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Choi S, Seo KB, Shim S, Shin JY, Kang H. Early and Delayed Postoperative Rehabilitation after Arthroscopic Rotator Cuff Repair: A Comparative Study of Clinical Outcomes. Clin Shoulder Elb 2019; 22:190-194. [PMID: 33330218 PMCID: PMC7714306 DOI: 10.5397/cise.2019.22.4.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/26/2019] [Accepted: 10/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The duration of immobilization after arthroscopic rotator cuff repair and the optimal time to commence rehabilitation are still the subject of ongoing debates. This study was undertaken to evaluate the functional outcome and rotator cuff healing status after arthroscopic rotator cuff repair by comparing early and delayed rehabilitation. METHODS Totally, 76 patients with small, medium, and large sized rotator cuff tears underwent arthroscopic repair using the suture-bridge technique. In early rehabilitation group, 38 patients commenced passive range of motion at postoperative day 2 whereas 38 patients assigned to the delayed rehabilitation group commenced passive range of motion at postoperative week 3. At the end of the study period, clinical and functional evaluations (Constant score, the University of California, Los Angeles [UCLA] shoulder score) were carried out, subsequent to measuring the range of motion, visual analogue scale for pain, and isokinetic dynamometer test. Rotator cuff healing was confirmed by magnetic resonance imaging at least 6 months after surgery. RESULTS No significant difference was obtained in range of motion and visual analogue scale between both groups. Functional outcomes showed similar improvements in the Constant score (early: 67.0-88.0; delayed: 66.9-91.0; p<0.001) and the UCLA shoulder score (early: 20.3-32.3; delayed: 20.4-32.4; p<0.001). Furthermore, rotator cuff healing showed no significant differences between the groups (range, 6-15 months; average, 10.4 months). CONCLUSIONS Delayed passive rehabilitation does not bring about superior outcomes. Therefore, early rehabilitation would be useful to help patients resume their daily lives.
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Affiliation(s)
- Sungwook Choi
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Kyu Bum Seo
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Seungjae Shim
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Ju Yeon Shin
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Hyunseong Kang
- Department of Orthopedic Surgery, Jeju National University School of Medicine, Jeju, Korea
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Abstract
Tendons link muscle to bone and transfer forces necessary for normal movement. Tendon injuries can be debilitating and their intrinsic healing potential is limited. These challenges have motivated the development of model systems to study the factors that regulate tendon formation and tendon injury. Recent advances in understanding of embryonic and postnatal tendon formation have inspired approaches that aimed to mimic key aspects of tendon development. Model systems have also been developed to explore factors that regulate tendon injury and healing. We highlight current model systems that explore developmentally inspired cellular, mechanical, and biochemical factors in tendon formation and tenogenic stem cell differentiation. Next, we discuss in vivo, in vitro, ex vivo, and computational models of tendon injury that examine how mechanical loading and biochemical factors contribute to tendon pathologies and healing. These tendon development and injury models show promise for identifying the factors guiding tendon formation and tendon pathologies, and will ultimately improve regenerative tissue engineering strategies and clinical outcomes.
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Affiliation(s)
- Sophia K Theodossiou
- Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, Moscow, ID 83844, USA
| | - Nathan R Schiele
- Biological Engineering, University of Idaho, 875 Perimeter Dr. MS 0904, Moscow, ID 83844, USA
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Dukan R, Bommier A, Rousseau MA, Boyer P. Arthroscopic knotless tape bridging with autologous platelet-rich fibrin gel augmentation: functional and structural results. PHYSICIAN SPORTSMED 2019; 47:455-462. [PMID: 31136263 DOI: 10.1080/00913847.2019.1623994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Rotator cuff repairs remain a source of iterative ruptures and disappointing functional results. In this goal, autologous platelet-rich plasma (PRP) has been used to improve tendon healing. This prospective study assessed the contribution of fully autologous gel concentrates (platelet concentrates and thrombin) on healing after cuff repair.Methods: A consecutive series of 69 patients who underwent primary arthroscopic knotless tape bridging primary cuff repair of supraspinatus tear were evaluated. Two groups were created (A: n = 32, B: n = 37). Autologous PRP gel, obtained preoperatively by PRP mixed with autologous thrombin extracted from platelet-poor plasma, was injected at bone-tendon interface at end of repair in group A. Gel structure avoided evacuation of concentrates with irrigation liquid. Constant, QuickDash and Visual Analogue Scale (VAS) scores were assessed pre-operatively and then successively post-operatively. Healing was assessed by 24-month control MRI according to Sugaya's classification. Sugaya 3, 4, and 5 were considered as iterative ruptures.Results: Average age was 56 years (±7.8). Mean follow-up was similar: 28.6 months (±3.3) vs 32.4 months (±9.4). Mean preoperative Constant was similar: 53.4 (±3.4) vs 54.6 (±5.4). Group A patients received 3.5 ml (±1.5 ml) of autologous PRP gel. No specific complication of injection was found. We observed higher trend in favour of PRP without significativity: Constant 86.7 (±11.1) vs 81.6 (±14.4), p = 0.11; VAS: 0.6 (±0.3) vs 1.1 (±0.9), p = 0.13; Forward flexion: 139.5° (±14.4°) vs 137.7° (± 16.5°), p = 0.63; Strength score: 17.6 vs 14.8, p = 0.66; QuickDash: 6.2 (±5.3) vs 8.2 (±6.9), p = 0.32 . On MRI, 90% (n = 3) of repairs were healed in group A versus 86% (n = 5) in group B.Conclusion: In this preliminary study, the group treated with autologous PRP gel showed a trend towards better clinical and radiological results. These results were not significant at the last follow-up. Only significantly higher clinical results were found at 3 months.Study design: Therapeutic prospective comparative cohort study; Level of evidence III.
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Affiliation(s)
- Ruben Dukan
- Université Paris Diderot, Bichat Hospital, service d'orthopédie, Paris, France
| | - Aude Bommier
- Université Paris Diderot, Bichat Hospital, service d'orthopédie, Paris, France
| | | | - Patrick Boyer
- Université Paris Diderot, Bichat Hospital, service d'orthopédie, Paris, France
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Qin S, Wang W, Liu Z, Hua X, Fu S, Dong F, Li A, Liu Z, Wang P, Dai L, Liang P, Zhang J, Cao W, Xiong X, Chen H, Xu J. Fibrochondrogenic differentiation potential of tendon-derived stem/progenitor cells from human patellar tendon. J Orthop Translat 2019; 22:101-108. [PMID: 32440505 PMCID: PMC7231964 DOI: 10.1016/j.jot.2019.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/16/2019] [Accepted: 08/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background Bone–tendon junction (BTJ) is a unique structure connecting tendon and bone through a fibrocartilage zone. Owing to its unique structure, the regeneration of BTJ remains a challenge. Here, we study the fibrochondrogenic differentiation of human tendon-derived stem/progenitor cells (TSPCs) both in vitro and in vivo. Methods TSPCs were isolated from human patellar tendon tissues and investigated for their multidifferentiation potential. TSPCs were cultured in chondrogenic medium with transforming growth factor beta 3 (TGF-β3) and BMP-2 in vitro and examined for the expression of fibrochondrogenic marker genes by quantitative real-time reverse transcription polymerase chain reaction, enzyme-linked immunosorbent assay, and immunofluorescence. TSPCs pretreated were also seeded in collage II sponge and then transplanted in immunocompromised nude mice to examine if the fibrochondrogenic characteristics were conserved in vivo. Results We found that TSPCs were differentiated towards fibrochondrogenic lineage, accompanied by the expression of collagen I, collagen II, SRY-box transcription factor 9 (Sox 9), and tenascin C. Furthermore, after TSPCs were seeded in collagen II sponge and transplanted in immunocompromised nude mice, they expressed fibrochondrogenic genes, including proteoglycan, collagen I, and collagen II. Conclusion Taken together, this study showed that TSPCs are capable of differentiating towards fibrocartilage-like cells, and the fibrochondrogenic characteristics were conserved even in vivo, and thus might have the potential application for fibrocartilage regeneration in BTJ repair. The translational potential of this article TSPCs are able to differentiate into fibrocartilage-like cells and thus might well be one potential cell source for fibrocartilage regeneration in a damaged BTJ repair.
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Affiliation(s)
- Shengnan Qin
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wen Wang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Zhihe Liu
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Xing Hua
- Department of Pathology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - SaiChuen Fu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Fei Dong
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Zhen Liu
- Department of Pathology, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Pengzhen Wang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Libing Dai
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Peihong Liang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jinli Zhang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Wenjuan Cao
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Xifeng Xiong
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Honghui Chen
- Guangzhou Institute of Traumatic Surgery, Department of Orthopaedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, Australia
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Lü J, Shi Y, Wang Y, Kang X, Bian X, Yuan B, Zhu M, Tang K. [Research progress of structured repair of tendon-bone interface]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1064-1070. [PMID: 31512444 PMCID: PMC8355852 DOI: 10.7507/1002-1892.201811139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 07/15/2019] [Indexed: 01/08/2023]
Abstract
In sports system, the tendon-bone interface has the effect of tensile and bearing load, so the effect of healing plays a crucial role in restoring joint function. The process of repair is the formation of scar tissue, so it is difficult to achieve the ideal effect for morphology and biomechanical strength. The tissue engineering method can promote the tendon-bone interface healing from the seed cells, growth factors, and scaffolds, and is a new direction in the field of development of the tendon-bone interface healing.
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Affiliation(s)
- Jingtong Lü
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Youxing Shi
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Yunjiao Wang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Xia Kang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Xuting Bian
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Bao Yuan
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Min Zhu
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, State Key Laboratory of Trauma, Burn, and Combined Injury, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), Chongqing, 400038,
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Kim HJ, Kee YM, Kim JY, Rhee YG. Safe time frame of staged bilateral arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2019; 28:1707-1715. [PMID: 31053388 DOI: 10.1016/j.jse.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/07/2019] [Accepted: 02/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have assessed the outcomes of staged bilateral arthroscopic rotator cuff repair (ARCR). This study aimed to determine the influencing factors related to the outcomes of patients who underwent staged bilateral ARCR and to verify an optimal interval for performing the second rotator cuff repair in staged bilateral ARCR. METHODS We analyzed 166 shoulders that underwent staged bilateral ARCR. The average interval between the first- and second-side surgical procedures was 21.9 ± 19.7 months. The minimum follow-up period was 2 years. RESULTS Clinical outcomes and retear rates were not significantly different according to the order of surgical procedures, sex, arm dominance, age, and tear size (P > .05 for all). The cutoff value for the optimal interval between the first and second surgical procedures for the University of California, Los Angeles score and American Shoulder and Elbow Surgeons score was 9 months, with the area under the curve equal to 0.815 (P < .001) for the University of California, Los Angeles score and 0.806 (P < .001) for the American Shoulder and Elbow Surgeons score. The group with an interval of 9 months or less between the first- and second-side surgical procedures showed significantly inferior clinical outcomes and a higher retear rate (35%) compared with the group with an interval greater than 9 months (retear rate, 10%) (P < .05). CONCLUSION Staged bilateral ARCR resulted in significant improvements in clinical outcomes regardless of the order of surgical procedures, sex, arm dominance, age, and tear size. To optimize clinical outcomes of staged bilateral ARCR, second-side surgery should be delayed until 9 months after the first-side surgical procedure.
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Affiliation(s)
- Hwan Jin Kim
- Department of Orthopaedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Young Moon Kee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Riggin CN, Chen M, Gordon JA, Schultz SM, Soslowsky LJ, Khoury V. Ultrasound-Guided Dry Needling of the Healthy Rat Supraspinatus Tendon Elicits Early Healing Without Causing Permanent Damage. J Orthop Res 2019; 37:2035-2042. [PMID: 31042318 PMCID: PMC6688919 DOI: 10.1002/jor.24329] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
Overuse-induced tendinopathy is highly prevalent in the general population. Percutaneous fenestration, or dry needling, techniques have been increasing in popularity, but despite their current use, there are no controlled laboratory studies to provide fundamental support for this practice. The objective of this study was to establish a model for percutaneous needling of the rat supraspinatus tendon using ultrasound guidance and to evaluate the biological response of needling healthy tendon. A total of 44 male Sprague-Dawley rats (477 ± 39 g) were used to evaluate the effect of dry needling on healthy supraspinatus tendon properties. Ten rats were reserved as un-needled control animals, and the remaining animals underwent either mild or moderate bilateral needling protocols and were sacrificed at 1 or 6 weeks post-needling (n = 8-10/group). Color Doppler ultrasound imaging was performed to analyze blood flow within the tendon. Histological and immunohistochemical analyses were used to determine cellular, inflammatory, and extracellular matrix properties of the tissue. Finally, quasi-static tensile mechanical analysis was performed to obtain viscoelastic, structural, and material properties to evaluate the tendon healing outcome. Data were tested for normality, and then two-way analysis of variance tests were performed followed by post hoc tests for multiple comparisons. Both the mild and moderate needling groups caused a transient healing response at early time points as shown by a statistically significant (p < 0.05) reduction in mechanical properties, and increase in blood flow, inflammation, and production of collagen III and glycosaminoglycans as compared to the control. Furthermore, mild needling properties returned to or exceeded pre-needling values at the 6-week time point. Clinical significance: Needling the rat supraspinatus tendon is a feasible technique that causes a transient healing response followed by a return to, or improvement of, normal tendon properties, indicating potential applicability in understanding the effects of current practices utilizing dry needling of tendons in humans. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2035-2042, 2019.
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Affiliation(s)
- Corinne N Riggin
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Mengcun Chen
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA,Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Quhan, China
| | - Joshua A Gordon
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan M Schultz
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Louis J Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA, USA,Corresponding Author: Louis J Soslowsky, McKay Orthopaedic Research Laboratory, University of Pennsylvania, 424 Stemmler Hall, 36 Street and Hamilton Walk, Philadelphia, PA 19104, USA, , Tel: 215-898-8653, Fax: 215-573-2133
| | - Viviane Khoury
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
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Gillis JA, Soreide E, Khouri JS, Kadar A, Berger RA, Moran SL. Outcomes of the Adams-Berger Ligament Reconstruction for the Distal Radioulnar Joint Instability in 95 Consecutive Cases. J Wrist Surg 2019; 8:268-275. [PMID: 31404256 PMCID: PMC6685731 DOI: 10.1055/s-0039-1685235] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
Objective The objective of this article is to evaluate the outcomes and complication rate for Adams-Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure. Methods We conducted a retrospective chart review to evaluate adult patients that had undergone reconstruction of the DRUJ for instability with the Adams-Berger procedure between 1998 and 2015 within our institution with > 24 months follow-up. Charts were reviewed for patient demographics, mechanism of injury, outcome, and complications. Results Ninety-five wrists in 93 patients were included. Mean age at surgery was 37.3 years with 65.2 months follow-up. At the last follow-up, 90.8% had a stable DRUJ, 5.3% did not, and 3.4% had some laxity. Postoperatively, 75.9% described either no pain or mild pain. Grip strength increased while pronosupination decreased. Procedure success was 86.3%, as 12 patients underwent revision at 13.3 months postoperatively. Reconstructive failure was more common in females when an interference screw was utilized for tendon fixation. Age, timing of surgery, type of graft, sigmoid notch anatomy, and previous surgery did not affect revision or failure rate. Conclusion Our findings demonstrate that Adams-Berger reconstruction of the DRUJ provides reliable long-term results with an overall success of 86% at > 5 years follow-up. Level of evidence/Type of study This is a Level IV, therapeutic study.
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Affiliation(s)
- Joshua A. Gillis
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Endre Soreide
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedic Surgery, Oslo University Hospital, Nydalen, Oslo, Norway
| | - Joseph S. Khouri
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Assaf Kadar
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Orthopedic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, Minnesota
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Calejo I, Costa‐Almeida R, Reis RL, Gomes ME. A Textile Platform Using Continuous Aligned and Textured Composite Microfibers to Engineer Tendon-to-Bone Interface Gradient Scaffolds. Adv Healthc Mater 2019; 8:e1900200. [PMID: 31190369 DOI: 10.1002/adhm.201900200] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/20/2019] [Indexed: 12/30/2022]
Abstract
Tendon-to-bone interfaces exhibit a hierarchical multitissue transition. To replicate the progression from mineralized to nonmineralized tissue, a novel 3D fibrous scaffold is fabricated with spatial control over mineral distribution and cellular alignment. For this purpose, wet-spun continuous microfibers are produced using polycaprolactone (PCL)/ gelatin and PCL/gelatin/hydroxyapatite nano-to-microparticles (HAp). Higher extrusion rates result in aligned PCL/gelatin microfibers while, in the case of PCL/gelatin/HAp, the presence of minerals leads to a less organized structure. Biological performance using human adipose-derived stem cells (hASCs) demonstrates that topography of PCL/gelatin microfibers can induce cytoskeleton elongation, resembling native tenogenic organization. Matrix mineralization on PCL/gelatin/HAp wet-spun composite microfibers suggest the production of an osteogenic-like matrix, without external addition of osteogenic medium supplementation. As proof of concept, a 3D gradient structure is produced by assembling PCL/gelatin and PCL/gelatin/HAp microfibers, resulting in a fibrous scaffold with a continuous topographical and compositional gradient. Overall, the feasibility of wet-spinning for the generation of continuously aligned and textured microfibers is demonsrated, which can be further assembled into more complex 3D gradient structures to mimic characteristic features of tendon-to-bone interfaces.
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Affiliation(s)
- Isabel Calejo
- 3B's Research Groupi3Bs ‐ Research Institute on BiomaterialsBiodegradables and BiomimeticsUniversity of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineAvePark, Parque de Ciência e Tecnologia Zona Industrial da Gandra 4805‐017 Barco Guimarães Portugal
- ICVS/3B's‐ PT Government Associate Laboratory 4806‐909 Braga Guimarães Portugal
| | - Raquel Costa‐Almeida
- 3B's Research Groupi3Bs ‐ Research Institute on BiomaterialsBiodegradables and BiomimeticsUniversity of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineAvePark, Parque de Ciência e Tecnologia Zona Industrial da Gandra 4805‐017 Barco Guimarães Portugal
- ICVS/3B's‐ PT Government Associate Laboratory 4806‐909 Braga Guimarães Portugal
| | - Rui L. Reis
- 3B's Research Groupi3Bs ‐ Research Institute on BiomaterialsBiodegradables and BiomimeticsUniversity of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineAvePark, Parque de Ciência e Tecnologia Zona Industrial da Gandra 4805‐017 Barco Guimarães Portugal
- ICVS/3B's‐ PT Government Associate Laboratory 4806‐909 Braga Guimarães Portugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of Minho Avepark 4805‐017 Barco Guimarães Portugal
| | - Manuela E. Gomes
- 3B's Research Groupi3Bs ‐ Research Institute on BiomaterialsBiodegradables and BiomimeticsUniversity of MinhoHeadquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineAvePark, Parque de Ciência e Tecnologia Zona Industrial da Gandra 4805‐017 Barco Guimarães Portugal
- ICVS/3B's‐ PT Government Associate Laboratory 4806‐909 Braga Guimarães Portugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of Minho Avepark 4805‐017 Barco Guimarães Portugal
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Calejo I, Costa-Almeida R, Reis RL, Gomes ME. Enthesis Tissue Engineering: Biological Requirements Meet at the Interface. TISSUE ENGINEERING PART B-REVIEWS 2019; 25:330-356. [DOI: 10.1089/ten.teb.2018.0383] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Isabel Calejo
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Raquel Costa-Almeida
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L. Reis
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
| | - Manuela E. Gomes
- 3B's Research Group, I3Bs—Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal
- ICVS/3B's—PT Government Associate Laboratory, Braga/Guimarães, Portugal
- The Discoveries Center for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal
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A Systematic Review of Proposed Rehabilitation Guidelines Following Anatomic and Reverse Shoulder Arthroplasty. J Orthop Sports Phys Ther 2019; 49:337-346. [PMID: 31021690 DOI: 10.2519/jospt.2019.8616] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Total shoulder arthroplasty (TSA) is indicated for patients with glenohumeral arthritis. In this procedure, the humeral head and glenoid surface are replaced with prosthetic components. Reverse total shoulder arthroplasty (RTSA) is indicated for patients with glenohumeral arthritis and a poorly functioning rotator cuff. In this procedure, a glenosphere articulates with a humerosocket. While those surgeries are commonly performed, a thorough review of the literature is required to determine the areas of agreement and variations in postoperative rehabilitation. OBJECTIVES To describe the literature on rehabilitation protocols following anatomic TSA and RTSA. METHODS For this systematic review, a computerized search was conducted in medical databases from inception to May 21, 2018 for relevant descriptive studies on TSA and RTSA rehabilitation protocols. The methodological index for nonrandomized studies tool and the modified Downs and Black tool for randomized controlled trials were used for assessment of the individual studies. RESULTS Sixteen studies met the inclusion criteria, of which 1 provided level I evidence, 1 provided level III evidence, 2 provided level IV evidence, and 12 provided level V evidence. Ten of the studies described rehabilitation guidelines for TSA and 6 described those for RTSA. Following TSA, the use of a sling was recommended for a duration that varied from 3 to 8 weeks, and 4 of the 10 published protocols included resisted exercise during the initial stage of healing (the first 6 weeks after surgery). Seven of 10 published protocols recommended limiting shoulder external rotation to 30° and that passive range of motion be fully restored by 12 weeks post surgery. Suggested use of a sling post RTSA varied from "for comfort only" to 6 weeks, motion parameters varied from no passive range of motion to precautionary range limits, and all protocols agreed on performing deltoid isometric exercises early post surgery. There was a high level of heterogeneity for the rehabilitation guidelines and associated precautions for both TSA and RTSA. CONCLUSION The majority of published protocols were descriptive in nature. Published rehabilitation strategies following TSA and RTSA are based on biomechanical principles, healing time frames, and exercise loading principles, with little consistency among protocols. There is a need to determine optimal rehabilitation approaches post TSA and RTSA based on clinical outcomes. LEVEL OF EVIDENCE Therapy, level 5. J Orthop Sports Phys Ther 2019;49(5):337-346. doi:10.2519/jospt.2019.8616.
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Kurdziel MD, Davidson A, Ross D, Seta J, Doshi S, Baker KC, Maerz T. Biomechanical properties of the repaired and non-repaired rat supraspinatus tendon in the acute postoperative period. Connect Tissue Res 2019; 60:254-264. [PMID: 29929403 DOI: 10.1080/03008207.2018.1488970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The rat rotator cuff (RC) model is used to study RC pathology and potential treatment; however, native scar-mediated healing allows the rat RC to recover at 4-6 weeks but little is known about acute healing. This study characterized the properties of the repaired and non-repaired rat RC following surgical detachment. MATERIALS AND METHODS Forty-eight rats underwent surgical RC detachment and received surgical repair (Repair) or left unrepaired (Defect) to either 12 or 19 days. Healthy controls were obtained from contralateral limbs. Biomechanical properties were assessed using stress relaxation and failure testing and mechanical modeling performed using quasilinear viscoelastic (QLV) and structurally based elastic models. Histology and micro-magnetic resonance imaging were used to qualitatively grade tendon-to-bone healing. RESULTS Repair and Defect exhibited significantly inferior mechanical properties compared to Healthy at both time points. Repair had significant increases in peak, equilibrium, and ultimate stress, modulus, and stiffness and significant decreases in cross-sectional area, % relaxation, and QLV constant "C" between 12 and 19 days, whereas Defect showed no change. CONCLUSIONS This study demonstrates acute differences in mechanical properties of the rat supraspinatus tendon in the presence and absence of surgical repair. Understanding the longitudinal recovery of mechanical properties can facilitate more accurate characterization of RC pathology or future treatments.
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Affiliation(s)
- Michael D Kurdziel
- a Department of Orthopaedic Surgery , Beaumont Health , Royal Oak , MI , USA.,b Department of Orthopaedic Surgery , OU-WB School of Medicine , Rochester , MI , USA
| | - Abigail Davidson
- a Department of Orthopaedic Surgery , Beaumont Health , Royal Oak , MI , USA
| | - David Ross
- a Department of Orthopaedic Surgery , Beaumont Health , Royal Oak , MI , USA
| | - Joseph Seta
- a Department of Orthopaedic Surgery , Beaumont Health , Royal Oak , MI , USA
| | - Shashin Doshi
- b Department of Orthopaedic Surgery , OU-WB School of Medicine , Rochester , MI , USA
| | - Kevin C Baker
- a Department of Orthopaedic Surgery , Beaumont Health , Royal Oak , MI , USA.,b Department of Orthopaedic Surgery , OU-WB School of Medicine , Rochester , MI , USA
| | - Tristan Maerz
- c Department of Orthopaedic Surgery & Medsport , University of Michigan , Ann Arbor , MI , USA
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Rothrauff BB, Smith CA, Ferrer GA, Novaretti JV, Pauyo T, Chao T, Hirsch D, Beaudry MF, Herbst E, Tuan RS, Debski RE, Musahl V. The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats. J Shoulder Elbow Surg 2019; 28:654-664. [PMID: 30527883 DOI: 10.1016/j.jse.2018.08.044] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/26/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-β3 (TGF-β3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats. METHODS Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats). After 8 weeks, animals received 1 of 8 interventions (n = 12 shoulders/group): (1) no repair, (2) repair only, or repair augmented with (3) fibrin, (4) GelMA, (5) fibrin + ADSCs, (6) GelMA + ADSCs, (7) fibrin + ADSCs + TGF-β3, or (8) GelMA + ADSCs + TGF-β3. An equal number of animals underwent acute tendon transection and immediate application of 1 of 8 interventions. Enthesis healing was evaluated 4 weeks after the repair by microcomputed tomography, histology, and mechanical testing. RESULTS Increased bone loss and reduced structural properties were seen in chronic compared with acute tears. Bone mineral density of the proximal humerus was higher in repairs of chronic tears augmented with fibrin + ADSCs and GelMA + ADSCs than in unrepaired chronic tears. Similar improvement was not seen in acute tears. No intervention enhanced histologic appearance or structural properties in acute or chronic tears. CONCLUSIONS Surgical repair augmented with ADSCs may provide more benefit in chronic tears compared with acute tears, although there was no added benefit to supplementing ADSCs with TGF-β3.
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Affiliation(s)
- Benjamin B Rothrauff
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine A Smith
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald A Ferrer
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - João V Novaretti
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thierry Pauyo
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tom Chao
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - David Hirsch
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mason F Beaudry
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rocky S Tuan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Sheps DM, Silveira A, Beaupre L, Styles-Tripp F, Balyk R, Lalani A, Glasgow R, Bergman J, Bouliane M. Early Active Motion Versus Sling Immobilization After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Arthroscopy 2019; 35:749-760.e2. [PMID: 30827428 DOI: 10.1016/j.arthro.2018.10.139] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the effect of early mobilization (EM) with standard rehabilitation (SR) over the initial 24 months following arthroscopic rotator cuff (RC) repair. METHODS A total of 206 patients with full-thickness RC tears undergoing arthroscopic repair were randomized following preoperative assessment of shoulder range of motion (ROM), pain, strength, and health-related quality of life (HRQOL) to either EM (n = 103; self-weaned from sling and performed pain-free active ROM during the first 6 weeks) or SR (n = 103; wore a sling for 6 weeks with no active ROM). Shoulder ROM, pain, and HRQOL were reassessed at 6 weeks and 3, 6, 12, and 24 months postoperatively by a blinded assessor. At 6, 12, and 24 months, strength was reassessed. At 12 months, ultrasound verified RC integrity. Independent t tests assessed 6-week group differences and 2-way repeated measures analysis of variance assessed changes over time between groups. RESULTS The groups were similar preoperatively (P > .12). The mean age of participants was 55.9 (minimum, 26; maximum, 79) years, and 131 (64%) were men. A total of 171 (83%) patients were followed to 24 months. At 6 weeks postoperatively, EM participants had significantly better forward flexion and abduction (P < .03) than the SR participants; no other group differences were noted. Over 24 months, there were no group differences in ROM after 6 weeks (P > .08), and pain (P > .06), strength (P = .35), or HRQOL (P > .20) at any time. Fifty-two (25%) subjects (30% EM; 33% SR) had a full-thickness tear present at 12-month postoperative ultrasound testing (P > .8). CONCLUSIONS EM did not show significant clinical benefits, but there was no compromise of postoperative ROM, pain, strength, or HRQOL. Repair integrity was similar at 12 months postoperatively between groups. Consideration should be given to allow pain-free active ROM within the first 6 weeks following arthroscopic RC repair. LEVEL OF EVIDENCE Level I, high-quality randomized controlled trial.
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Affiliation(s)
- David M Sheps
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Anelise Silveira
- Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Lauren Beaupre
- Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Fiona Styles-Tripp
- Division of Orthopedic Surgery, Grey Nuns Hospital, Edmonton, Alberta, Canada
| | - Robert Balyk
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Grey Nuns Hospital, Edmonton, Alberta, Canada
| | - Aleem Lalani
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Robert Glasgow
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Grey Nuns Hospital, Edmonton, Alberta, Canada
| | - Joseph Bergman
- Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Martin Bouliane
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, University of Alberta, Edmonton, Alberta, Canada; Division of Orthopedic Surgery, Grey Nuns Hospital, Edmonton, Alberta, Canada
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Nakagawa Y, Lebaschi AH, Wada S, E. Green SJ, Wang D, Album ZM, Carballo CB, Deng XH, Rodeo SA. Duration of postoperative immobilization affects MMP activity at the healing graft-bone interface: Evaluation in a mouse ACL reconstruction model. J Orthop Res 2019; 37:325-334. [PMID: 30431170 PMCID: PMC6411439 DOI: 10.1002/jor.24177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/22/2018] [Indexed: 02/04/2023]
Abstract
Excessive MMP activity may impair tendon-to-bone healing. However, little is known about the effect of joint motion on MMP activity after ACL reconstruction. The aim of this study was to determine the effect of different durations of knee immobilization on MMP activity in a mouse ACL reconstruction model using a fluorescent MMP probe which detects MMP 2, 3, 9, and 13 and near-infra red in vivo imaging. Sixty C57BL male mice underwent ACL reconstruction. Post-operatively, the animals were treated with free cage activity (Group 1), or with the use of an external fixator to restrict knee motion and weight bearing for 5 days (Group 2), 14 days (Group 3), and 28 days (Group 4). At days 3, 7, 16, 23, and 30, five mice underwent IVIS imaging. At days 3, 7, 16, and 30, histological analysis was also performed. Probe signal intensity in the whole limb peaked at day 7, followed by a decrease at day 16, and maintenance up to day 30. There was no significant difference among groups at any time point based on IVIS, but histologic localization of MMP probe signal showed significantly less activity in Group 2 and Group 3 compared to Group 4 in the bone tunnel at day 30. We demonstrated that short-term immobilization led to less MMP activity around the bone tunnel compared with prolonged immobilization. A short period of immobilization after ACL reconstruction might enhance graft-bone interface healing by mitigating excess MMP expression. These findings have implications for post-operative rehabilitation protocols following ACL reconstruction. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:325-334, 2019.
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Affiliation(s)
- Yusuke Nakagawa
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York,Department of Cartilage Regeneration, Tokyo Medical and Dental University, Tokyo, Japan
| | - Amir H. Lebaschi
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Susumu Wada
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Samuel J E. Green
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Dean Wang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Zoe M. Album
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Camilla B. Carballo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
| | - Scott A. Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopaedic Soft Tissue Research, Hospital for Special Surgery, 535 East 70th Street, New York 10021, New York
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Kim DH, Min SG, Yoon JP, Park GY, Choi JH, Jung JW, Lee HJ, Kim HJ, Chung SW, Kim JY. Mechanical Augmentation With Absorbable Alginate Sheet Enhances Healing of the Rotator Cuff. Orthopedics 2019; 42:e104-e110. [PMID: 30540880 DOI: 10.3928/01477447-20181206-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/08/2018] [Indexed: 02/03/2023]
Abstract
For anatomical restoration of a repaired rotator cuff, mechanical augmentation of the repaired structure is essential. Using histological and biomechanical evaluation in a rat model, the authors sought to determine the efficacy of an absorbable alginate sheet at the supraspinatus tendon-to-bone repair site for healing of the rotator cuff tear. Forty adult (12 weeks old) male Sprague- Dawley wild-type rats were used in this study. The animals were randomly separated into 2 groups: group 1, conventional supraspinatus repair with acute repair; or group 2, supraspinatus repair with absorbable alginate sheet. Biomechanical and histological analyses were performed at 6 and 12 weeks after index rotator cuff surgery. Compared with group 1, group 2 exhibited a significantly greater mean ultimate failure load (group 1, 23.70±3.87 N; group 2, 61.44±43.67 N; P=.023) and mean ultimate stress (group 1, 2.83±0.50 MPa; group 2, 7.36±2.87 MPa; P=.020). However, 6-week outcomes were not significantly different. On histological scoring, compared with group 1, group 2 exhibited a significantly greater mean 6-week score (group 1, 4.10±1.72 points; group 2, 7.80±1.47 points; P<.001) and mean 12-week score (group 1, 3.50±1.00 points; group 2, 5.25±2.62 points; P=.020). Mechanical augmentation with absorbable alginate may improve tendon healing after surgical repair of the rotator cuff. [Orthopedics. 2019; 42(1):e104-e110.].
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Liu F, Meng Q, Yin H, Yan Z. Stem Cells in Rotator Cuff Injuries and Reconstructions: A Systematic Review and Meta-Analysis. Curr Stem Cell Res Ther 2019; 14:683-697. [PMID: 31244430 DOI: 10.2174/1574888x14666190617143952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Multiple studies have focused on stem cell-based treatments for rotator cuff disorders; however, the outcomes are not consistent. OBJECTIVES This systematic review and meta-analysis were performed to evaluate the effects of stem cells on rotator cuff healing. METHODS A detailed search of relevant studies was conducted in three databases including Pubmed/ Medline, Cochrane library, and Embase databases, using the following keywords: "rotator cuff" or "Tissue Engineering" AND "stem cell" from inception to January 01, 2019. The standard mean difference (SMD) and 95% confidence interval (CI) for each individual study were extracted from the original studies or calculated based on relevant data and pooled to obtain integrated estimates using random effects modeling. RESULTS A total of 22 studies were identified. The results demonstrated that the ultimate strain in the stem cell group was significantly higher than that in the control group at 4 and 8 weeks. Muscle weight in the stem cell group was higher than the control group at 8 weeks, while no significant differences were detected at 16 weeks. The stem cell group had lower visual analog scale scores (VAS) at 1, 3, and 6 months, and higher American shoulder and elbow surgeons score (ASES) at 3 months. In addition, the walking distance, time, and speed in the stem cell group were significantly superior to those in the control group. CONCLUSIONS This meta-analysis confirms that stem cells improved the rehabilitation of rotator cuff disorders. However, larger-scale studies are needed to further support these findings.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan 250021, Shandong, China
| | - Qingqi Meng
- Department of Orthopaedics, Guangzhou Red Cross Hospital, Jinan University, Tongfu road 396, Haizhu district, Guangzhou, China
| | - Heyong Yin
- Department of Trauma Surgery, University of Regensburg, Am biopark 9, 93049 Regensburg, Germany
| | - Zexing Yan
- Department of Trauma Surgery, University of Regensburg, Am biopark 9, 93049 Regensburg, Germany
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Cheema AN, Newton JB, Boorman-Padgett JF, Weiss SN, Nuss CA, Gittings DJ, Farber DC, Soslowsky LJ. Nicotine impairs intra-substance tendon healing after full thickness injury in a rat model. J Orthop Res 2019; 37:94-103. [PMID: 30345583 PMCID: PMC6411046 DOI: 10.1002/jor.24167] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/11/2018] [Indexed: 02/04/2023]
Abstract
Nicotine is harmful to many bodily systems; however, the effects of nicotine on intra-substance tendon healing remain largely unexplored. The purpose of this study was to examine the functional, structural, and biomechanical effects of nicotine on the healing of Achilles tendons in rats after an acute full-thickness injury. Sixty Sprague-Dawley rats were enrolled in this study. Half were exposed to 0.9% saline and half to 61 ng/mL of nicotine for 3 months via subcutaneous osmotic pumps. At 3 months, all rats underwent blunt full thickness transection of the left Achilles tendon and were immobilized for one week in plantarflexion. In-vivo assays were conducted prior to injury, at 21 days, and at 42 days post-injury and included the following: Functional limb assessment, passive joint mechanics, and vascular evaluation. Rats were sacrificed at 21 and 42 days for biomechanical testing and histologic evaluation. Rats exposed to nicotine demonstrated decreased vascularity, greater alteration in gait mechanics, and increased passive ROM of the ankle joint. Biomechanically, the nicotine tendons failed at lower maximum loads, were less stiff, had smaller cross-sectional areas and had altered viscoelastic properties. Histologically, nicotine tendons demonstrated decreased vessel density at the injury site. This study demonstrates that nicotine leads to worse functional outcomes and biomechanical properties in tendons. The decreased vascularity in the nicotine group may suggest an underlying mechanism for inferior tendon healing. Patients should be counseled that using nicotine products increase their risk of poor tendon healing and may predispose them to tendon re-rupture. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
| | | | | | | | | | | | | | - Louis J. Soslowsky
- Corresponding Author: Louis J. Soslowsky, McKay Orthopaedic Research Laboratory, University of Pennsylvania, 3450 Hamilton Walk, 110 Stemmler Hall, Philadelphia, PA 19104-6081, United States of America, Phone: 215-898- 8653, Fax: 215-573- 2133,
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Porter MD. Surgical Technique Influences Rehabilitation Regimen: Letter to the Editor. Am J Sports Med 2019; 47:NP6-NP7. [PMID: 30781984 DOI: 10.1177/0363546518810705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Calejo I, Costa-Almeida R, Gomes ME. Cellular Complexity at the Interface: Challenges in Enthesis Tissue Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1144:71-90. [PMID: 30632116 DOI: 10.1007/5584_2018_307] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The complex heterogeneous cellular environment found in tendon-to-bone interface makes this structure a challenge for interface tissue engineering. Orthopedic surgeons still face some problems associated with the formation of fibrotic tissue or re-tear occurring after surgical re-attachment of tendons to the bony insertion or the application of grafts. Unfortunately, an understanding of the cellular component of enthesis lags far behind of other well-known musculoskeletal interfaces, which blocks the development of new treatment options for the healing and regeneration of this multifaceted junction. In this chapter, the main characteristics of tendon and bone cell populations are introduced, followed by a brief description of the interfacial cellular niche, highlighting molecular mechanisms governing tendon-to-bone attachment and mineralization. Finally, we describe and critically assess some challenges faced concerning the use of cell-based strategies in tendon-to-bone healing and regeneration.
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Affiliation(s)
- Isabel Calejo
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Raquel Costa-Almeida
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Manuela E Gomes
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal. .,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal. .,The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Guimarães, Portugal.
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Bakti N, Antonios T, Phadke A, Singh B. Early versus delayed mobilization following rotator cuff repair. J Clin Orthop Trauma 2019; 10:257-260. [PMID: 30828188 PMCID: PMC6382997 DOI: 10.1016/j.jcot.2019.01.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 02/08/2023] Open
Abstract
Rotator cuff tears are a common cause for pain and reduced function. Tears of the tendons of the cuff can be a result of a degenerative process or as a consequence of trauma. Management of cuff tears are surrounded by controversy from indications for surgical management to rehabilitation protocol post-surgical repair. The aim of post surgical rehabilitation is to improve functional outcome, reduce pain and promote tendon healing. In the case of rotator cuff repair, rehabilitation can be broadly divided into early passive range of motion (EPM) and delayed range of motion (DRM). The EPM regime is defined by minimal immobilisation of the shoulder and passive mobilisation of the joint within the first post-operative period. In contrast, DRM immobilises the shoulder joint up to six weeks post-operatively. Proponents of EPM state various advantages of their rehabilitation protocol including improved range of motion and earlier return to normal activities of daily living. However, there has also been concern that this rehabilitation regime may result in an increased rate of re-rupture. Since this is a highly controversial issue, various high quality literature have been published looking to clarify which regime is best following rotator cuff surgery. Reviewing these articles, it appears that there is an increase rate of re-tear of the repaired rotator cuff tendon when the EPM regime is employed. Statistical significance however was limited by small sample sizes. Range of motion post-repair also appears to be associated with post-operative rehabilitation regime. As expected, the EPM regime has been shown to improve range of motion post-repair. Despite this, literature reports patients managed with the DPM showed a statistically better patient reported outcome measure. We conclude that based on the evidence we currently have, early range of motion post rotator cuff repair is related with an increase risk of re-tear. The DPM regime reduces this risk with the possible complication of reduced range of shoulder movement. This problem is thought to be an easier clinical issue to deal with compared to re-rupture of the repaired rotator cuff tendon. There is however lack of data to achieve statistical significance in most of these analysis. There is a definite need for a large, multi-centre single blinded randomised controlled trial to further shed light on this controversial topic.
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Affiliation(s)
- Nik Bakti
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK,Corresponding author.
| | - Tony Antonios
- Department of Trauma & Orthopaedics, Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Akshay Phadke
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - Bijayendra Singh
- Department of Trauma & Orthopaedics, Medway NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK
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Chen K, Hu X, Blemker SS, Holmes JW. Multiscale computational model of Achilles tendon wound healing: Untangling the effects of repair and loading. PLoS Comput Biol 2018; 14:e1006652. [PMID: 30550566 PMCID: PMC6310293 DOI: 10.1371/journal.pcbi.1006652] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/28/2018] [Accepted: 11/15/2018] [Indexed: 12/11/2022] Open
Abstract
Mechanical stimulation of the healing tendon is thought to regulate scar anisotropy and strength and is relatively easy to modulate through physical therapy. However, in vivo studies of various loading protocols in animal models have produced mixed results. To integrate and better understand the available data, we developed a multiscale model of rat Achilles tendon healing that incorporates the effect of changes in the mechanical environment on fibroblast behavior, collagen deposition, and scar formation. We modified an OpenSim model of the rat right hindlimb to estimate physiologic strains in the lateral/medial gastrocnemius and soleus musculo-tendon units during loading and unloading conditions. We used the tendon strains as inputs to a thermodynamic model of stress fiber dynamics that predicts fibroblast alignment, and to determine local collagen synthesis rates according to a response curve derived from in vitro studies. We then used an agent-based model (ABM) of scar formation to integrate these cell-level responses and predict tissue-level collagen alignment and content. We compared our model predictions to experimental data from ten different studies. We found that a single set of cellular response curves can explain features of observed tendon healing across a wide array of reported experiments in rats–including the paradoxical finding that repairing transected tendon reverses the effect of loading on alignment–without fitting model parameters to any data from those experiments. The key to these successful predictions was simulating the specific loading and surgical protocols to predict tissue-level strains, which then guided cellular behaviors according to response curves based on in vitro experiments. Our model results provide a potential explanation for the highly variable responses to mechanical loading reported in the tendon healing literature and may be useful in guiding the design of future experiments and interventions. Tendons and ligaments transmit force between muscles and bones throughout the body and are comprised of highly aligned collagen fibers that help bear high loads. The Achilles tendon is exposed to exceptionally high loads and is prone to rupture. When damaged Achilles tendons heal, they typically have reduced strength and stiffness, and while most believe that appropriate physical therapy can help improve these mechanical properties, both clinical and animal studies of mechanical loading following injury have produced highly variable and somewhat disappointing results. To help better understand the effects of mechanical loading on tendon healing and potentially guide future therapies, we developed a computational model of rat Achilles tendon healing and showed that we could predict the main effects of different mechanical loading and surgical repair conditions reported across a wide range of published studies. Our model offers potential explanations for some surprising findings of prior studies and for the high variability observed in those studies and may prove useful in designing future therapies or experiments to test new therapies.
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Affiliation(s)
- Kellen Chen
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States of America
| | - Xiao Hu
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States of America
| | - Silvia S. Blemker
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States of America
- Department of Mechanical and Aerospace Engineering, University of Virginia, Charlottesville, VA, United States of America
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, United States of America
| | - Jeffrey W. Holmes
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States of America
- Department of Medicine, University of Virginia, Charlottesville, VA, United States of America
- * E-mail:
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74
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Calejo I, Costa‐Almeida R, Gonçalves AI, Berdecka D, Reis RL, Gomes ME. Bi-directional modulation of cellular interactions in an in vitro co-culture model of tendon-to-bone interface. Cell Prolif 2018; 51:e12493. [PMID: 30105786 PMCID: PMC6528866 DOI: 10.1111/cpr.12493] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/13/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This work aimed at studying in vitro interactions between human tendon-derived cells (hTDCs) and pre-osteoblasts (pre-OBs) that may trigger a cascade of events involved in enthesis regeneration. MATERIALS AND METHODS The effect of 5 osteogenic medium (OM) conditions over the modulation of hTDCs and pre-OBs towards the tenogenic and osteogenic phenotypes, respectively, was studied. Three different medium conditions were chosen for subsequently establishing a direct co-culture system in order to study the expression of bone, tendon and interface-related markers. RESULTS A higher matrix mineralization and ALP activity was observed in co-cultures in the presence of OM. Higher transcription levels of bone- (ALPL, RUNX2, SPP1) and interface-related genes (ACAN, COMP) were found in co-cultures. The expression of aggrecan was influenced by the presence of OM and cell-cell interactions occurring in co-culture. CONCLUSIONS The present work assessed both the influence of OM on cell phenotype modulation and the importance of co-culture models while promoting cell-cell interactions and the exchange of soluble factors in triggering an interface-like phenotype to potentially modulate enthesis regeneration.
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Affiliation(s)
- I. Calejo
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
| | - Raquel Costa‐Almeida
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
| | - Ana Isabel Gonçalves
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
| | - Dominika Berdecka
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
| | - Rui Luis Reis
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of MinhoBarco, GuimarãesPortugal
| | - Manuela Estima Gomes
- 3B's Research Group ‐ Biomaterials, Biodegradables and BiomimeticsUniversity of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine– Parque de Ciência e TecnologiaBarco, GuimarãesPortugal
- ICVS/3B's—PT Government Associate LaboratoryBraga/GuimarãesPortugal
- The Discoveries Centre for Regenerative and Precision MedicineHeadquarters at University of MinhoBarco, GuimarãesPortugal
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75
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Chen M, Shetye S, Huegel J, Riggin CN, Gittings DJ, Nuss CA, Weiss SN, Kuntz AF, Soslowsky LJ. Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model. Am J Sports Med 2018; 46:3486-3494. [PMID: 30419172 PMCID: PMC6563917 DOI: 10.1177/0363546518805091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. HYPOTHESIS Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. STUDY DESIGN Controlled laboratory study. METHODS Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. RESULTS Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. CONCLUSION Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. CLINICAL RELEVANCE This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.
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Affiliation(s)
- Mengcun Chen
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Snehal Shetye
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julianne Huegel
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Corinne N. Riggin
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel J. Gittings
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Courtney A. Nuss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie N. Weiss
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew F. Kuntz
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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76
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Deprés-Tremblay G, Chevrier A, Snow M, Rodeo S, Buschmann MD. Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit. J Biomater Appl 2018; 33:792-807. [PMID: 30426861 DOI: 10.1177/0885328218811386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.
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Affiliation(s)
| | | | - Martyn Snow
- 2 The Royal Orthopaedic Hospital, Birmingham, UK
| | - Scott Rodeo
- 3 The Hospital for Special Surgery, New York, NY, USA
| | - Michael D Buschmann
- 4 Ecole Polytechnique de Montreal, 2900 Boul Edouard-Montpetit, Montreal, Canada
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77
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Zhou Y, Hu J, Zhou J, Zeng Z, Cao Y, Wang Z, Chen C, Zheng C, Chen H, Lu H. Three-dimensional characterization of the microstructure in rabbit patella-patellar tendon interface using propagation phase-contrast synchrotron radiation microtomography. JOURNAL OF SYNCHROTRON RADIATION 2018; 25:1833-1840. [PMID: 30407196 DOI: 10.1107/s160057751801353x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 09/22/2018] [Indexed: 06/08/2023]
Abstract
Understanding the three-dimensional ultrastructure morphology of tendon-to-bone interface may allow the development of effective therapeutic interventions for enhanced interface healing. This study aims to assess the feasibility of propagation phase-contrast synchrotron radiation microtomography (PPC-SRµCT) for three-dimensional characterization of the microstructure in rabbit patella-patellar tendon interface (PPTI). Based on phase retrieval for PPC-SRµCT imaging, this technique is capable of visualizing the three-dimensional internal architecture of PPTI at a cellular high spatial resolution including bone and tendon, especially the chondrocytes lacuna at the fibrocartilage layer. The features on the PPC-SRµCT image of the PPTI are similar to those of a histological section using Safranin-O staining/fast green staining. The three-dimensional microstructure in the rabbit patella-patellar tendon interface and the spatial distributions of the chondrocytes lacuna and their quantification volumetric data are displayed. Furthermore, a color-coding map differentiating cell lacuna in terms of connecting beads is presented after the chondrocytes cell lacuna was extracted. This provides a more in-depth insight into the microstructure of the PPTI on a new scale, particularly the cell lacuna arrangement at the fibrocartilage layer. PPC-SRµCT techniques provide important complementary information to the conventional histological method for characterizing the microstructure of the PPTI, and may facilitate in investigations of the repair mechanism of the PPTI after injury and in evaluating the efficacy of a different therapy.
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Affiliation(s)
- Yongchun Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Jingyong Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Ziteng Zeng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Zhanwen Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Can Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Cheng Zheng
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Huabin Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha 410008, People's Republic of China
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78
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No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial. Arthroscopy 2018; 34:2765-2774. [PMID: 30195953 DOI: 10.1016/j.arthro.2018.05.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to compare clinical and radiologic results among patients with 3 versus 6 weeks of immobilization after arthroscopic rotator cuff (RC) repair in a prospective randomized controlled non-inferiority trial. METHODS One hundred twenty patients were included after RC surgery for a small- to medium-sized tear of supraspinatus and upper infraspinatus tendons. Group A was immobilized in a simple sling for 3 weeks, and group B had a brace with a small abduction pillow with the arm in neutral position for 6 weeks. All patients started active range of motion when they removed the sling/brace. One hundred eighteen (98%) patients were assessed at 1-year follow-up. They underwent magnetic resonance imaging (MRI) of the shoulder, filled out the Western Ontario Rotator Cuff (WORC) index, and were evaluated with a Constant Murley (CM) score. RESULTS Statistical non-inferiority was demonstrated for the 2 groups on the basis of the WORC index, the primary endpoint at 1 year. The objective for the non-inferiority test was to determine whether the expected mean WORC index for group A was at most 13% worse than standard treatment (Group B). The WORC index at 1 year was similar in both groups, with mean percent scores of 83% in group A and 87% in group B (mean difference = -4; 95% one-sided CI -9, -4). Age-adjusted CM scores were also similar, with means of 86 in group A and 90 in group B (mean difference = -4; 95% CI -13, 5; P = .37). MRI after 1 year showed 50 (89%) patients in each group with healed RC repair. Four patients in group A had complications: 1 acute postoperative infection, 2 cases of postoperative capsulitis treated with corticosteroid injections, and 1 repeat operation because of a loose anchor and subacromial pain. No patients in group B had complications. CONCLUSION RC repair resulted in improved postoperative shoulder function, regardless of whether the shoulder was immobilized for 3 or 6 weeks. Three weeks of postoperative immobilization with sling use was non-inferior to the commonly used regimen involving 6 weeks of immobilization in a brace with regard to the WORC index at 12 months' follow-up. MRI indicated similar degrees of healing between the groups. Based on these findings, it is safe to immobilize patients in a simple sling for 3 to 6 weeks after repair of small to medium RC tears. LEVEL OF EVIDENCE Level I, high-quality randomized controlled trial with statistically significant differences.
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79
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Kjær BH, Magnusson SP, Warming S, Henriksen M, Krogsgaard MR, Juul-Kristensen B. Progressive early passive and active exercise therapy after surgical rotator cuff repair - study protocol for a randomized controlled trial (the CUT-N-MOVE trial). Trials 2018; 19:470. [PMID: 30176943 PMCID: PMC6122575 DOI: 10.1186/s13063-018-2839-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 08/04/2018] [Indexed: 01/08/2023] Open
Abstract
Background Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear. Methods The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up. Discussion We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear. Trial registration ClinicalTrials.gov, NCT02969135. Registered on 15 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2839-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Birgitte Hougs Kjær
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark. .,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark.
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,Institute of Sports Medicine, Department of Orthopaedic Surgery M, Copenhagen Bispebjerg-Frederiksberg Hospital, and Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susan Warming
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Marius Henriksen
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark.,The Parker Institute, Bispebjerg-Frederiksberg Hospital, Ndr. Fasanvej 57, DK-2000, Frederiksberg, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopaedic Surgery, Bispebjerg-Frederiksberg Hospital, Bispebjerg Bakke 23, DK-2400, Copenhagen, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK-5230, Odense, Denmark
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80
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Sevick JL, Abusara Z, Andrews SH, Xu M, Khurshid S, Chatha J, Hart DA, Shrive NG. Fibril deformation under load of the rabbit Achilles tendon and medial collateral ligament femoral entheses. J Orthop Res 2018; 36:2506-2515. [PMID: 29637610 DOI: 10.1002/jor.23912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/30/2018] [Indexed: 02/04/2023]
Abstract
Microscopic visualization under load of the region connecting ligaments/tendons to bone, the enthesis, has been performed previously; however, specific investigation of individual fibril deformation may add insight to such studies. Detailed visualization of fibril deformation would inform on the mechanical strategies employed by this tissue in connecting two mechanically disparate materials. Clinically, an improved understanding of enthesis mechanics may help guide future restorative efforts for torn or injured ligaments/tendons, where the enthesis is often a point of weakness. In this study, a custom ligament/tendon enthesis loading device was designed and built, a unique method of sample preparation was devised, and second harmonic and two-photon fluorescence microscopy were used to capture the fibril-level load response of the rabbit Achilles tendon and medial collateral ligament femoral entheses. A focus was given to investigation of the mechanical problem of fibril embedment. Resultant images indicate a rapid (occurring over approximately 60 μm) change in fibril orientation at the interface of ligament/tendon and calcified fibrocartilage early in the loading regime, before becoming relatively constant. Such a change in fibril angle helps confirm the materially graded region demonstrated by others, while, in this case, providing additional insight into fibril bending. We speculate that the scale of the mechanical problem (i.e., fibril diameters being on the order of 250 nm) allows fibrils to bend over the small (relative to the imaging field of view, but large relative to fibril diameter) distances observed; thus, potentially lessening required embedment lengths. Nevertheless, this behavior merits further investigation to be confirmed. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2506-2515, 2018.
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Affiliation(s)
- Johnathan L Sevick
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Biomedical Engineering Graduate Program, University of Calgary, Calgary, Alberta, Canada
| | - Ziad Abusara
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, Human Performance Laboratory, University of Calgary, Calgary, Alberta, Canada
| | - Stephen H Andrews
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Minjia Xu
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Saad Khurshid
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Jansher Chatha
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - David A Hart
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Nigel G Shrive
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,Department of Civil Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
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81
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Lemmon EA, Locke RC, Szostek AK, Ganji E, Killian ML. Partial-width injuries of the rat rotator cuff heal with fibrosis. Connect Tissue Res 2018; 59:437-446. [PMID: 29874950 PMCID: PMC6324170 DOI: 10.1080/03008207.2018.1485666] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Identify the healing outcomes following a partial-width, full-thickness injury to the rotator cuff tendon-bone attachment and establish if the adult attachment can regenerate the morphology of the healthy attachment. HYPOTHESIS We hypothesized that a partial-width injury to the attachment would heal via fibrosis and bone remodeling, resulting in increased cellularity and extra-cellular matrix deposition, reduced bone volume (BV), osteoclast presence, and decreased collagen organization compared to shams. MATERIALS AND METHODS A partial-width injury was made using a biopsy punch at the center one-third of the rat infraspinatus attachment. Contralateral limbs underwent a sham operation. Rats were sacrificed at 3 and 8 weeks after injury for analyses. Analyses performed at each time point included cellularity (Hematoxylin & Eosin), ECM deposition (Masson's Trichrome), BV (micro-computed tomography; microCT), osteoclast activity (Tartrate Resistant Acid Phosphatase; TRAP), and collagen fibril organization (Picrosirius Red). Injured and sham shoulders were compared at both 3 and 8 weeks using paired, two-way ANOVAs with repeated measures (Sidak's correction for multiple comparisons). RESULTS Cellularity and ECM deposition increased at both 3 and 8 weeks compared to sham contralateral attachments. BV decreased and osteoclast presence increased at both 3 and 8 weeks compared to sham contralateral limbs. Collagen fibril organization was reduced at 3 weeks after injury compared to 3-week sham attachments. CONCLUSIONS These findings suggest that a partial-width injury to the rotator cuff attachment does not fully regenerate the native structure of the healthy attachment. The injury model healed via scar-like fibrosis and did not propagate into a full-width tear after 8 weeks of healing.
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Affiliation(s)
- Elisabeth A Lemmon
- a Department of Animal and Food Sciences and Biomedical Engineering , University of Delaware , Newark , DE , USA
| | - Ryan C Locke
- b Department of Biomedical Engineering , University of Delaware , Newark , DE , USA
| | - Adrianna K Szostek
- a Department of Animal and Food Sciences and Biomedical Engineering , University of Delaware , Newark , DE , USA
| | - Elahe Ganji
- c Department of Mechanical Engineering and Biomedical Engineering , University of Delaware , Newark , DE , USA
| | - Megan L Killian
- b Department of Biomedical Engineering , University of Delaware , Newark , DE , USA
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82
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Derwin KA, Galatz LM, Ratcliffe A, Thomopoulos S. Enthesis Repair: Challenges and Opportunities for Effective Tendon-to-Bone Healing. J Bone Joint Surg Am 2018; 100:e109. [PMID: 30106830 PMCID: PMC6133216 DOI: 10.2106/jbjs.18.00200] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
On May 22, 2017, the National Institutes of Health (NIH)/National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) hosted a roundtable on "Innovative Treatments for Enthesis Repair." A summary of the roundtable discussion, as well as a list of the extramural participants, can be found at https://www.niams.nih.gov/about/meetings-events/roundtables/roundtable-innovative-treatments-enthesis-repair. This paper reviews the challenges and opportunities for developing effective treatment strategies for enthesis repair that were identified at the roundtable discussion.
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Affiliation(s)
- Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio,E-mail address for K.A. Derwin:
| | - Leesa M. Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Department of Biomedical Engineering, Columbia University, New York, NY
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83
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Deng XH, Lebaschi A, Camp CL, Carballo CB, Coleman NW, Zong J, Grawe BM, Rodeo SA. Expression of Signaling Molecules Involved in Embryonic Development of the Insertion Site Is Inadequate for Reformation of the Native Enthesis: Evaluation in a Novel Murine ACL Reconstruction Model. J Bone Joint Surg Am 2018; 100:e102. [PMID: 30063598 PMCID: PMC6661256 DOI: 10.2106/jbjs.16.01066] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Since healing of anterior cruciate ligament (ACL) grafts occurs by formation of a fibrovascular scar-tissue interface rather than by reformation of the native fibrocartilage transition zone, the purpose of our study was to examine expression of various signaling molecules and transcription factors that are known to be involved in embryologic insertion-site development following ACL reconstruction. We also aimed to characterize a murine model of ACL reconstruction to allow future study of the molecular mechanisms of healing. METHODS Seventy-nine mice underwent reconstruction of the ACL with autograft. Healing was assessed using histology in 12 mice and quantitative real-time polymerase chain reaction (qRT-PCR) gene-expression analysis in 3 mice at 1 week postoperatively (Group-1 mice) and by biomechanical analysis in 7, histological analysis in 7, immunohistochemical analysis in 5, microcomputed tomography analysis in 5, and qRT-PCR analyses in 8 at 2 weeks (Group-2 mice) and 4 weeks (Group-3 mice) postoperatively. Fifteen additional mice did not undergo surgery and were used for biomechanical (7 mice), qRT-PCR (3 mice), and immunohistochemical (5 mice) analyses to obtain baseline data for the native ACL. RESULTS Histological analysis demonstrated healing by formation of fibrovascular tissue at the tendon-bone interface. Immunohistochemical analysis showed a positive expression of proteins in the Indian hedgehog, Wnt, and parathyroid hormone-related protein (PTHrP) pathways. There was minimal Sox-9 expression. Gene-expression analysis showed an initial increase in markers of tissue repair and turnover, followed by a subsequent decline. Mean failure force and stiffness of the native ACL were 5.60 N and 3.44 N/mm, respectively. Mean failure force and stiffness were 1.29 N and 2.28 N/mm, respectively, in Group 2 and were 1.79 N and 2.59 N/mm, respectively, in Group 3, with 12 of 14 failures in these study groups occurring by tunnel pull-out. CONCLUSIONS The spatial and temporal pattern of expression of signaling molecules that direct embryologic insertion-site formation was not adequate to restore the structure and composition of the native insertion site. CLINICAL RELEVANCE Development of a murine model to study ACL reconstruction will allow the use of transgenic animals to investigate the cellular, molecular, and biomechanical aspects of tendon-to-bone healing following ACL reconstruction, ultimately suggesting methods to improve healing in patients.
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Affiliation(s)
- Xiang-Hua Deng
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Amir Lebaschi
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Christopher L. Camp
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Camila B. Carballo
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Nathan W. Coleman
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Jianchun Zong
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY
| | - Brian M. Grawe
- Sports Medicine and Shoulder Reconstruction, Department of Orthopaedics, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Scott A. Rodeo
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY,E-mail address for S.A. Rodeo:
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84
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Bianco ST, Moser HL, Galatz LM, Huang AH. Biologics and stem cell-based therapies for rotator cuff repair. Ann N Y Acad Sci 2018; 1442:35-47. [PMID: 30008172 DOI: 10.1111/nyas.13918] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022]
Abstract
The rotator cuff is composed of several distinct muscles and tendons that function in concert to coordinate shoulder motion. Injuries to these tendons frequently result in permanent dysfunction and persistent pain. Despite considerable advances in operation techniques, surgical repair alone still does not fully restore rotator cuff function. This review focuses on recent research in the use of biologics and stem cell-based therapies to augment repair, highlighting promising avenues for future work and remaining challenges. While a number of animal models are used for rotator cuff studies, the anatomy of the rotator cuff varies dramatically between species. Since the rodent rotator cuff shares the most anatomical features with the human, this review will focus primarily on rodent models to enable consistent interpretation of outcome measures.
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Affiliation(s)
- Spencer T Bianco
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Helen L Moser
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York.,Shoulder, Elbow and Orthopaedic Sports Medicine, Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Leesa M Galatz
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice H Huang
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York
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85
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Richardson WJ, Kegerreis B, Thomopoulos S, Holmes JW. Potential strain-dependent mechanisms defining matrix alignment in healing tendons. Biomech Model Mechanobiol 2018; 17:1569-1580. [PMID: 30003433 DOI: 10.1007/s10237-018-1044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/18/2018] [Indexed: 12/13/2022]
Abstract
Tendon mechanical function after injury and healing is largely determined by its underlying collagen structure, which in turn is dependent on the degree of mechanical loading experienced during healing. Experimental studies have shown seemingly conflicting outcomes: although collagen content steadily increases with increasing loads, collagen alignment peaks at an intermediate load. Herein, we explored potential collagen remodeling mechanisms that could give rise to this structural divergence in response to strain. We adapted an established agent-based model of collagen remodeling in order to simulate various strain-dependent cell and collagen interactions that govern long-term collagen content and fiber alignment. Our simulation results show two collagen remodeling mechanisms that give rise to divergent collagen content and alignment in healing tendons: (1) strain-induced collagen fiber damage in concert with increased rates of deposition at higher strains, or (2) strain-dependent rates of enzymatic degradation. These model predictions identify critical future experiments needed to isolate each mechanism's specific contribution to the structure of healing tendons.
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Affiliation(s)
- William J Richardson
- Department of Bioengineering, Clemson University, Clemson, SC, USA
- Institute for Biological Interfaces of Engineering, Clemson University, Clemson, SC, USA
| | - Brian Kegerreis
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Jeffrey W Holmes
- Department of Biomedical Engineering, University of Virginia, Box 800759, Charlottesville, VA, 22908, USA.
- Department of Medicine, University of Virginia, Charlottesville, VA, USA.
- Robert M. Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA.
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86
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Locke RC, Peloquin JM, Lemmon EA, Szostek A, Elliott DM, Killian ML. Strain Distribution of Intact Rat Rotator Cuff Tendon-to-Bone Attachments and Attachments With Defects. J Biomech Eng 2018; 139:2657103. [PMID: 28979985 DOI: 10.1115/1.4038111] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Indexed: 12/28/2022]
Abstract
This study aimed to experimentally track the tissue-scale strains of the tendon-bone attachment with and without a localized defect. We hypothesized that attachments with a localized defect would develop strain concentrations and would be weaker than intact attachments. Uniaxial tensile tests and digital image correlation were performed on rat infraspinatus tendon-to-bone attachments with defects (defect group) and without defects (intact group). Biomechanical properties were calculated, and tissue-scale strain distributions were quantified for superior and inferior fibrous and calcified regions. At the macroscale, the defect group exhibited reduced stiffness (31.3±3.7 N/mm), reduced ultimate load (24.7±3.8 N), and reduced area under the curve at ultimate stress (3.7±1.5 J/m2) compared to intact attachments (42.4±4.3 N/mm, 39.3±3.7 N, and 5.6±1.4 J/m2, respectively). Transverse strain increased with increasing axial load in the fibrous region of the defect group but did not change for the intact group. Shear strain of the superior fibrous region was significantly higher in the defect group compared to intact group near yield load. This work experimentally identified that attachments may resist failure by distributing strain across the interface and that strain concentrations develop near attachment defects. By establishing the tissue-scale deformation patterns of the attachment, we gained insight into the micromechanical behavior of this interfacial tissue and bolstered our understanding of the deformation mechanisms associated with its ability to resist failure.
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Affiliation(s)
- Ryan C Locke
- Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - John M Peloquin
- Department of Biomedical Engineering, University of Delaware, 161 Colburn Lab 150 Academy Street, Newark, DE 19716 e-mail:
| | - Elisabeth A Lemmon
- Departments of Animal and Food Sciences and Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - Adrianna Szostek
- Departments of Animal and Food Sciences and Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
| | - Dawn M Elliott
- Mem. ASME Department of Biomedical Engineering, University of Delaware, 161 Colburn Lab 150 Academy Street, Newark, DE 19716 e-mail:
| | - Megan L Killian
- Mem. ASME Department of Biomedical Engineering, University of Delaware, 5 Innovation Way, Newark, DE 19716 e-mail:
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87
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Rahman H, Currier E, Johnson M, Goding R, Johnson AW, Kersh ME. Primary and Secondary Consequences of Rotator Cuff Injury on Joint Stabilizing Tissues in the Shoulder. J Biomech Eng 2018; 139:2654666. [PMID: 28916837 DOI: 10.1115/1.4037917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 01/08/2023]
Abstract
Rotator cuff tears (RCTs) are one of the primary causes of shoulder pain and dysfunction in the upper extremity accounting over 4.5 million physician visits per year with 250,000 rotator cuff repairs being performed annually in the U.S. While the tear is often considered an injury to a specific tendon/tendons and consequently treated as such, there are secondary effects of RCTs that may have significant consequences for shoulder function. Specifically, RCTs have been shown to affect the joint cartilage, bone, the ligaments, as well as the remaining intact tendons of the shoulder joint. Injuries associated with the upper extremities account for the largest percent of workplace injuries. Unfortunately, the variable success rate related to RCTs motivates the need for a better understanding of the biomechanical consequences associated with the shoulder injuries. Understanding the timing of the injury and the secondary anatomic consequences that are likely to have occurred are also of great importance in treatment planning because the approach to the treatment algorithm is influenced by the functional and anatomic state of the rotator cuff and the shoulder complex in general. In this review, we summarized the contribution of RCTs to joint stability in terms of both primary (injured tendon) and secondary (remaining tissues) consequences including anatomic changes in the tissues surrounding the affected tendon/tendons. The mechanical basis of normal shoulder joint function depends on the balance between active muscle forces and passive stabilization from the joint surfaces, capsular ligaments, and labrum. Evaluating the role of all tissues working together as a system for maintaining joint stability during function is important to understand the effects of RCT, specifically in the working population, and may provide insight into root causes of shoulder injury.
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Affiliation(s)
- Hafizur Rahman
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801 e-mail:
| | - Eric Currier
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801 e-mail:
| | - Marshall Johnson
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332 e-mail:
| | - Rick Goding
- Department of Orthopaedic, Joint Preservation Institute of Iowa, West Des Moines, IA 50266 e-mail:
| | - Amy Wagoner Johnson
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801 e-mail:
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801 e-mail:
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88
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Camp CL, Klinger CE, Lazaro LE, Villa JC, van der List JP, Altchek DW, Lorich DG, Dines JS. Osseous Vascularity of the Medial Elbow After Ulnar Collateral Ligament Reconstruction: A Comparison of the Docking and Modified Jobe Techniques. Orthop J Sports Med 2018; 6:2325967118763153. [PMID: 29637083 PMCID: PMC5888827 DOI: 10.1177/2325967118763153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Although vascularity plays a critical role in healing after ulnar collateral ligament (UCL) reconstruction, intraosseous blood flow to the medial epicondyle (ME) and sublime tubercle remains undefined. Purpose To quantify vascular disruption caused by tunnel drilling with the modified Jobe and docking techniques for UCL reconstruction. Study Design Controlled laboratory study. Methods Eight matched pairs (16 specimens) of fresh-frozen cadaveric upper extremities were randomized to 1 of 2 study groups: docking technique or modified Jobe technique. One elbow in each pair underwent tunnel drilling by the assigned technique, while the contralateral elbow served as a control. Pregadolinium and postgadolinium magnetic resonance imaging were performed to quantify intraosseous vascularity within the ME, trochlea, and proximal ulna. Three-dimensional computed tomography (CT) and gross dissection were performed to assess terminal vessel integrity. Results Ulnar tunnel drilling had minimal impact on vascularity of the proximal ulna, with maintenance of >95% blood flow for each technique. Perfusion in the ME was reduced 14% (to 86% of baseline) for the docking technique and 60% (to 40% of baseline) for the modified Jobe technique (mean difference, 46%; P = .029). Three-dimensional CT and gross dissection revealed increased disruption of small perforating vessels of the posterior aspect of the ME for the modified Jobe technique. Conclusion Although tunnel drilling in the sublime tubercle appears to have a minimal effect on intraosseous vascularity of the proximal ulna, both the docking and modified Jobe techniques reduce flow in the ME. This reduction was 4 times greater for the modified Jobe technique, and these findings have important implications for UCL reconstruction surgery. Clinical Relevance As the rate of revision UCL reconstructions continues to rise, investigation into causes for failure of primary surgery is needed. One potential cause is poor tendon-to-bone healing due to inadequate vascularity. This study quantifies the amount of vascular insult that is incurred in the ME during UCL reconstruction. While vascular insult is only one of many factors that affects the surgical success rate, surgeons performing this procedure should be mindful of this potential for vascular disruption.
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Affiliation(s)
- Christopher L. Camp
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Christopher L. Camp, MD, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA () (Twitter: @ChrisCampMD)
| | - Craig E. Klinger
- Orthopedic Trauma Service, Hospital for Special Surgery, New York, New York, USA
| | - Lionel E. Lazaro
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Jordan C. Villa
- Orthopedic Trauma Service, Hospital for Special Surgery, New York, New York, USA
| | - Jelle P. van der List
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - David W. Altchek
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
| | - Dean G. Lorich
- Orthopedic Trauma Service, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S. Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA
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89
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Wang XM, Ji G, Wang XM, Kang HJ, Wang F. Biological and Biomechanical Evaluation of Autologous Tendon Combined with Ligament Advanced Reinforcement System Artificial Ligament in a Rabbit Model of Anterior Cruciate Ligament Reconstruction. Orthop Surg 2018; 10:144-151. [PMID: 29624874 DOI: 10.1111/os.12370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 01/14/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To compare the biomechanical and histological changes in a rabbit model after reconstructing the anterior cruciate ligament (ACL) with solely autologous tendon and with autologous tendon combined with the ligament advanced reinforcement system (LARS) artificial ligament. METHODS Anterior cruciate ligament reconstruction was performed in 72 knees from 36 healthy New Zealand white rabbits (bodyweight, 2500-3000 g). The Achilles tendons were harvested bilaterally. The left ACL were reconstructed solely with autografts (autologous tendon group), while the right ACL were reconstructed with autografts combined with LARS ligaments (combined ligaments group). The gross observation, histological determination, and the tension failure loads in both groups were evaluated at 12 weeks (n = 18) and 24 weeks (n = 18) postoperatively. RESULTS Gross examination of the knee joints showed that all combined ligaments were obviously covered by a connective tissue layer at 12 weeks, and were completely covered at 24 weeks. Fibrous tissue ingrowth was observed between fascicles and individual fibers in the bone-artificial ligament interface at both time points; this fibrovascular tissue layer localized at the bone-artificial ligament interface tended to be denser in specimens obtained at 24 weeks compared with those obtained at 12 weeks. The tension failure loads of the knees were similar in the autologous tendon group and the combined ligaments group at 12 weeks (144.15 ± 3.92 N vs. 140.88 ± 2.75 N; P > 0.05), and at 24 weeks (184.15 ± 1.96 N vs. 180.88 ± 3.21 N; P > 0.05). CONCLUSION Reconstructing the ACL in rabbits using autologous tendon combined with the LARS artificial ligament results in satisfactory biointegration, with no obvious immunological rejection between the autologous tendon and the artificial ligament, and is, therefore, a promising ACL reconstruction method.
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Affiliation(s)
- Xin-Min Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiao-Meng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hui-Jun Kang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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90
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Lipman K, Wang C, Ting K, Soo C, Zheng Z. Tendinopathy: injury, repair, and current exploration. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:591-603. [PMID: 29593382 PMCID: PMC5865563 DOI: 10.2147/dddt.s154660] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Both acute and chronic tendinopathy result in high morbidity, requiring management that is often lengthy and expensive. However, limited and conflicting scientific evidence surrounding current management options has presented a challenge when trying to identify the best treatment for tendinopathy. As a result of shortcomings of current treatments, response to available therapies is often poor, resulting in frustration in both patients and physicians. Due to a lack of understanding of basic tendon-cell biology, further scientific investigation is needed in the field for the development of biological solutions. Optimization of new delivery systems and therapies that spatially and temporally mimic normal tendon physiology hold promise for clinical application. This review focuses on the clinical importance of tendinopathy, the structure of healthy tendons, tendon injury, and healing, and a discussion of current approaches for treatment that highlight the need for the development of new nonsurgical interventions.
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Affiliation(s)
| | - Chenchao Wang
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, University of California, Los Angeles, CA, USA.,First Hospital of China Medical University, Shenyang, China.,Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, University of California, Los Angeles, CA, USA
| | - Kang Ting
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Chia Soo
- Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Orthopaedic Hospital Research Center, University of California, Los Angeles, CA, USA
| | - Zhong Zheng
- Division of Growth and Development, Section of Orthodontics, School of Dentistry, University of California, Los Angeles, CA, USA
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91
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Abstract
PURPOSE OF REVIEW With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. RECENT FINDINGS Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue. Recent electromyography studies have identified exercises which elicit highest level of muscle activation for individual dynamic stabilizers. The physical therapist should also be aware of potential complications and be prepared to manage appropriately if they should arise. During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendon-to-bone healing. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. Advanced strengthening is initiated when all preceding criteria have been met. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames.
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Affiliation(s)
- Terrance A Sgroi
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA.
| | - Michelle Cilenti
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA
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92
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Ma R, Schär M, Chen T, Sisto M, Nguyen J, Voigt C, Deng XH, Rodeo SA. Effect of Dynamic Changes in Anterior Cruciate Ligament In Situ Graft Force on the Biological Healing Response of the Graft-Tunnel Interface. Am J Sports Med 2018; 46:915-923. [PMID: 29298079 DOI: 10.1177/0363546517745624] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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) grafts that are placed for reconstruction are subject to complex forces. Current "anatomic" ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood. PURPOSE The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel. STUDY DESIGN Controlled laboratory study. METHODS Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro-computed tomography, and histological analyses. RESULTS ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [ P = .013] and 10.90 ± 2.8 N [ P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks. CONCLUSION The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration. CLINICAL RELEVANCE Current "anatomic" techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction.
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Affiliation(s)
- Richard Ma
- Missouri Orthopaedic Institute, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Michael Schär
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
| | - Tina Chen
- Missouri Orthopaedic Institute, Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, USA
| | - Marco Sisto
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
| | - Joseph Nguyen
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
| | - Clifford Voigt
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
| | - Xiang-Hua Deng
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service, Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, New York, USA
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93
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Madhurakkat Perikamana SK, Lee J, Ahmad T, Kim EM, Byun H, Lee S, Shin H. Harnessing biochemical and structural cues for tenogenic differentiation of adipose derived stem cells (ADSCs) and development of an in vitro tissue interface mimicking tendon-bone insertion graft. Biomaterials 2018. [PMID: 29522987 DOI: 10.1016/j.biomaterials.2018.02.046] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Tendon-bone interface tissue is extremely challenging to engineer because it exhibits complex gradients of structure, composition, biologics, and cellular phenotypes. As a step toward engineering these transitional zones, we initially analyzed how different (topographical or biological) cues affect tenogenic differentiation of adipose-derived stem cells (ADSCs). We immobilized platelet-derived growth factor - BB (PDGF-BB) using polydopamine (PD) chemistry on random and aligned nanofibers and investigated ADSC proliferation and tenogenic differentiation. Immobilized PDGF greatly enhanced the proliferation and tenogenic differentiation of ADSCs; however, nanofiber alignment had no effect. Interestingly, the PDGF immobilized aligned nanofiber group showed a synergistic effect with maximum expression of tenogenic markers for 14 days. We also generated a nanofiber surface with spatially controlled presentation of immobilized PDGF on an aligned architecture, mimicking native tendon tissue. A gradient of immobilized PDGF was able to control the phenotypic differentiation of ADSCs into tenocytes in a spatially controlled manner, as confirmed by analysis of the expression of tenogenic markers and immunofluorescence staining. We further explored the gradient formation strategy by generation of a symmetrical gradient on the nanofiber surface for the generation of a structure mimicking bone-patellar-tendon-bone with provision for gradient immobilization of PDGF and controlled mineralization. Our study reveals that, together with biochemical cues, favorable topographical cues are important for tenogenic differentiation of ADSCs, and gradient presentation of PDGF can be used as a tool for engineering stem cell-based bone-tendon interface tissues.
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Affiliation(s)
- Sajeesh Kumar Madhurakkat Perikamana
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Jinkyu Lee
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Taufiq Ahmad
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Eun Mi Kim
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Hayeon Byun
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Sangmin Lee
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Heungsoo Shin
- Department of Bioengineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; BK21 Plus Future Biopharmaceutical Human Resources Training and Research Team, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
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94
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Rehabilitation following rotator cuff repair: A work of the Commission Rehabilitation of the German Society of Shoulder and Elbow Surgery e. V. (DVSE) in collaboration with the German Association for Physiotherapy (ZVK) e. V., the Association Physical Therapy, Association for Physical Professions (VPT) e. V. and the Section Rehabilitation-Physical Therapy of the German Society for Orthopaedics and Trauma e. V. (DGOU). ACTA ACUST UNITED AC 2018. [PMID: 29527239 PMCID: PMC5834570 DOI: 10.1007/s11678-018-0448-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. Objectives To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e. V. (DVSE) shoulder experts. Materials and methods A literature search for the years 2004-2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane CentralRegister of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via online questionnaire. Results A total of 17 studies, four reviews and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.
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95
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Abstract
Management of failed rotator cuff repair may be difficult, especially in young patients. Various nonmodifiable and modifiable patient factors, including age, tendon quality, rotator cuff tear characteristics, acute or chronic rotator cuff tear, bone quality, tobacco use, and medications, affect rotator cuff repair healing. Surgical variables, such as the technique, timing, tension on the repair, the biomechanical construct, and fixation, as well as the postoperative rehabilitation strategy also affect rotator cuff repair healing. Variable outcomes have been reported in patients who undergo revision rotator cuff repair; however, a systematic surgical approach may increase the likelihood of a successful outcome. Numerous cellular and mechanical biologic augments, including platelet-rich plasma, platelet-rich fibrin matrix, mesenchymal stem cells, and acellular dermal matrix grafts, have been used in rotator cuff repair; however, conflicting or inconclusive outcomes have been reported in patients who undergo revision rotator cuff repair with the use of these augments. A variety of tendon transfer options, including latissimus dorsi, teres major, lower trapezius, pectoralis minor, pectoralis major, combined pectoralis major and latissimus dorsi, and combined latissimus dorsi and teres major, are available for the management of massive irreparable rotator cuff tears. Ultimately, the optimization of surgical techniques and the use of appropriate biologic/tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair.
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96
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Kim JH, Oh SH, Min HK, Lee JH. Dual growth factor-immobilized asymmetrically porous membrane for bone-to-tendon interface regeneration on rat patellar tendon avulsion model. J Biomed Mater Res A 2017; 106:115-125. [PMID: 28880464 DOI: 10.1002/jbm.a.36212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 12/17/2022]
Abstract
Insufficient repair of the bone-to-tendon interface (BTI) with structural/compositional gradients has been a significant challenge in orthopedics. In this study, dual growth factor (platelet-derived growth factor-BB [PDGF-BB] and bone morphogenetic protein-2 [BMP-2])-immobilized polycaprolactone (PCL)/Pluronic F127 asymmetrically porous membrane was fabricated to estimate its feasibility as a potential strategy for effective regeneration of BTI injury. The growth factors immobilized (via heparin-intermediated interactions) on the membrane were continuously released for up to ∼80% of the initial loading amount after 5 weeks without a significant initial burst. From the in vivo animal study using a rat patellar tendon avulsion model, it was observed that the PDGF-BB/BMP-2-immobilized membrane accelerates the regeneration of the BTI injury, probably because of the continuous release of both growth factors (biological stimuli) and their complementary effect to create a multiphasic structure (bone, fibrocartilage, and tendon) like a native structure, as well as the role of the asymmetrically porous membrane as a physical barrier (nanopore side; prevention of fibrous tissue invasion into the defect site) and scaffold (micropore side; guidance for tissue regeneration). © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 115-125, 2018.
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Affiliation(s)
- Joong-Hyun Kim
- Department of Nanobiomedical Science, Dankook University, 119 Dandae Ro, Dongnam Gu, Cheonan, 31116, Republic of Korea.,Department of Periodontology, School of Dentistry and Institute of Oral Bioscience, Chonbuk National University, 567 Baekjedae Ro, Deokjin Gu, Jeonju, 54896, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science, Dankook University, 119 Dandae Ro, Dongnam Gu, Cheonan, 31116, Republic of Korea.,Department of Pharmaceutical Engineering, Dankook University, 119 Dandae Ro, Dongnam Gu, Cheonan, 31116, Republic of Korea
| | - Hyun Ki Min
- Department of Advanced Materials and Chemical Engineering, Hannam University, 1646 Yuseong Daero, Yuseong Gu, Daejeon, 34054, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials and Chemical Engineering, Hannam University, 1646 Yuseong Daero, Yuseong Gu, Daejeon, 34054, Republic of Korea
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97
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Takahashi H, Tamaki H, Oyama M, Yamamoto N, Onishi H. Time-Dependent Changes in the Structure of Calcified Fibrocartilage in the Rat Achilles Tendon-Bone Interface With Sciatic Denervation. Anat Rec (Hoboken) 2017; 300:2166-2174. [PMID: 28902469 DOI: 10.1002/ar.23684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 12/18/2022]
Abstract
The enthesis transmits a physiological load from soft to hard tissue via fibrocartilage. The histological alterations induced by this physiological loading remain unclear. This study was performed to examine the histomorphological alterations in the collagen fiber bundle alignment and depth of collagen interdigitation between the calcified fibrocartilage and the bone. We examined the Achilles enthesis of rats with sciatic denervation to explore the mechanical effects of structural changes in the enthesis. The parallelism of the collagen fiber bundles was significantly reduced 8 weeks after denervation. However, the depth of collagen interdigitation significantly increased at 2 and 4 weeks after denervation and then significantly decreased 8 weeks after denervation. In conclusion, a lack of muscle loading induced structural alterations in the distal calcified fibrocartilage. These findings suggest that while structural changes in the enthesis are necessary for the development of physiological loading, structural deformities are required in the long term. Anat Rec, 300:2166-2174, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Hideaki Takahashi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hiroyuki Tamaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Mineo Oyama
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Noriaki Yamamoto
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Orthopedic Surgery, Niigata Rehabilitation Hospital, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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98
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Boys AJ, McCorry MC, Rodeo S, Bonassar LJ, Estroff LA. Next Generation Tissue Engineering of Orthopedic Soft Tissue-to-Bone Interfaces. MRS COMMUNICATIONS 2017; 7:289-308. [PMID: 29333332 PMCID: PMC5761353 DOI: 10.1557/mrc.2017.91] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/28/2017] [Indexed: 05/17/2023]
Abstract
Soft tissue-to-bone interfaces are complex structures that consist of gradients of extracellular matrix materials, cell phenotypes, and biochemical signals. These interfaces, called entheses for ligaments, tendons, and the meniscus, are crucial to joint function, transferring mechanical loads and stabilizing orthopedic joints. When injuries occur to connected soft tissue, the enthesis must be re-established to restore function, but due to structural complexity, repair has proven challenging. Tissue engineering offers a promising solution for regenerating these tissues. This prospective review discusses methodologies for tissue engineering the enthesis, outlined in three key design inputs: materials processing methods, cellular contributions, and biochemical factors.
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Affiliation(s)
- Alexander J Boys
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
| | | | - Scott Rodeo
- Orthopedic Surgery, Hospital for Special Surgery, New York, NY
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY
- Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, NY
- Orthopedic Surgery, Weill Medical College of Cornell University, Cornell University, New York, NY
- New York Giants, East Rutherford, NJ
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Lawrence J Bonassar
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY
- Kavli Institute at Cornell, Cornell University, Ithaca, NY
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99
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Chandrasekaran S, Pankow M, Peters K, Huang HS. Composition and structure of porcine digital flexor tendon‐bone insertion tissues. J Biomed Mater Res A 2017; 105:3050-3058. [DOI: 10.1002/jbm.a.36162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/19/2017] [Accepted: 07/26/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Sandhya Chandrasekaran
- Department of Mechanical and Aerospace EngineeringNorth Carolina State University, R3158 Engineering Building 3, Campus Box 7910, 911 Oval DriveRaleigh North Carolina27695 USA
| | - Mark Pankow
- Department of Mechanical and Aerospace EngineeringNorth Carolina State University, R3158 Engineering Building 3, Campus Box 7910, 911 Oval DriveRaleigh North Carolina27695 USA
| | - Kara Peters
- Department of Mechanical and Aerospace EngineeringNorth Carolina State University, R3158 Engineering Building 3, Campus Box 7910, 911 Oval DriveRaleigh North Carolina27695 USA
| | - Hsiao‐Ying Shadow Huang
- Department of Mechanical and Aerospace EngineeringNorth Carolina State University, R3158 Engineering Building 3, Campus Box 7910, 911 Oval DriveRaleigh North Carolina27695 USA
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100
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Camp CL, Lebaschi A, Cong GT, Album Z, Carballo C, Deng XH, Rodeo SA. Timing of Postoperative Mechanical Loading Affects Healing Following Anterior Cruciate Ligament Reconstruction: Analysis in a Murine Model. J Bone Joint Surg Am 2017; 99:1382-1391. [PMID: 28816898 DOI: 10.2106/jbjs.17.00133] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Following anterior cruciate ligament (ACL) reconstruction, the mechanical loading of the tissues has a significant impact on tendon-to-bone healing. The purpose of this study was to determine the effect of the timing of the initiation of mechanical loading on healing of a tendon graft in a bone tunnel. METHODS ACL reconstruction using a flexor tendon autograft was performed in 56 mice randomized to 4 groups with differing times to initiation of postoperative mechanical loading: (1) immediate, (2) 5 days, (3) 10 days, or (4) 21 days following surgery. An external fixator was placed across the knee at the time of surgery and removed when mechanical loading was scheduled to commence. Following removal of the external fixator, animals were permitted free, unrestricted cage activity. All mice were killed on postoperative day 28, and tendon-to-bone healing was assessed by biomechanical testing, microcomputed tomography (micro-CT), and histological analysis. RESULTS The mean failure force (and standard deviation) of the reconstructed ACL at the time of sacrifice was highest for Group 2 (3.29 ± 0.68 N) compared with Groups 1, 3, and 4 (p = 0.008). Micro-CT bone volume fraction was greatest for Group 2 in the femoral tunnel (p = 0.001), tibial tunnel (p = 0.063), and both bones (p < 0.001). Similarly, histological analysis demonstrated a narrower scar tissue interface and increased direct contact at the tendon-bone interface (p = 0.012) for Group 2. CONCLUSIONS Following ACL reconstruction, a defined period of immobilization without weight-bearing appears to improve biomechanical strength of the healing tendon-bone interface, while prolonged periods without mechanical load and motion decrease the ultimate load to failure in this murine model. CLINICAL RELEVANCE The ideal period of restricted weight-bearing and motion following ACL reconstruction remains undefined. In a murine model, improved healing was noted for animals immobilized for a brief period of 5 days. This work may serve as an initial step in determining the ideal time period in a clinical population.
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Affiliation(s)
- Christopher L Camp
- 1Mayo Clinic, Rochester, Minnesota 2Tissue Engineering, Regeneration, and Repair Program, Hospital for Special Surgery, New York, NY
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