg Res 2019; 14:36. [PMID: 30696479 PMCID: PMC6352336 DOI: 10.1186/s13018-019-1072-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background To conduct a meta-analysis to compare the curative effect of treating the full thickness tear of the rotator cuff using the arthroscopic bone marrow stimulation (BMS) technology and provide the evidence for its extensive clinical application. Methods A systematic literature search was conducted to evaluate the studies on comparison of the curative effect of routine surgery with or without BMS on rotator cuff tear in the major medical databases. The literature was screened according to the inclusion and exclusion standards, and the quality assessment was conducted, then Review Manager 5.3 software was used for meta-analysis. Results Eight articles were eligible for inclusion. There were no statistically significant differences between BMS and control groups for overall outcome scores (P > 0.05). Except the Constant score of BMS group was significantly higher than that of the control group at the third follow-up month (P = 0.007). However, the postoperative re-tear rate of the BMS group was significantly lower than that of the control group (P < 0.001). Furthermore, we made a subgroup analysis and found that the postoperative Constant and UCLA score had no significant differences among all groups (P > 0.05), and the re-tear rates of the BMS groups were lower than those of the control groups (P = 0.001, P = 0.0002). Conclusions BMS technology has no significant influence on the postoperative clinical result of patients. However, it can obviously promote the tendon-to-bone healing of the rotator cuff and decrease the re-tear rate, which provides evidence for the clinical treatment.
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Affiliation(s)
- Zhuoyang Li
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yijun Zhang
- Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Reichert P, Królikowska A, Kentel M, Witkowski J, Gnus J, Satora W, Czamara A. A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair. J Orthop Sci 2019; 24:103-108. [PMID: 30219603 DOI: 10.1016/j.jos.2018.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/14/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation. METHODS A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions. RESULTS The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24-1.00), circumferences (p = 0.15-0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07-1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01-0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb. CONCLUSION The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.
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Affiliation(s)
- Paweł Reichert
- Division of Sports Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | | | | | - Jarosław Witkowski
- Division of Sports Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Jan Gnus
- Division of Sports Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Satora
- Department of Trauma and Orthopedic Surgery, St. Luke's Hospital, Bielsko-Biała, Poland
| | - Andrzej Czamara
- Department of Physiotherapy, The College of Physiotherapy in Wroclaw, Wroclaw, Poland
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Interference screw insertion angle has no effect on graft fixation strength for insertional Achilles tendon reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26:3606-3610. [PMID: 29445875 DOI: 10.1007/s00167-018-4864-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the effect of two interference screw insertion angles on the biomechanical properties of the insertional Achilles tendon (IAT) reconstruction. METHODS Nine matched pairs of fresh-frozen human cadaveric Achilles tendon specimens were randomized to two groups with interference screw insertion angles of 60° and 120°. The IAT reconstruction was performed by fixing the graft tendon with the interference screw. Each specimen was loaded to failure. The load at failure, stiffness, and mode of failure were documented. Differences in load at failure and stiffness were analysed. RESULTS There was no statistically significant difference between the 60° and 120° groups for failure load (149.137 ± 20.836 versus 155.428 ± 28.343 N, respectively, n.s.) and stiffness (14.523 ± 2.824 N/mm versus 14.727 ± 2.192 N/mm, respectively, n.s.). The most common mode of failure was the graft pulling out of the bone tunnel when the screw broke. CONCLUSIONS Graft fixation at two different interference screw insertion angles for IAT reconstruction exhibited equivalent biomechanical performance. When performing this procedure, surgeons may choose the interference screw insertion angle based on personal preference.
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Sensini A, Gualandi C, Zucchelli A, Boyle LA, Kao AP, Reilly GC, Tozzi G, Cristofolini L, Focarete ML. Tendon Fascicle-Inspired Nanofibrous Scaffold of Polylactic acid/Collagen with Enhanced 3D-Structure and Biomechanical Properties. Sci Rep 2018; 8:17167. [PMID: 30464300 PMCID: PMC6249227 DOI: 10.1038/s41598-018-35536-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 10/29/2018] [Indexed: 12/21/2022] Open
Abstract
Surgical treatment of tendon lesions still yields unsatisfactory clinical outcomes. The use of bioresorbable scaffolds represents a way forward to improve tissue repair. Scaffolds for tendon reconstruction should have a structure mimicking that of the natural tendon, while providing adequate mechanical strength and stiffness. In this paper, electrospun nanofibers of two crosslinked PLLA/Collagen blends (PLLA/Coll-75/25, PLLA/Coll-50/50) were developed and then wrapped in bundles, where the nanofibers are predominantly aligned along the bundles. Bundle morphology was assessed via SEM and high-resolution x-ray computed tomography (XCT). The 0.4-micron resolution in XCT demonstrated a biomimetic morphology of the bundles for all compositions, with a predominant nanofiber alignment and some scatter (50-60% were within 12° from the axis of the bundle), similar to the tendon microstructure. Human fibroblasts seeded on the bundles had increased metabolic activity from day 7 to day 21 of culture. The stiffness, strength and toughness of the bundles are comparable to tendon fascicles, both in the as-spun condition and after crosslinking, with moderate loss of mechanical properties after ageing in PBS (7 and 14 days). PLLA/Coll-75/25 has more desirable mechanical properties such as stiffness and ductility, compared to the PLLA/Coll-50/50. This study confirms the potential to bioengineer tendon fascicles with enhanced 3D structure and biomechanical properties.
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Affiliation(s)
- Alberto Sensini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
| | - Chiara Gualandi
- Department of Chemistry "G. Ciamician" and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - Università di Bologna, 40126, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - Andrea Zucchelli
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
| | - Liam A Boyle
- INSIGNEO Institute for in silico Medicine, Department of Materials Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Alexander P Kao
- ZEISS Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK
| | - Gwendolen C Reilly
- INSIGNEO Institute for in silico Medicine, Department of Materials Science, University of Sheffield, Sheffield, S10 2TN, United Kingdom
| | - Gianluca Tozzi
- ZEISS Global Centre, School of Mechanical and Design Engineering, University of Portsmouth, PO1 3DJ, Portsmouth, UK
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum - Università di Bologna, 40131, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - Maria Letizia Focarete
- Department of Chemistry "G. Ciamician" and National Consortium of Materials Science and Technology (INSTM, Bologna RU), Alma Mater Studiorum - Università di Bologna, 40126, Bologna, Italy.
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (HST-ICIR), Alma Mater Studiorum - Università di Bologna, 40064, Ozzano dell'Emilia, Bologna, Italy.
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Abstract
In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing.
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Jancuska J, Matthews J, Miller T, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff. Orthop J Sports Med 2018; 6:2325967118797891. [PMID: 30320144 PMCID: PMC6154263 DOI: 10.1177/2325967118797891] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly. PURPOSE To quantify the number of systematic reviews and meta-analyses published on the RC and to provide a qualitative summary of the literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search for all systematic reviews and meta-analyses pertaining to the RC published between January 2007 and September 2017 was performed with PubMed, MEDLINE, and the Cochrane Database of Systematic Reviews. Narrative reviews and non-English language articles were excluded. RESULTS A total of 1078 articles were found, of which 196 met the inclusion criteria. Included articles were summarized and divided into 15 topics: anatomy and function, histology and genetics, diagnosis, epidemiology, athletes, nonoperative versus operative treatment, surgical repair methods, concomitant conditions and surgical procedures, RC tears after total shoulder arthroplasty, biological augmentation, postoperative rehabilitation, outcomes and complications, patient-reported outcome measures, cost-effectiveness of RC repair, and quality of randomized controlled trials. CONCLUSION A qualitative summary of the systematic reviews and meta-analyses published on the RC can provide surgeons with a single source of the most current literature.
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Affiliation(s)
- Jeffrey Jancuska
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - John Matthews
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Tyler Miller
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Melissa A. Kluczynski
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
| | - Leslie J. Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical
Science, University at Buffalo, Buffalo, New York, USA
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Abstract
Introduction. Tendons are specialised, heterogeneous connective tissues, which represent a significant healthcare challenge after injury. Primary surgical repair is the gold standard modality of care; however, it is highly dependent on the extent of injuries. Tissue engineering represents an alternative solution for good tissue integration and regeneration. In this review, we look at the advanced biomaterial composites employed to improve cellular growth while providing appropriate mechanical properties for tendon and ligament repair. Methodology. Comprehensive literature searches focused on advanced composite biomaterials for tendon and ligament tissue engineering. Studies were categorised depending on the application. Results. In the literature, a range of natural and/or synthetic materials have been combined to produce composite scaffolds tendon and ligament tissue engineering. In vitro and in vivo assessment demonstrate promising cellular integration with sufficient mechanical strength. The biological properties were improved with the addition of growth factors within the composite materials. Most in vivo studies were completed in small-scale animal models. Conclusions. Advanced composite materials represent a promising solution to the challenges associated with tendon and ligament tissue engineering. Nevertheless, these approaches still demonstrate limitations, including the necessity of larger-scale animal models to ease future clinical translation and comprehensive assessment of tissue response after implantation.
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Biomaterials in Tendon and Skeletal Muscle Tissue Engineering: Current Trends and Challenges. MATERIALS 2018; 11:ma11071116. [PMID: 29966303 PMCID: PMC6073924 DOI: 10.3390/ma11071116] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/20/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
Abstract
Tissue engineering is a promising approach to repair tendon and muscle when natural healing fails. Biohybrid constructs obtained after cells’ seeding and culture in dedicated scaffolds have indeed been considered as relevant tools for mimicking native tissue, leading to a better integration in vivo. They can also be employed to perform advanced in vitro studies to model the cell differentiation or regeneration processes. In this review, we report and analyze the different solutions proposed in literature, for the reconstruction of tendon, muscle, and the myotendinous junction. They classically rely on the three pillars of tissue engineering, i.e., cells, biomaterials and environment (both chemical and physical stimuli). We have chosen to present biomimetic or bioinspired strategies based on understanding of the native tissue structure/functions/properties of the tissue of interest. For each tissue, we sorted the relevant publications according to an increasing degree of complexity in the materials’ shape or manufacture. We present their biological and mechanical performances, observed in vitro and in vivo when available. Although there is no consensus for a gold standard technique to reconstruct these musculo-skeletal tissues, the reader can find different ways to progress in the field and to understand the recent history in the choice of materials, from collagen to polymer-based matrices.
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Wu Y, Han Y, Wong YS, Fuh JYH. Fibre-based scaffolding techniques for tendon tissue engineering. J Tissue Eng Regen Med 2018; 12:1798-1821. [DOI: 10.1002/term.2701] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 04/22/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Yang Wu
- Engineering Science and Mechanics Department; Penn State University; University Park PA USA
- The Huck Institutes of the Life Sciences, Penn State University; University Park PA USA
| | - Yi Han
- Department of Preventive Medicine; USC Keck School of Medicine; Los Angeles CA USA
| | - Yoke San Wong
- Department of Mechanical Engineering; National University of Singapore; Singapore Singapore
| | - Jerry Ying Hsi Fuh
- Department of Mechanical Engineering; National University of Singapore; Singapore Singapore
- National University of Singapore (Suzhou) Research Institute, Suzhou Industrial Park; Suzhou China
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Biomechanical, Biochemical, and Cell Biological Evaluation of Different Collagen Scaffolds for Tendon Augmentation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7246716. [PMID: 29854782 PMCID: PMC5966701 DOI: 10.1155/2018/7246716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/19/2018] [Indexed: 11/17/2022]
Abstract
Tendon augmentation is increasingly clinically relevant due to rising amount of tendon ruptures because of the aging and more demanding population. Therefore, newly developed scaffolds based on bovine epoxide stabilized collagen maintaining the native fibril-like collagen structure were characterized and compared to two commercially available porcine collagen scaffolds. For biomechanical testing (ultimate load, ultimate stress, stiffness, and elastic modulus), bovine collagen scaffolds were hydrated and compared to reference products. Cell viability and proliferation were assessed by seeding human primary fibroblasts on each collagen-based scaffold and cultured over various time periods (3 d, 7 d, and 14 d). Live/dead staining was performed and metabolic cell activity (WST-1 assay) was measured. Biochemical degradability was investigated by enzymatic digestion. The bovine collagen scaffold showed significantly enhanced biomechanical properties. These persisted over different rehydration times. Cell biological tests revealed that the bovine collagen scaffolds support reproducible cell colonization and a significant increase in the number of viable cells during cultivation. The results are comparable with the viability and proliferation rate of cells grown on porcine reference materials. With regard to biochemical degradability, all tested materials showed comparable resistance to enzymatic degradation in vitro. Due to imitating the natural tendon structure the new scaffold material is supposed to provide beneficial effects in future clinical application.
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Chen E, Yang L, Ye C, Zhang W, Ran J, Xue D, Wang Z, Pan Z, Hu Q. An asymmetric chitosan scaffold for tendon tissue engineering: In vitro and in vivo evaluation with rat tendon stem/progenitor cells. Acta Biomater 2018; 73:377-387. [PMID: 29678676 DOI: 10.1016/j.actbio.2018.04.027] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 04/08/2018] [Accepted: 04/16/2018] [Indexed: 01/02/2023]
Abstract
The poor healing capacity and typically incomplete regeneration of injured tendons has made tendon repair as a primary clinical concern. Several methods for repairing injured tendons have been developed in the last decade. Tendon regeneration using current tissue engineering techniques requires advanced biomaterials to satisfy both microstructural and mechanical criteria. In this study, a novel chitosan (CS)-based scaffold with asymmetric structure was fabricated using a self-deposition technique. The fabricated scaffolds were assessed with regard to the microstructural and mechanical demands of cell ingrowth and the prevention of peritendinous adhesion. In vitro studies showed that rat tendon stem/progenitor cells (TSPCs) seeded onto the CS scaffold displayed higher levels of tenogenic specific genes expression and protein production. Four and six weeks after the implantation of CS scaffolds on full-site Achilles tendon defects, in vivo tendon repair was evaluated by histology, immunohistochemistry, immunofluorescence, and mechanical measurements. The production of collagen I (COL1) and collagen III (COL3) demonstrated that the CS scaffolds were capable of inducing conspicuous tenogenic differentiation, higher tenomodulin (TNMD) production, and superior phenotypic maturity, compared with the empty defect group. The introduction of TSPCs into the CS scaffold resulted in a synergistic effect on tendon regeneration and yielded better-aligned collagen fibers with elongated, spindle-shaped cells. These findings indicated that the application of TSPC-seeded CS scaffolds would be a feasible approach for tendon repair. STATEMENT OF SIGNIFICANCE The poor healing capacity of injured tendons and inevitable peritendinous adhesion has made tendon regeneration a clinical priority. In this study, an asymmetric chitosan scaffold was developed to encapsulate rat tendon stem/progenitor cells (TSPCs), which could induce higher levels of tenogenic specific genes and protein expression. Remarkably, the introduction of TSPCs into the asymmetric chitosan scaffold generated a synergistic effect on in vivo tendon regeneration and lead to better-aligned collagen fibers compared with asymmetric chitosan scaffold alone. This work can provide new guidelines for the structure and property design of cell-seeded scaffolds for tendon regeneration.
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Affiliation(s)
- Erman Chen
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Ling Yang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Chenyi Ye
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Wei Zhang
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Jisheng Ran
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Deting Xue
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China
| | - Zhengke Wang
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Zhijun Pan
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310000, China; Orthopedics Research Institute, Zhejiang University, Hangzhou 310000, China.
| | - Qiaoling Hu
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou 310027, China.
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Lee KI, Lee JS, Kang KT, Shim YB, Kim YS, Jang JW, Moon SH, D'Lima DD. In Vitro and In Vivo Performance of Tissue-Engineered Tendons for Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:1641-1649. [PMID: 29578751 DOI: 10.1177/0363546518759729] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction is the current standard of care for ACL tears. However, the results are not consistently successful; autografts or allografts have certain disadvantages; and synthetic grafts have had poor clinical results. PURPOSE To determine if recellularization of decellularized tendons combined with mechanical stimulation in a bioreactor could replicate the mechanical properties of the native ACL and be successfully used for ACL reconstruction in vivo. STUDY DESIGN Controlled laboratory study. METHODS Porcine tibialis tendons were decellularized and then recellularized with human adult bone marrow-derived stem cells. Tendons were cultured in a tissue bioreactor that provided biaxial cyclic loading for up to 7 days. To reproduce mechanical stresses similar to those experienced by the ACL within the knee joint, the tendons were subjected to simultaneous tension and torsion in the bioreactor. Expression of tendon-specific genes and newly synthesized collagen and glycosaminoglycan were used to quantify the efficacy of recellularization and dynamic bioreactor culture. The ultimate tensile load to failure and stiffness of recellularized constructs were measured after dynamic stimulation. Finally, the tissue-engineered tendons were used to reconstruct the ACL in 24 pigs, and ultimate tensile load to failure and stiffness were assessed after 3 months. RESULTS Dynamic bioreactor culture significantly increased the expression of tendon-specific genes, the quantity of newly synthesized collagen and glycosaminoglycan, and the ultimate tensile load and stiffness of recellularized tendons. After in vivo reconstruction, the ultimate tensile load and stiffness of the tissue-engineered tendons increased significantly up to 3 months after surgery and were within 80% of the ultimate tensile load of the natural ACL. CONCLUSION This translational study indicates that recellularization and dynamic mechanical stimuli can significantly enhance matrix synthesis and ultimate tensile load of decellularized porcine tibialis tendons. This approach to tissue engineering can be very useful for ACL reconstruction and may overcome some of the disadvantages of autografts and allografts. CLINICAL RELEVANCE Dynamic bioreactor cultivation of tissue-engineered tendons may overcome the limitations of autografts and allografts.
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Affiliation(s)
- Kwang Il Lee
- The Institute of Biomaterial and Medical Engineering, Cellumed Co, Ltd, Seoul, Republic of Korea
| | - Jung Soo Lee
- The Institute of Biomaterial and Medical Engineering, Cellumed Co, Ltd, Seoul, Republic of Korea
| | - Kyoung Tak Kang
- Department of Mechanical Engineering, College of Engineering, Yonsei University, Seoul, Republic of Korea
| | - Young Bock Shim
- The Institute of Biomaterial and Medical Engineering, Cellumed Co, Ltd, Seoul, Republic of Korea
| | - Young Sik Kim
- The Institute of Biomaterial and Medical Engineering, Cellumed Co, Ltd, Seoul, Republic of Korea
| | - Ju Woong Jang
- The Institute of Biomaterial and Medical Engineering, Cellumed Co, Ltd, Seoul, Republic of Korea
| | - Seong Hwan Moon
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Darryl D D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California, USA
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Peixoto T, Pereira FAM, Silva PL, Guedes RM, Torres J, Lopes MA. Fibrous structures in augmentation for rotator cuff repair: an experimental comparison. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aac63e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Cai YZ, Zhang C, Jin RL, Shen T, Gu PC, Lin XJ, Chen JD. Arthroscopic Rotator Cuff Repair With Graft Augmentation of 3-Dimensional Biological Collagen for Moderate to Large Tears: A Randomized Controlled Study. Am J Sports Med 2018. [PMID: 29533674 DOI: 10.1177/0363546518756978] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Due to the highly organized tissue and avascular nature of the rotator cuff, rotator cuff tears have limited ability to heal after the tendon is reinserted directly on the greater tubercle of the humerus. Consequently, retears are among the most common complications after rotator cuff repair. Augmentation of rotator cuff repairs with patches has been an active area of research in recent years to reduce retear rate. HYPOTHESIS Graft augmentation with 3D collagen could prevent retears of the repaired tendon and improve tendon-bone healing in moderate to large rotator cuff tears. STUDY DESIGN Randomized controlled study; Level of evidence, 2. METHODS A prospective, randomized controlled study was performed in a consecutive series of 112 patients age 50 to 85 years who underwent rotator cuff repair with the suture-bridge technique (58 patients, control group) or the suture-bridge technique augmented with 3-dimensional (3D) collagen (54 patients, study group). All patients were followed for 28.2 months (range, 24-36 months). Visual analog scale score for pain, University of California Los Angeles (UCLA) shoulder score, and Constant score were determined. Magnetic resonance imaging was performed pre- and postoperatively (at a minimum of 24 months) to evaluate the integrity of the rotator cuff and the retear rate of the repaired tendon. Three patients in each group had biopsies at nearly 24 months after surgery with histological assessment and transmission electron microscopy. RESULTS A total of 104 patients completed the final follow-up. At the 12-month follow-up, the UCLA shoulder score was 28.1 ± 1.9 in the study group, which was significantly better than that in the control group (26.9 ± 2.1, P = .002). The Constant score was also significantly better in the study group (87.1 ± 3.2) than in the control group (84.9 ± 4.2, P = .003). However, at the final follow-up, no significant differences were found in the UCLA shoulder scores (29.4 ± 1.9 in the control group and 30.0 ± 1.6 in the study group, P = .052) or Constant scores (89.9 ± 3.2 in the control group and 90.8 ± 3.5 in the study group, P = .18). In terms of structural integrity, more patients in the study group had a favorable type I retear grade (18/51) than in the control group (10/53) ( P = .06). The postoperative retear rate was 34.0% in the control group and 13.7% in the study group, thus indicating a significantly lower retear rate in the study group ( P = .02). Biopsy specimens of the tendon-bone interface in 6 patients revealed more bone formation and more aligned fibers with larger diameters in the study group than in the control group. No intraoperative or postoperative complications were noted in either group. CONCLUSION 3D collagen augmentation could provide effective treatment of moderate to large rotator cuff tears, providing substantial functional improvement, and could reduce the retear rate. This technique could also promote new tendon-bone formation, thus exerting a prominent effect on tendon-bone healing.
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Affiliation(s)
- You-Zhi Cai
- Center for Sport Medicine, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China.,Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Center for Sport Medicine, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China.,Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou, China
| | - Ri-Long Jin
- Center for Sport Medicine, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Tong Shen
- Department of Orthopedics, the First People's Hospital, Fuyang, Hangzhou, Zhejiang, China
| | - Peng-Cheng Gu
- Center for Sport Medicine, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Xiang-Jin Lin
- Center for Sport Medicine, the First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, China
| | - Jian-De Chen
- Department of Orthopedics, the Traditional Chinese Medicine of Shaoxing Hospital, Shaoxing, Zhejiang, China
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Costa-Almeida R, Franco AR, Pesqueira T, Oliveira MB, Babo PS, Leonor IB, Mano JF, Reis RL, Gomes ME. The effects of platelet lysate patches on the activity of tendon-derived cells. Acta Biomater 2018; 68:29-40. [PMID: 29341933 DOI: 10.1016/j.actbio.2018.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/04/2017] [Accepted: 01/09/2018] [Indexed: 02/06/2023]
Abstract
Platelet-derived biomaterials are widely explored as cost-effective sources of therapeutic factors, holding a strong potential for endogenous regenerative medicine. Particularly for tendon repair, treatment approaches that shift the injury environment are explored to accelerate tendon regeneration. Herein, genipin-crosslinked platelet lysate (PL) patches are proposed for the delivery of human-derived therapeutic factors in patch augmentation strategies aiming at tendon repair. Developed PL patches exhibited a controlled release profile of PL proteins, including bFGF and PDGF-BB. Additionally, PL patches exhibited an antibacterial effect by preventing the adhesion, proliferation and biofilm formation by S. aureus, a common pathogen in orthopaedic surgical site infections. Furthermore, these patches supported the activity of human tendon-derived cells (hTDCs). Cells were able to proliferate over time and an up-regulation of tenogenic genes (SCX, COL1A1 and TNC) was observed, suggesting that PL patches may modify the behavior of hTDCs. Accordingly, hTDCs deposited tendon-related extracellular matrix proteins, namely collagen type I and tenascin C. In summary, PL patches can act as a reservoir of biomolecules derived from PL and support the activity of native tendon cells, being proposed as bioinstructive patches for tendon regeneration. STATEMENT OF SIGNIFICANCE Platelet-derived biomaterials hold great interest for the delivery of therapeutic factors for applications in endogenous regenerative medicine. In the particular case of tendon repair, patch augmentation strategies aiming at shifting the injury environment are explored to improve tendon regeneration. In this study, PL patches were developed with remarkable features, including the controlled release of growth factors and antibacterial efficacy. Remarkably, PL patches supported the activity of native tendon cells by up-regulating tenogenic genes and enabling the deposition of ECM proteins. This patch holds great potential towards simultaneously reducing post-implantation surgical site infections and promoting tendon regeneration for prospective in vivo applications.
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Ranne JO, Kainonen TU, Lempainen LL, Kosola JA, Kajander SA, Niemi PT. Arthroscopic Coracoclavicular Ligament Reconstruction Using a Synthetic Polycaprolactone-Based Polyurethane Urea Tendon Graft: A Report of 5 Cases. Surg Innov 2018; 25:224-229. [PMID: 29405887 DOI: 10.1177/1553350618756150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several techniques have been introduced to treat acromioclavicular (AC) separation using the semitendinosus tendon as a graft for coracoclavicular (CC) ligament reconstruction. However, the tendon may have been used previously or the patient may not want it harvested. Hence, synthetic tendon transfers have become increasingly popular. METHODS Five patients with chronic AC separations were treated. A synthetic polyurethane urea tendon graft (Artelon Tissue Reinforcement [ATR]) was chosen for its ability to partially transform into connective tissue. The patient follow-up period lasted 45 to 60 months. RESULTS The mean preoperative Constant Score increased from 64.8 to 100 postoperatively. The mean preoperative Simple Shoulder Test increased from 7.2 to 12 postoperatively. The mean postoperative increase of the CC distance was 1.5 mm. The mean expansion of the clavicular drill hole from the original was 2.1 mm. According to the postoperative magnetic resonance imaging, the grafts had healed well and the cross-sections of the grafts were up to 10.5 mm between the coracoid and the clavicle. DISCUSSION The synthetic ATR tendon strip was a practical method for reconstructing a torn CC ligament complex. The ATR graft appears promising for future CC ligament reconstructions.
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Affiliation(s)
| | | | | | - Jussi A Kosola
- 2 Helsingin Yliopisto Laaketieteellinen tiedekunta, Helsinki, Finland
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NAKAMURA N, KIMURA T, KISHIDA A. Medical Application of Decellularized Tissue-Polymer Complex. KOBUNSHI RONBUNSHU 2018. [DOI: 10.1295/koron.2017-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Naoko NAKAMURA
- College of Systems Engineering and Science, Shibaura Institute of Technology
| | - Tsuyoshi KIMURA
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University
| | - Akio KISHIDA
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University
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71
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Mohamed A, Oliva F, Nardoni S, Maffulli N. Failed synthetic graft after acute Achilles tendon repair. Muscles Ligaments Tendons J 2017; 7:396-402. [PMID: 29264352 DOI: 10.11138/mltj/2017.7.2.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The present case report aimed to determine the results of Flexor Hallucis Longus (FHL) transfer as a second surgery after synthetic tissue reinforcement graft (Artelon®) implanted to a primary repaired Achilles tendon (AT), that was undertaken by another orthopedic. One year post-operative the patient was referred to us with retrocalcaneal pain and difficulty in walking, associated with stiffness and significant impairment of daily living activities. Methods MRI and full clinical examination were the outcome measures applied before and 1 year after surgery. Removal of the synthetic graft and subsequent FHL autologous transfer was undertaken and the graft was sent for histology examination. After removing the below knee leg cast, patient started rehabilitation program supervised by a trained physiotherapist. Results The patient was allowed to return to his normal activities at the sixth post-operative month, 1 year post-surgery MRI showed correct position of the autograft in the calcaneous bone and in the centre of the native AT plus reduced oedema of the AT body, with clinical improvement of the patient who reported no pain and was able to walk on tiptoes. Conclusion Synthetic patch augmentation to enhance tendon healing should be subjected to proper investigation before using it in routine parctice, as it may act as a barrier against proper tendon healing. Level of evidence V.
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Affiliation(s)
- Asmaa Mohamed
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rome "Tor Vergata", Italy Physical medicine, Rheumatology and rehabilitation Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Italy
| | - Stefano Nardoni
- Department of Pathology "San Filippo Neri Hospital" Rome, Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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Marks M, Hensler S, Wehrli M, Scheibler AG, Schindele S, Herren DB. Trapeziectomy With Suspension-Interposition Arthroplasty for Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial Comparing the Use of Allograft Versus Flexor Carpi Radialis Tendon. J Hand Surg Am 2017; 42:978-986. [PMID: 28899589 DOI: 10.1016/j.jhsa.2017.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 06/01/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this randomized controlled trial was to compare the 12-month postoperative Michigan Hand Outcomes Questionnaire (MHQ) total score between patients with osteoarthritis (OA) at the first carpometacarpal (CMC I) joint who underwent trapeziectomy with suspension-interposition arthroplasty using the flexor carpi radialis (FCR) tendon and those receiving a human dermal collagen template (allograft). METHODS We included 60 patients with CMC I OA who met the indications for surgery. They were randomized into 1 of 2 groups: trapeziectomy using the FCR tendon or trapeziectomy with the allograft for suspension-interposition. Patients completed a set of questionnaires including the MHQ and were clinically assessed at baseline, 6 weeks, and 3, 6, and 12 months after surgery. Complications were recorded. RESULTS We operated on 29 patients using the FCR tendon; 31 patients received an allograft. Baseline MHQ total scores significantly increased from 51 (95% confidence interval [CI], 46-56) to 83 (95% CI, 78-87) and 53 (95% CI, 47-58) to 76 (95% CI, 69-84) by 12 months in the FCR and allograft groups, respectively. We found similar outcomes for both groups at all follow-up assessments. Five complications occurred in the FCR group, and 10 in the allograft group. Revision surgery was required for one allograft patient. CONCLUSIONS The use of the FCR tendon or allograft for trapeziectomy with suspension-interposition arthroplasty in patients with CMC I OA leads to similar outcomes with more complications, mainly tendon irritations, associated with the latter. Therefore, we only use the allograft in cases of severe instability requiring a larger amount of suspension-interposition material or for revision procedures after failed suspension-interposition with the FCR tendon. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Miriam Marks
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland.
| | - Stefanie Hensler
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland
| | - Martina Wehrli
- Department of Teaching, Research, and Development, Schulthess Klinik, Zurich, Switzerland
| | | | | | - Daniel B Herren
- Department of Hand Surgery, Schulthess Klinik, Zurich, Switzerland
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Usuelli FG, D'Ambrosi R, Manzi L, Indino C, Villafañe JH, Berjano P. Clinical Outcomes and Return to Sports in Patients with Chronic Achilles Tendon Rupture after Minimally Invasive Reconstruction with Semitendinosus Tendon Graft Transfer. JOINTS 2017; 5:212-216. [PMID: 29270558 PMCID: PMC5738487 DOI: 10.1055/s-0037-1608661] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective The purpose of the study is to evaluate the clinical results and return to sports in patients undergoing reconstruction of the Achilles tendon after minimally invasive reconstruction with semitendinosus tendon graft transfer. Methods Eight patients underwent surgical reconstruction with a minimally invasive technique and tendon graft augmentation with ipsilateral semitendinosus tendon for chronic Achilles tendon rupture (more than 30 days after the injury and a gap of >6 cm). Patients were evaluated at a minimum follow-up of 24 months after the surgery through the American Orthopaedic Foot and Ankle Society (AOFAS), the Achilles Tendon Total Rupture Scores (ATRS), the Endurance test, the calf circumference of the operated limb, and the contralateral and the eventual return to sports activity performed before the trauma. Results The mean age at surgery was 50.5 years. Five men and three women underwent the surgery. The average AOFAS was 92, mean Endurance test was 28.1, and the average ATRS was 87. All patients returned to their daily activities, and six out of eight patients have returned to sports activities prior to the accident (two football players, three runners, one tennis player) at a mean of 7.0 (range: 6.7-7.2) months after the surgery. No patient reported complications or reruptures. Conclusion Our study confirms encouraging results for the treatment of Achilles tendon rupture with a minimally invasive technique with semitendinosus graft augmentation. The technique can be considered safe and allows patients to return to their sports activity. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
| | - Riccardo D'Ambrosi
- Dipartimento di Scienze Biomediche per la Salute, IRCCS Istituto Ortopedico Galeazzi, Università degli Studi di Milano, Milan, Italy
| | - Luigi Manzi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Snedeker JG, Foolen J. Tendon injury and repair - A perspective on the basic mechanisms of tendon disease and future clinical therapy. Acta Biomater 2017; 63:18-36. [PMID: 28867648 DOI: 10.1016/j.actbio.2017.08.032] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/16/2017] [Accepted: 08/25/2017] [Indexed: 12/16/2022]
Abstract
Tendon is an intricately organized connective tissue that efficiently transfers muscle force to the bony skeleton. Its structure, function, and physiology reflect the extreme, repetitive mechanical stresses that tendon tissues bear. These mechanical demands also lie beneath high clinical rates of tendon disorders, and present daunting challenges for clinical treatment of these ailments. This article aims to provide perspective on the most urgent frontiers of tendon research and therapeutic development. We start by broadly introducing essential elements of current understanding about tendon structure, function, physiology, damage, and repair. We then introduce and describe a novel paradigm explaining tendon disease progression from initial accumulation of damage in the tendon core to eventual vascular recruitment from the surrounding synovial tissues. We conclude with a perspective on the important role that biomaterials will play in translating research discoveries to the patient. STATEMENT OF SIGNIFICANCE Tendon and ligament problems represent the most frequent musculoskeletal complaints for which patients seek medical attention. Current therapeutic options for addressing tendon disorders are often ineffective, and the need for improved understanding of tendon physiology is urgent. This perspective article summarizes essential elements of our current knowledge on tendon structure, function, physiology, damage, and repair. It also describes a novel framework to understand tendon physiology and pathophysiology that may be useful in pushing the field forward.
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75
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Oryan A, Sharifi P, Moshiri A, Silver IA. The role of three-dimensional pure bovine gelatin scaffolds in tendon healing, modeling, and remodeling: an in vivo investigation with potential clinical value. Connect Tissue Res 2017; 58:424-437. [PMID: 27662266 DOI: 10.1080/03008207.2016.1238468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
AIM OF THE STUDY Large tendon defects involving extensive tissue loss present complex clinical problems. Surgical reconstruction of such injuries is normally performed by transplanting autogenous and allogenous soft tissues that are expected to remodel to mimic a normal tendon. However, the use of grafts has always been associated with significant limitations. Tissue engineering employing artificial scaffolds may provide acceptable alternatives. Gelatin is a hydrolyzed form of collagen that is bioactive, biodegradable, and biocompatible. The present study has investigated the suitability of gelatin scaffold for promoting healing of a large tendon-defect model in rabbits. MATERIALS AND METHODS An experimental model of a large tendon defect was produced by partial excision of the Achilles tendon of the left hind leg in adult rabbits. To standardize and stabilize the length of the tendon defect a modified Kessler core suture was anchored in the sectioned tendon ends. The defects were either left untreated or filled with three-dimensional gelatin scaffold. Before euthanasia 60 days after injury, the progress of healing was evaluated clinically. Samples of healing tendon were harvested at autopsy and evaluated by gross, histopathologic, scanning, and transmission electron microscopy, and by biomechanical testing. RESULTS The treated animals showed superior weight-bearing and physical activity compared with those untreated, while frequency of peritendinous adhesions around the healing site was reduced. The gelatin scaffold itself was totally degraded and replaced by neo-tendon that morphologically had significantly greater numbers, diameters, density, and maturation of collagen fibrils, fibers, and fiber bundles than untreated tendon scar tissue. It also had mechanically higher ultimate load, yield load, stiffness, maximum stress and elastic modulus, when compared to the untreated tendons. CONCLUSION Gelatin scaffold may be a valuable option in surgical reconstruction of large tendon defects.
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Affiliation(s)
- Ahmad Oryan
- a Department of Pathology, School of Veterinary Medicine , Shiraz University , Shiraz , Iran
| | - Pardis Sharifi
- a Department of Pathology, School of Veterinary Medicine , Shiraz University , Shiraz , Iran
| | - Ali Moshiri
- b RAZI Drug Research Center , Iran University of Medical Sciences , Tehran , Iran
| | - Ian A Silver
- c Department of Anatomy, Center for Comparative and Clinical Anatomy , School of Veterinary Science , Bristol , UK
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76
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Autograft Reconstruction for Chronic Achilles Tendon Disorders. TECHNIQUES IN FOOT AND ANKLE SURGERY 2017. [DOI: 10.1097/btf.0000000000000154] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dale TP, Mazher S, Webb WR, Zhou J, Maffulli N, Chen GQ, El Haj AJ, Forsyth NR. Tenogenic Differentiation of Human Embryonic Stem Cells. Tissue Eng Part A 2017; 24:361-368. [PMID: 28548630 DOI: 10.1089/ten.tea.2017.0017] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tendon healing is complex to manage because of the limited regeneration capacity of tendon tissue; stem cell-based tissue engineering approaches may provide alternative healing strategies. We sought to determine whether human embryonic stem cells (hESC) could be induced to differentiate into tendon-like cells by the addition of exogenous bone morphogenetic protein (BMP)12 (growth differentiation factor[GDF]7) and BMP13 (GDF6). hESC (SHEF-1) were maintained with or without BMP12/13 supplementation, or supplemented with BMP12/13 and the Smad signaling cascade blocking agent, dorsomorphin. Primary rat tenocytes were included as a positive control in immunocytochemistry analysis. A tenocyte-like elongated morphology was observed in hESC after 40-days continuous supplementation with BMP12/13 and ascorbic acid (AA). These cells displayed a tenomodulin expression pattern and morphology consistent with that of the primary tenocyte control. Analysis of tendon-linked gene transcription in BMP12/13 supplemented hESC demonstrated consistent expression of COL1A2, COL3A1, DCN, TNC, THBS4, and TNMD levels. Conversely, when hESCs were cultured in the presence of BMP12/13 and dorsomorphin COL3A1, DCN, and TNC gene expression and tendon matrix formation were inhibited. Taken together, we have demonstrated that hESCs are responsive to tenogenic induction via BMP12/13 in the presence of AA. The directed in vitro generation of tenocytes from pluripotent stem cells may facilitate the development of novel repair approaches for this difficult to heal tissue.
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Affiliation(s)
- Tina P Dale
- 1 Guy Hilton Research Centre, Institute for Science and Technology in Medicine, Faculty of Medicine and Health Sciences, Keele University , Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Shazia Mazher
- 1 Guy Hilton Research Centre, Institute for Science and Technology in Medicine, Faculty of Medicine and Health Sciences, Keele University , Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom
| | - William R Webb
- 1 Guy Hilton Research Centre, Institute for Science and Technology in Medicine, Faculty of Medicine and Health Sciences, Keele University , Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Jing Zhou
- 2 School of Life Science, Tsinghua University , Beijing, China
| | - Nicola Maffulli
- 3 Centre for Sport and Exercise Medicine, Queen Mary University of London , United Kingdom
| | - Guo-Qiang Chen
- 2 School of Life Science, Tsinghua University , Beijing, China
| | - Alicia J El Haj
- 1 Guy Hilton Research Centre, Institute for Science and Technology in Medicine, Faculty of Medicine and Health Sciences, Keele University , Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Nicholas R Forsyth
- 1 Guy Hilton Research Centre, Institute for Science and Technology in Medicine, Faculty of Medicine and Health Sciences, Keele University , Thornburrow Drive, Stoke-on-Trent, Staffordshire, United Kingdom
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Foolen J, Wunderli SL, Loerakker S, Snedeker JG. Tissue alignment enhances remodeling potential of tendon-derived cells - Lessons from a novel microtissue model of tendon scarring. Matrix Biol 2017. [PMID: 28636876 DOI: 10.1016/j.matbio.2017.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tendinopathy is a widespread and unresolved clinical challenge, in which associated pain and hampered mobility present a major cause for work-related disability. Tendinopathy associates with a change from a healthy tissue with aligned extracellular matrix (ECM) and highly polarized cells that are connected head-to-tail, towards a diseased tissue with a disorganized ECM and randomly distributed cells, scar-like features that are commonly attributed to poor innate regenerative capacity of the tissue. A fundamental clinical dilemma with this scarring process is whether treatment strategies should focus on healing the affected (disorganized) tissue or strengthen the remaining healthy (anisotropic) tissue. The question was thus asked whether the intrinsic remodeling capacity of tendon-derived cells depends on the organization of the 3D extracellular matrix (isotropic vs anisotropic). Progress in this field is hampered by the lack of suitable in vitro tissue platforms. We aimed at filling this critical gap by creating and exploiting a next generation tissue platform that mimics aspects of the tendon scarring process; cellular response to a gradient in tissue organization from isotropic (scarred/non-aligned) to highly anisotropic (unscarred/aligned) was studied, as was a transient change from isotropic towards highly anisotropic. Strikingly, cells residing in an 'unscarred' anisotropic tissue indicated superior remodeling capacity (increased gene expression levels of collagen, matrix metalloproteinases MMPs, tissue inhibitors of MMPs), when compared to their 'scarred' isotropic counterparts. A numerical model then supported the hypothesis that cellular remodeling capacity may correlate to cellular alignment strength. This in turn may have improved cellular communication, and could thus relate to the more pronounced connexin43 gap junctions observed in anisotropic tissues. In conclusion, increased tissue anisotropy was observed to enhance the cellular potential for functional remodeling of the matrix. This may explain the poor regenerative capacity of tenocytes in chronic tendinopathy, where the pathological process has resulted in ECM disorganization. Additionally, it lends support to treatment strategies that focus on strengthening the remaining healthy tissue, rather than regenerating scarred tissue.
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Affiliation(s)
- Jasper Foolen
- Department of Orthopaedics, University Hospital Balgrist, Lengghalde 5, CH-8008 Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Lengghalde 5, CH-8008 Zurich, Switzerland; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stefania L Wunderli
- Department of Orthopaedics, University Hospital Balgrist, Lengghalde 5, CH-8008 Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Lengghalde 5, CH-8008 Zurich, Switzerland
| | - Sandra Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Jess G Snedeker
- Department of Orthopaedics, University Hospital Balgrist, Lengghalde 5, CH-8008 Zurich, Switzerland; Institute for Biomechanics, ETH Zurich, Lengghalde 5, CH-8008 Zurich, Switzerland.
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79
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Stone KR, Walgenbach A, Galili U. Induced Remodeling of Porcine Tendons to Human Anterior Cruciate Ligaments by α-GAL Epitope Removal and Partial Cross-Linking. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:412-419. [PMID: 28068870 PMCID: PMC5567590 DOI: 10.1089/ten.teb.2016.0332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review describes a novel method developed for processing porcine tendon and other ligament implants that enables in situ remodeling into autologous ligaments in humans. The method differs from methods using extracellular matrices (ECMs) that provide postoperative orthobiological support (i.e., augmentation grafts) for healing of injured ligaments, in that the porcine bone-patellar-tendon-bone itself serves as the graft replacing ruptured anterior cruciate ligament (ACL). The method allows for gradual remodeling of porcine tendon into autologous human ACL while maintaining the biomechanical integrity. The method was first evaluated in a preclinical model of monkeys and subsequently in patients. The method overcomes detrimental effects of the natural anti-Gal antibody and harnesses anti-non-gal antibodies for the remodeling process in two steps: Step 1. Elimination of α-gal epitopes—this epitope that is abundant in pigs (as in other nonprimate mammals) binds the natural anti-Gal antibody, which is the most abundant natural antibody in humans. This interaction, which can induce fast resorption of the porcine implant, is avoided by enzymatic elimination of α-gal epitopes from the implant with recombinant α-galactosidase. Step 2. Partial cross-linking of porcine tendon with glutaraldehyde—this cross-linking generates covalent bonds in the ECM, which slow infiltration of macrophages into the implant. Anti-non-gal antibodies are produced in recipients against the multiple porcine antigenic proteins and proteoglycans because of sequence differences between human and porcine homologous proteins. Anti-non-gal antibodies bind to the implant ECM, recruit macrophages, and induce the implant destruction by directing proteolytic activity of macrophages. Partial cross-linking of the tendon ECM decreases the extent of macrophage infiltration and degradation of the implant and enables concomitant infiltration of fibroblasts that follow the infiltrating macrophages. These fibroblasts align with the implant collagen fibers and secrete their own collagen and other ECM proteins, which gradually remodel the porcine tendon into human ACL. This ligamentization process lasts ∼2 years and the biomechanical integrity of the graft is maintained throughout the whole period. These studies are the first, and so far the only, to demonstrate remodeling of porcine tendon implants into permanently functional autologous ACL in humans.
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Affiliation(s)
- Kevin R Stone
- 1 The Stone Clinic and Foundation , San Francisco, California
| | - Ann Walgenbach
- 1 The Stone Clinic and Foundation , San Francisco, California
| | - Uri Galili
- 2 Department of Surgery, University of Massachusetts Medical School , Worcester, Massachusetts (retired)
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80
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Pandey R, Tafazal S, Shyamsundar S, Modi A, Singh HP. Outcome of partial repair of massive rotator cuff tears with and without human tissue allograft bridging repair. Shoulder Elbow 2017; 9:23-30. [PMID: 28572847 PMCID: PMC5441617 DOI: 10.1177/1758573216665114] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 07/24/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The surgical management of massive rotator cuff tears remains a challenge. It is suggested that, even in a massive tear that appears irreparable, attempting to repair it as much as possible can be helpful in improving functional outcomes. However the results can be short term and variable. The purpose of our study was to determine if human tissue allograft bridged repair of massive irreparable rotator cuff tears to achieve a complete repair produces similar outcomes compared to partial repair alone. METHODS We prospectively reviewed outcome scores in 13 patients who underwent partial repair alone for massive irreparable rotator cuff tears and compared them to 13 patients who had partial repairs bridged with allograft. Oxford and Constant scores were compared pre-operatively and at a minimum follow-up of 2 years (range 2 years to 5 years). RESULTS The mean improvement in the Constant score at final follow-up compared to pre-operative scores was 27.7 points in the partial repair group and 42.8 points in the allograft group (p < 0.01). The Oxford Shoulder Score improved mean of 19.3 points in the partial repair group and 29 points in the allograft group (p < 0.02) at 2 years. CONCLUSIONS Human tissue matrix allograft provides a better outcome for open bridging of irreparable rotator cuff tears than partial repair alone.
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Affiliation(s)
| | | | | | | | - Harvinder Pal Singh
- Harvinder Pal Singh, Department of Orthopaedic Surgery, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK.
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81
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Nakamura N, Kimura T, Kishida A. Overview of the Development, Applications, and Future Perspectives of Decellularized Tissues and Organs. ACS Biomater Sci Eng 2016; 3:1236-1244. [DOI: 10.1021/acsbiomaterials.6b00506] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Naoko Nakamura
- Institute of Biomaterials
and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062 Japan
| | - Tsuyoshi Kimura
- Institute of Biomaterials
and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062 Japan
| | - Akio Kishida
- Institute of Biomaterials
and Bioengineering, Tokyo Medical and Dental University, 2-3-10 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-0062 Japan
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82
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Bellini D, Cencetti C, Sacchetta AC, Battista AM, Martinelli A, Mazzucco L, Scotto D’Abusco A, Matricardi P. PLA-grafting of collagen chains leading to a biomaterial with mechanical performances useful in tendon regeneration. J Mech Behav Biomed Mater 2016; 64:151-60. [DOI: 10.1016/j.jmbbm.2016.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
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83
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Brown MN, Shiple BJ, Scarpone M. Regenerative Approaches to Tendon and Ligament Conditions. Phys Med Rehabil Clin N Am 2016; 27:941-984. [DOI: 10.1016/j.pmr.2016.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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84
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Arshi A, Cohen JR, Wang JC, Hame SL, McAllister DR, Jones KJ. Operative Management of Patellar Instability in the United States: An Evaluation of National Practice Patterns, Surgical Trends, and Complications. Orthop J Sports Med 2016; 4:2325967116662873. [PMID: 27631015 PMCID: PMC5010099 DOI: 10.1177/2325967116662873] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Treatment of patellofemoral instability has evolved as our understanding of the relevant pathoanatomy has improved. In light of these developments, current practice patterns and management trends have likely changed to reflect these advancements; however, this has not been evaluated in a formal study. Purpose: To determine nationwide patient demographics, surgical trends, and postoperative complications associated with the operative management of patellar instability surgery. Study Design: Descriptive epidemiological study. Methods: A large private-payer database (PearlDiver) comprising patients covered by Humana and United Healthcare insurance policies was retrospectively reviewed using Current Procedural Terminology (CPT) codes to identify patients who underwent surgery for patellar instability. The study cohort was established by querying for patients billed under CPT codes 27420, 27422, or 27427 while satisfying the diagnostic requirement of patellar instability (International Classification of Diseases–9th Revision codes 718.36, 718.86, or 836.3). Patient demographics, surgical trends, concomitant procedures, and postoperative complications were determined. Results: A total of 6190 patients underwent surgical management for patellar instability. Adolescents (age range, 10-19 years) represented 51.5% of cases, and 59.6% were female. The number of patellar instability procedures increased annually over the study period in both the Humana (P = .004, R2 = 0.76) and United Healthcare (P = .097, R2 = 0.54) cohorts. The most common concomitant procedures were lateral retinacular release (43.7%), chondroplasty (31.1%), tibial tubercle osteotomy (13.1%), removal of loose bodies (10.5%), osteochondral grafting (9.5%), and microfracture surgery (9.5%). Manipulation under anesthesia was required in 4.6% of patients within 1 year. Patellar fracture within 1 year and infection within 30 days occurred in 2.1% and 1.2% of patients, respectively. Conclusion: Patellar instability surgery has increased over the past decade. This finding may be attributed to growing clinical evidence to support these procedures as well as increased surgeon familiarity and comfort with these specific techniques. We observed an unexpectedly high rate of concomitant lateral retinacular release. Overall, the rates of commonly recognized complications (stiffness, patellar fracture, and postoperative infection) were similar to those observed in smaller case series.
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Affiliation(s)
- Armin Arshi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeremiah R Cohen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jeffrey C Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sharon L Hame
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - David R McAllister
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kristofer J Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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85
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Sandri M, Filardo G, Kon E, Panseri S, Montesi M, Iafisco M, Savini E, Sprio S, Cunha C, Giavaresi G, Veronesi F, Fini M, Salvatore L, Sannino A, Marcacci M, Tampieri A. Fabrication and Pilot In Vivo Study of a Collagen-BDDGE-Elastin Core-Shell Scaffold for Tendon Regeneration. Front Bioeng Biotechnol 2016; 4:52. [PMID: 27446909 PMCID: PMC4923187 DOI: 10.3389/fbioe.2016.00052] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/03/2016] [Indexed: 11/13/2022] Open
Abstract
The development of bio-devices for complete regeneration of ligament and tendon tissues is presently one of the biggest challenges in tissue engineering. Such device must simultaneously possess optimal mechanical performance, suitable porous structure, and biocompatible microenvironment. This study proposes a novel collagen-BDDGE-elastin (CBE)-based device for tendon tissue engineering, by the combination of two different modules: (i) a load-bearing, non-porous, “core scaffold” developed by braiding CBE membranes fabricated via an evaporative process and (ii) a hollow, highly porous, “shell scaffold” obtained by uniaxial freezing followed by freeze-drying of CBE suspension, designed to function as a physical guide and reservoir of cells to promote the regenerative process. Both core and shell materials demonstrated good cytocompatibility in vitro, and notably, the porous shell architecture directed cell alignment and population within the sample. Finally, a prototype of the core module was implanted in a rat tendon lesion model, and histological analysis demonstrated its safety, biocompatibility, and ability to induce tendon regeneration. Overall, our results indicate that such device may have the potential to support and induce in situ tendon regeneration.
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Affiliation(s)
- Monica Sandri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Giuseppe Filardo
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy; Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy
| | - Elizaveta Kon
- Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy; Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, II Orthopaedic and Traumatologic Clinic, Bologna, Italy
| | - Silvia Panseri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Monica Montesi
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Michele Iafisco
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Elisa Savini
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Simone Sprio
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
| | - Carla Cunha
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal
| | - Gianluca Giavaresi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute , Bologna , Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, Bologna, Italy; Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, Department RIT Rizzoli-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luca Salvatore
- Department of Engineering for Innovation, University of Salento , Lecce , Italy
| | - Alessandro Sannino
- Department of Engineering for Innovation, University of Salento , Lecce , Italy
| | - Maurilio Marcacci
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto , Porto , Portugal
| | - Anna Tampieri
- Institute of Science and Technology for Ceramics, National Research Council , Faenza , Italy
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86
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Lee KW, Lee JS, Kim YS, Shim YB, Jang JW, Lee KI. Effective healing of chronic rotator cuff injury using recombinant bone morphogenetic protein-2 coated dermal patch in vivo. J Biomed Mater Res B Appl Biomater 2016; 105:1840-1846. [PMID: 27228085 DOI: 10.1002/jbm.b.33716] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 11/06/2022]
Abstract
Biologic augmentation for rotator cuff repair is a challenging treatment in patients with chronic large, massive, and irreparable rotator cuff injuries. Particularly, the use of an extracellular matrix (ECM) patch such as dermal tissue offered improved biomechanical properties in previous studies. Cytokines induce cell chemotaxis, proliferation, matrix synthesis, and cell differentiation. Moreover, osteoinductive growth factors such as bone morphogenetic protein-2 (BMP-2) affect the formation of new bone and fibrocartilage in lesions. However, the effects of using a dermal patch in combination with BMP-2 have not been evaluated to date, although many researchers have recognized the importance thereof. In this study, rhBMP-2-coated dermal patch (1 cm × 2 cm) isolated from human cadaveric donor was inserted in a rabbit model of chronic rotator cuff injury for in vivo evaluation. Bone mineral density and biomechanical strength were tested and histological and histomorphometric analyses were performed. The results showed that insertion of an rhBMP-2-coated acellular dermal patch not only significantly ameliorated new bone formation, it also improved biomechanical properties such as ultimate tensile strength. Thus, the use of this combination may improve the chronic rotator cuff injury-healing rate and clinical outcomes after rotator cuff repair. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1840-1846, 2017.
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Affiliation(s)
- Kwang-Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jung-Soo Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Sik Kim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Bock Shim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Ju-Woong Jang
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Kwang-Il Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
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87
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Takeuchi M, Suzue N, Matsuura T, Higashino K, Sakai T, Hamada D, Goto T, Takata Y, Nishisho T, Goda Y, Sato R, Tonogai I, Mineta K, Sairyo K. Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon: a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 61:417-20. [PMID: 25264065 DOI: 10.2152/jmi.61.417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture.
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88
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Parmaksiz M, Dogan A, Odabas S, Elçin AE, Elçin YM. Clinical applications of decellularized extracellular matrices for tissue engineering and regenerative medicine. Biomed Mater 2016; 11:022003. [DOI: 10.1088/1748-6041/11/2/022003] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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89
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Izadifar Z, Chang T, Kulyk W, Chen X, Eames BF. Analyzing Biological Performance of 3D-Printed, Cell-Impregnated Hybrid Constructs for Cartilage Tissue Engineering. Tissue Eng Part C Methods 2016; 22:173-88. [PMID: 26592915 DOI: 10.1089/ten.tec.2015.0307] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Three-dimensional (3D) bioprinting of hybrid constructs is a promising biofabrication method for cartilage tissue engineering because a synthetic polymer framework and cell-impregnated hydrogel provide structural and biological features of cartilage, respectively. During bioprinting, impregnated cells may be subjected to high temperatures (caused by the adjacent melted polymer) and process-induced mechanical forces, potentially compromising cell function. This study addresses these biofabrication issues, evaluating the heat distribution of printed polycaprolactone (PCL) strands and the rheological property and structural stability of alginate hydrogels at various temperatures and concentrations. The biocompatibility of parameters from these studies was tested by culturing 3D hybrid constructs bioprinted with primary cells from embryonic chick cartilage. During initial two-dimensional culture expansion of these primary cells, two morphologically and molecularly distinct cell populations ("rounded" and "fibroblastic") were isolated. The biological performance of each population was evaluated in 3D hybrid constructs separately. The cell viability, proliferation, and cartilage differentiation were observed at high levels in hybrid constructs of both cell populations, confirming the validity of these 3D bioprinting parameters for effective cartilage tissue engineering. Statistically significant performance variations were observed, however, between the rounded and fibroblastic cell populations. Molecular and morphological data support the notion that such performance differences may be attributed to the relative differentiation state of rounded versus fibroblastic cells (i.e., differentiated chondrocytes vs. chondroprogenitors, respectively), which is a relevant issue for cell-based tissue engineering strategies. Taken together, our study demonstrates that bioprinting 3D hybrid constructs of PCL and cell-impregnated alginate hydrogel is a promising approach for cartilage tissue engineering.
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Affiliation(s)
- Zohreh Izadifar
- 1 Division of Biomedical Engineering, University of Saskatchewan , Saskatoon, Canada
| | - Tuanjie Chang
- 2 Department of Anatomy and Cell Biology, University of Saskatchewan , Saskatoon, Canada
| | - William Kulyk
- 2 Department of Anatomy and Cell Biology, University of Saskatchewan , Saskatoon, Canada
| | - Xiongbiao Chen
- 1 Division of Biomedical Engineering, University of Saskatchewan , Saskatoon, Canada .,3 Department of Mechanical Engineering, University of Saskatchewan , Saskatoon, Canada
| | - B Frank Eames
- 1 Division of Biomedical Engineering, University of Saskatchewan , Saskatoon, Canada .,2 Department of Anatomy and Cell Biology, University of Saskatchewan , Saskatoon, Canada
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90
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Decellularized and Engineered Tendons as Biological Substitutes: A Critical Review. Stem Cells Int 2016; 2016:7276150. [PMID: 26880985 PMCID: PMC4736572 DOI: 10.1155/2016/7276150] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/10/2015] [Indexed: 12/18/2022] Open
Abstract
Tendon ruptures are a great burden in clinics. Finding a proper graft material as a substitute for tendon repair is one of the main challenges in orthopaedics, for which the requirement of a biological scaffold would be different for each clinical application. Among biological scaffolds, the use of decellularized tendon-derived matrix increasingly represents an interesting approach to treat tendon ruptures. We analyzed in vitro and in vivo studies focused on the development of efficient protocols for the decellularization and for the cell reseeding of the tendon matrix to obtain medical devices for tendon substitution. Our review considered also the proper tendon source and preclinical animal models with the aim of entering into clinical trials. The results highlight a wide panorama in terms of allogenic or xenogeneic tendon sources, specimen dimensions, physical or chemical decellularization techniques, and the cell type variety for reseeding from terminally differentiated to undifferentiated mesenchymal stem cells and their static or dynamic culture employed to generate implantable constructs tested in different animal models. We try to identify the most efficient approach to achieve an optimal biological scaffold for biomechanics and intrinsic properties, resembling the native tendon and being applicable in clinics in the near future, with particular attention to the Achilles tendon substitution.
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91
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Flexor digitorum lateralis tendon transposition for the repair of bilateral calcaneal tendon rupture in a cat with severe thermal injury. Vet Comp Orthop Traumatol 2015; 29:89-93. [PMID: 26640837 DOI: 10.3415/vcot-15-01-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 10/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a novel technique utilizing the flexor digitorum lateralis tendon to repair rupture of the common calcaneal tendon with a gap defect. CLINICAL REPORT An eight-month-old male Domestic Shorthair cat with bilateral common calcaneal tendon rupture secondary to severe thermal injury underwent bilateral common calcaneal tendon repair performed in two stages. The first stage involved using the flexor digitorum lateralis tendon to reconstruct the common calcaneal tendon and a semitendinosus muscle flap for improved blood supply. A calcaneotibial screw was used for immobilization of the tarsocrural joint. The second surgery involved free skin grafting for complete wound closure. Twelve weeks after the calcaneotibial screws were placed, the calcaneotibial screws were removed and fibreglass splints were applied. The splints were removed after two weeks. RESULTS Full recovery took five months between the surgery and the final follow-up examination. The cat had a functional gait with no lameness and was able to jump to a height of approximately 75 cm. CLINICAL SIGNIFICANCE Use of the flexor digitorum lateralis tendon may be considered for repair of a common calcaneal tendon rupture when a gap exists and traditional tendon lengthening techniques are not feasible.
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92
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Vavken P, Sadoghi P, Palmer M, Rosso C, Mueller AM, Szoelloesy G, Valderrabano V. Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective. Am J Sports Med 2015; 43:3071-6. [PMID: 25767267 DOI: 10.1177/0363546515572777] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It has been suggested that platelet-rich plasma (PRP) improves healing after arthroscopic rotator cuff repair. The current literature provides ample but inconsistent data on this topic. PURPOSE To systematically review the current in vivo evidence for the use of platelet concentrates (PRP) in the arthroscopic treatment of rotator cuff tears to assess effectiveness, safety, and cost-effectiveness. STUDY DESIGN Meta-analysis and cost-effectiveness analysis. METHODS Published evidence from controlled, human trials of rotator cuff repair augmented with platelet concentrates was systematically gathered, and data on retear rates were extracted. Mathematical and clinical heterogeneity was evaluated, and fixed-effect meta-analysis was performed to calculate the risk ratio (RR) of retears and the number needed to treat (NNT). Subgroup analyses were made for small/medium tears (n = 404) and large/massive tears (n = 374). Cost-effectiveness was assessed using data from this meta-analysis and using cost data from the literature, including extensive sensitivity analyses, to calculate the incremental cost-effectiveness ratio (ICER). RESULTS Thirteen studies published between 2010 and 2014 were identified for analysis. The RR for retear for all patients was 0.87 (95% CI, 0.67-1.12; P = .286). For small- and medium-sized tears (<3 cm), the RR for retear was 0.60 (95% CI, 0.37-0.97), consistent with a significant difference in favor of PRP use (P = .038). This translated into an NNT of 14 (95% CI, 7-125). However, at an ICER of US$127,893 per quality-adjusted life year gained, assuming a 5% revision rate, the use of PRP was not cost-effective for small- and medium-sized tears. CONCLUSION In large tears, even with double-row repair, the beneficial effects of PRP alone are insufficient to compensate the progressed tissue damage. The study data suggest that PRP may promote healing of small- and medium-sized tears to reduce retear rates. However, despite the substantial biological effect, at current cost, the use of PRP is not cost-effective in arthroscopic repair of small- and medium-sized tears.
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Affiliation(s)
- Patrick Vavken
- Division of Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA Harvard Center for Population and Development Studies, Harvard School of Public Health, Boston, Massachusetts, USA Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Patrick Sadoghi
- Department of Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | | | - Claudio Rosso
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland ALTIUS Swiss Sportmed Center, Basel, Switzerland
| | - Andreas M Mueller
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Gregor Szoelloesy
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, University Hospital Basel, Basel, Switzerland
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93
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Hakimi O, Mouthuy PA, Zargar N, Lostis E, Morrey M, Carr A. A layered electrospun and woven surgical scaffold to enhance endogenous tendon repair. Acta Biomater 2015; 26:124-35. [PMID: 26275911 DOI: 10.1016/j.actbio.2015.08.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 08/01/2015] [Accepted: 08/11/2015] [Indexed: 01/26/2023]
Abstract
Surgical reattachments of tendon to bone in the rotator cuff are reported to fail in around 40% of cases. There are no adequate solutions to improve tendon healing currently available. Electrospun, sub-micron materials, have been extensively studied as scaffolds for tendon repair with promising results, but are too weak to be surgically implanted or to mechanically support the healing tendon. To address this, we developed a bonding technique that enables the processing of electrospun sheets into multi-layered, robust, implantable fabrics. Here, we show a first prototype scaffold created with this method, where an electrospun sheet was reinforced with a woven layer. The resulting scaffold presents a maximum suture pull out strength of 167N, closely matched with human rotator cuff tendons, and the desired nanofibre-mediated bioactivity in vitro and in vivo. This type of scaffold has potential for broader application for augmenting other soft tissues.
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Affiliation(s)
- O Hakimi
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom.
| | - P A Mouthuy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - N Zargar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - E Lostis
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
| | - M Morrey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom; Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - A Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, England, United Kingdom
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94
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Ryu RK, Ryu JH, Abrams JS, Savoie FH. Arthroscopic Implantation of a Bio-Inductive Collagen Scaffold for Treatment of an Articular-Sided Partial Rotator Cuff Tear. Arthrosc Tech 2015; 4:e483-5. [PMID: 26697308 PMCID: PMC4662338 DOI: 10.1016/j.eats.2015.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/21/2015] [Indexed: 02/03/2023] Open
Abstract
The treatment of articular-sided partial rotator cuff tears remains a challenge to the treating orthopaedic surgeon. Treatment algorithms have included nonoperative management, debridement alone, and debridement and subacromial decompression, as well as articular-sided rotator cuff repair and completion of the tear on the bursal side followed by a traditional arthroscopic rotator cuff repair. Implantation of a bio-inductive collagen scaffold on the bursal side of the rotator cuff to potentially heal an articular-sided tear represents a novel approach to this difficult clinical entity.
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Affiliation(s)
- Richard K.N. Ryu
- The Ryu Hurvitz Orthopedic Clinic, Santa Barbara, California, U.S.A.,Address correspondence to Richard K.N. Ryu, M.D., The Ryu Hurvitz Orthopedic Clinic, 2936 De La Vina St, Santa Barbara, CA 93105, U.S.A.
| | - Jessica H.J. Ryu
- Orthopedic Surgery Residency Program, Stanford University Menlo Park, California, U.S.A
| | | | - Felix H. Savoie
- Department of Orthopedic Surgery, Tulane University, New Orleans, Louisiana, U.S.A
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95
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96
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Cobb TK, Walden AL, Cao Y. Long-Term Outcome of Arthroscopic Resection Arthroplasty With or Without Interposition for Thumb Basal Joint Arthritis. J Hand Surg Am 2015; 40:1844-51. [PMID: 26118723 DOI: 10.1016/j.jhsa.2015.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/11/2015] [Accepted: 05/12/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To report results on 144 cases following arthroscopic resection arthroplasty (ARA) with or without interposition for basal joint arthritis. METHODS Cases undergoing ARA for thumb carpometacarpal osteoarthritis between 2004 and 2011 were prospectively enrolled (n = 178). Data were collected before surgery and after surgery at 1, 3, 6, and 12 months and annually thereafter. Patients were excluded for less than 1-year follow-up or concomitant procedures that interfered with evaluation of the variable of interest (interposition). Human acellular dermal matrix (GRAFTJACKET) was the most commonly used interposition. Outcomes on 19 cases of interposition using collagen bioimplant (OrthADAPT) and porous polyurethaneurea (Artelon) scaffolds were also reported. Comparative analyses were performed on 52 patients with GRAFTJACKET interposition and on 73 without. Mean follow-up was 7.4 and 5.6 years with and without interposition, respectively. Descriptive statistics were evaluated on all baseline variables. Raw change scores of grip, pinch, and pain outcomes were evaluated. Confounding variables at a significance level of P less than .05 were adjusted for in linear mixed models, and an analysis of covariance was employed through an unstructured type of variance-covariance matrix. RESULTS Change scores from baseline to 1 year for the interposition group for pain (numerical rating scale, 0-10), pinch, and grip was -5.8, 3.3, and 7, respectively, and -5.1, 2.1, and 9 for the noninterposition group. Postoperative mean satisfaction was 4.7 and 4.4 for the with- and without-interposition groups, respectively. There were 4 failures with and 2 without interposition. Artelon and OrthADAPT did poorly with unacceptably high failure rates. CONCLUSIONS This study suggested that interposition is not necessary following ARA for thumb basal joint arthritis. Because arthroscopic interposition of material contributes to health care costs in terms of patient and facility costs without clear benefit to the patient, routine use of expensive interposition products should be abandoned or carefully evaluated with a prospective randomized controlled trial. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Tyson K Cobb
- Orthopaedic Surgery, Hand and Upper Extremity Service, Orthopaedic Specialists, Inc., Davenport, IA.
| | - Anna L Walden
- Department of Research, Orthopaedic Specialists, Inc., Davenport, IA
| | - Ying Cao
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, MD
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97
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Morais DS, Torres J, Guedes RM, Lopes MA. Current Approaches and Future Trends to Promote Tendon Repair. Ann Biomed Eng 2015; 43:2025-35. [DOI: 10.1007/s10439-015-1369-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/16/2015] [Indexed: 01/31/2023]
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98
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Abstract
This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario.
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99
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Youngstrom DW, Rajpar I, Kaplan DL, Barrett JG. A bioreactor system for in vitro tendon differentiation and tendon tissue engineering. J Orthop Res 2015; 33:911-8. [PMID: 25664422 PMCID: PMC5098427 DOI: 10.1002/jor.22848] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/27/2015] [Indexed: 02/04/2023]
Abstract
There is significant clinical demand for functional tendon grafts in human and veterinary medicine. Tissue engineering techniques combining cells, scaffolds, and environmental stimuli may circumvent the shortcomings of traditional transplantation processes. In this study, the influence of cyclic mechanical stimulation on graft maturation and cellular phenotype was assessed in an equine model. Decellularized tendon scaffolds from four equine sources were seeded with syngeneic bone marrow-derived mesenchymal stem cells and subjected to 0%, 3%, or 5% strain at 0.33 Hz for up to 1 h daily for 11 days. Cells cultured at 3% strain integrated deep into their scaffolds, altered extracellular matrix composition, adopted tendon-like gene expression profiles, and increased construct elastic modulus and ultimate tensile strength to native levels. This bioreactor protocol is therefore suitable for cultivating replacement tendon material or as an in vitro model for studying differentiation of stem cells toward tendon.
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Affiliation(s)
- Daniel W. Youngstrom
- Program in Biomedical and Veterinary Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Leesburg, Virginia, United States of America
| | - Ibtesam Rajpar
- Program in Biomedical and Veterinary Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Leesburg, Virginia, United States of America
| | - David L. Kaplan
- Department of Biomedical Engineering, Tissue Engineering Resource Center, Tufts University, Medford, Massachusetts, United States of America
| | - Jennifer G. Barrett
- Department of Large Animal Clinical Sciences, Marion duPont Scott Equine Medical Center, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Leesburg, Virginia, United States of America
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100
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Abstract
Tendon injuries are common and present a clinical challenge to orthopedic surgery mainly because these injuries often respond poorly to treatment and require prolonged rehabilitation. Therapeutic options used to repair ruptured tendons have consisted of suture, autografts, allografts, and synthetic prostheses. To date, none of these alternatives has provided a successful long-term solution, and often the restored tendons do not recover their complete strength and functionality. Unfortunately, our understanding of tendon biology lags far behind that of other musculoskeletal tissues, thus impeding the development of new treatment options for tendon conditions. Hence, in this review, after introducing the clinical significance of tendon diseases and the present understanding of tendon biology, we describe and critically assess the current strategies for enhancing tendon repair by biological means. These consist mainly of applying growth factors, stem cells, natural biomaterials and genes, alone or in combination, to the site of tendon damage. A deeper understanding of how tendon tissue and cells operate, combined with practical applications of modern molecular and cellular tools could provide the long awaited breakthrough in designing effective tendon-specific therapeutics and overall improvement of tendon disease management.
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