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Moreira A, Benjamin Ravetti L, Carrapeiro Prina D, Paschoal Nogueira M. Anterior tibial tendon transfer in idiopathic clubfoot: pull-out vs. other fixations - a systematic review. BMC Musculoskelet Disord 2024; 25:638. [PMID: 39134994 PMCID: PMC11318294 DOI: 10.1186/s12891-024-07621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/23/2024] [Indexed: 08/16/2024] Open
Abstract
PURPOSE Review the literature and describe the complications associated with each of the anterior tibial tendon transfer (ATTT) techniques described. METHODS A systematic review of the literature was performed with the keywords ''clubfoot'', ''Ponseti'' and ''anterior tibial''. Studies in patients with clubfoot recurrence, who underwent ATTT, whose method of tendon fixation was different from the classical method, were included. RESULTS Six studies were included in this systematic review, which described multiple techniques for tibialis anterior fixation: bone anchors, interference screws, endobotton, K-wires, transosseous suture, and suture to the plantar fascia. In the papers that described postoperative complications, no major complications were reported, however the samples are generally small. CONCLUSION Several options have now emerged for tendon fixation in tendon transfers around the foot and ankle, including ATTT for treatment of relapsed clubfoot. To our knowledge this is the first paper that questioned the potential complications associated with the use of these new techniques. Due to the scarcity of published works in favor of other fixation methods, we believe that the traditional method is the optimal one for the transfer of the tendon of the tibialis anterior muscle.
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Affiliation(s)
- Andreia Moreira
- Hospital Pedro Hispano, ULS Matosinhos, Portugal, Matosinhos, Portugal
| | | | | | - Monica Paschoal Nogueira
- Hospital do Servidor Publico Estadual de São Paulo, Sao Paulo, SP, Brazil.
- Núcleo de Apoio à Pesquisa Ortopédica Avançada (NAPOA), Sao Paulo, SP, Brazil.
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2
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Shi BY, Sriram V, Wu SY, Huang D, Cheney A, Metzger MF, Sundberg O, Lyons KM, McKenna CE, Nishimura I, Kremen TJ. Novel bisphosphonate-based cathepsin K-triggered compound targets the enthesis without impairing soft tissue-to-bone healing. Front Bioeng Biotechnol 2024; 12:1308161. [PMID: 38433822 PMCID: PMC10905384 DOI: 10.3389/fbioe.2024.1308161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Background: Osteoadsorptive fluorogenic sentinel 3 (OFS-3) is a recently described compound that contains a bone-targeting bisphosphonate (BP) and cathepsin K (Ctsk)-triggered fluorescence signal. A prior study in a murine Achilles repair model demonstrated its effectiveness at targeting the site of tendon-to-bone repair, but the intrinsic effect of this novel bisphosphonate chaperone on tendon-to-bone healing has not been previously explored. We hypothesized that application of this bisphosphonate-fluorophore cargo conjugate would not affect the biomechanical properties or histologic appearance of tendon-bone repairs. Materials and Methods: Right hindlimb Achilles tendon-to-bone repair was performed on 12-week old male mice. Animals were divided into 2 groups of 18 each: 1) Achilles repair with OFS-3 applied directly to the repair site prior to closure, and 2) Achilles repair with saline applied prior to closure. Repaired hindlimbs from 12 animals per group were harvested at 6 weeks for biomechanical analysis with a custom 3D-printed jig. At 4 and 6 weeks, repaired hindlimbs from the remaining animals were assessed histologically using H&E, immunohistochemistry (IHC) staining for the presence of Ctsk, and second harmonic generation (SHG) imaging to evaluate collagen fibers. Results: At 6 weeks, there was no significant difference in failure load, stiffness, toughness, or displacement to failure between repaired hindlimbs that received OFS-3 versus saline. There was no difference in tissue healing on H&E or Ctsk staining on immunohistochemistry between animals that received OFS-3 versus saline. Finally, second harmonic generation imaging demonstrated no difference in collagen fiber parameters between the two groups. Conclusion: OFS-3 did not significantly affect the biomechanical properties or histologic appearance of murine Achilles tendon-to-bone repairs. This study demonstrates that OFS-3 can target the site of tendon-to-bone repair without causing intrinsic negative effects on healing. Further development of this drug delivery platform to target growth factors to the site of tendon-bone repair is warranted.
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Affiliation(s)
- Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Varun Sriram
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Shannon Y. Wu
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Dave Huang
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Alexis Cheney
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
| | - Melodie F. Metzger
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Oskar Sundberg
- Department of Chemistry, University of Southern California, Los Angeles, CA, United States
| | - Karen M. Lyons
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
- Department of Molecular, Cellular, and Developmental Biology, University of California at Los Angeles, Los Angeles, CA, United States
| | - Charles E. McKenna
- Department of Chemistry, University of Southern California, Los Angeles, CA, United States
| | - Ichiro Nishimura
- Weintraub Center for Reconstructive Biotechnology, School of Dentistry, University of California at Los Angeles, Los Angeles, CA, United States
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, United States
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3
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Abdel-Mordy Kandeel A. Intra-articular soft arthroscopic Latarjet technique as a Bankart-plus procedure for type V superior labrum anterior-posterior lesion: lower rate of instability recurrence and better functional outcomes of a prospective cohort study. J Shoulder Elbow Surg 2023; 32:1838-1849. [PMID: 36907315 DOI: 10.1016/j.jse.2023.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Intra-articular soft arthroscopic Latarjet technique (in-SALT) involves augmentation of arthroscopic Bankart repair (ABR) with soft tissue tenodesis of long head of biceps to upper subscapularis. This study was conducted to investigate superiority of outcomes of in-SALT-augmented ABR over those of concurrent ABR and anterosuperior labral repair (ASL-R) in management of type V superior labrum anterior-posterior (SLAP) lesion. METHODS This prospective cohort study (conducted between January 2015 and January 2022) included 53 patients with arthroscopic diagnosis of type V SLAP lesion. Patients were allocated into 2 consecutive groups: group A of 19 patients managed with concurrent ABR/ASL-R and group B of 34 patients managed with in-SALT-augmented ABR. Outcome measurements included 2-year postoperative pain, range of motion, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Rowe instability scores. Failure was defined as frank/subtle postoperative recurrence of glenohumeral instability or objective diagnosis of Popeye deformity. RESULTS The statistically matched studied groups showed significant postoperative improvement in outcome measurements. However, group B demonstrated significantly better 3-month postoperative visual analog scale score (3.6 vs. 2.6, P = .006) and 24-month postoperative external rotation at 0° abduction (44° vs. 50°, P = .020) and ASES (84 vs. 92, P < .001) and Rowe (83 vs. 88, P = .032) scores. Rate of postoperative recurrence of glenohumeral instability was relatively lower in group B (10.5% vs. 2.9%, P = .290). No Popeye deformity was reported. CONCLUSION For management of type V SLAP lesion, in-SALT-augmented ABR yielded a relatively lower rate of postoperative recurrence of glenohumeral instability and significantly better functional outcomes compared with concurrent ABR/ASL-R. However, currently reported favorable outcomes of in-SALT should be validated via further biomechanical and clinical studies.
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Bain GI, Amarasooriya M. Scapholunate instability: why are the surgical outcomes still so far from ideal? J Hand Surg Eur Vol 2023; 48:257-268. [PMID: 36799288 DOI: 10.1177/17531934221148009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The wrist is a universal joint with intrinsic and extrinsic ligaments that function and fail as ligamentous complexes. Those related to scapholunate instability (SLI) include the dorsal scapholunate complex (DSLC), volar radiolunate complex and scaphotrapeziotrapezoid complex. Together the DSLC, scaphoid and lunate create an 'acetabulum' for the capitate, with the dorsal intercarpal ligament being a labrum to contain the capitate. SLI results from failure of the DSLC, typically from its scaphoid attachments. Failure of the lunate and or triquetral attachments increases the instability. DSLC failure leads to radioscaphoid instability, which is the symptomatic clinical problem. SLI reconstruction with open surgery and trans-osseous tendon graft techniques have been challenging. We discuss a biological arthroscopic approach to identify, mobilize and debride the disrupted DSLC. This ligament/capsular/periosteum sheet is then advanced and secured to the debrided footprint. Thereby reconstituting the acetabulum, labrum and scaphoid stability.
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Affiliation(s)
- Gregory I Bain
- Department of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia.,Flinders University, Adelaide, South Australia, Australia
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5
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Su T, Zhu YC, Du MZ, Jiang YF, Guo QW, Hu YL, Jiao C, Jiang D. Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:4181-4188. [PMID: 35674772 DOI: 10.1007/s00167-022-07011-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques. METHODS From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson-Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups. RESULTS All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group. CONCLUSIONS Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Ming-Ze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
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6
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Wu Y, Shao Y, Xie D, Pan J, Chen H, Yao J, Liang J, Ke H, Cai D, Zeng C. Effect of secretory leucocyte protease inhibitor on early tendon-to-bone healing after anterior cruciate ligament reconstruction in a rat model. Bone Joint Res 2022; 11:503-512. [PMID: 35866455 PMCID: PMC9350708 DOI: 10.1302/2046-3758.117.bjr-2021-0358.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS To verify whether secretory leucocyte protease inhibitor (SLPI) can promote early tendon-to-bone healing after anterior cruciate ligament (ACL) reconstruction. METHODS In vitro: the mobility of the rat bone mesenchymal stem cells (BMSCs) treated with SLPI was evaluated by scratch assay. Then the expression levels of osteogenic differentiation-related genes were analyzed by real-time quantitative PCR (qPCR) to determine the osteogenic effect of SLPI on BMSCs. In vivo: a rat model of ACL reconstruction was used to verify the effect of SLPI on tendon-to-bone healing. All the animals of the SLPI group and the negative control (NC) group were euthanized for histological evaluation, micro-CT scanning, and biomechanical testing. RESULTS SLPI improved the migration ability of BMSCs and upregulated the expression of genes related to osteogenic differentiation of BMSCs in vitro. In vivo, the SLPI group had higher histological scores at the tendon-bone interface by histological evaluation. Micro-CT showed more new bone formation and bone ingrowth around the grafted tendon in the SLPI group. Evaluation of the healing strength of the tendon-bone connection showed that the SLPI group had a higher maximum failure force and stiffness. CONCLUSION SLPI can effectively promote early tendon-to-bone healing after ACL reconstruction via enhancing the migration and osteogenic differentiation of BMSCs. Cite this article: Bone Joint Res 2022;11(7):503-512.
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Affiliation(s)
- Yongmao Wu
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China.,Department of Orthopedics, Fourth Affiliated Hospital of Guangxi Medical University/ Liuzhou Workers' Hospital, Liuzhou, China
| | - Yan Shao
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China
| | - Denghui Xie
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China
| | - Jianying Pan
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China
| | - Huabin Chen
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Juncheng Yao
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jiarong Liang
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haolin Ke
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Daozhang Cai
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China
| | - Chun Zeng
- Department of Orthopedics, Orthopedic Hospital of Guangdong Province, Academy of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.,The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Joint Degeneration Diseases, Guangzhou, China
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7
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Beamon WL, Duffy DJ, Chang YJ, Moore GE. Effect of calcanean bone-tunnel orientation for teno-osseous repair in a canine common calcanean tendon avulsion model. Vet Surg 2022; 51:688-696. [PMID: 35277992 PMCID: PMC9314852 DOI: 10.1111/vsu.13796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/13/2022] [Accepted: 02/13/2022] [Indexed: 11/27/2022]
Abstract
Objective To determine the influence of bone‐tunnel anchoring technique on teno‐osseous repair of the common calcanean tendon (CCT) in dogs. Study design Randomized, ex vivo, biomechanical. Population Forty‐two skeletally mature canine hindlimbs. Methods Canine hindlimbs were dissected to produce a model simulating avulsion of the CCT and accessory tendons from the calcaneus. Hindlimbs were randomized to 1 of 3 anchoring techniques (n = 14/group): a single transverse tunnel (TT), vertical tunnels (VT), or modified bone tunnels (MT) for teno‐osseous repair in a 3‐loop‐pulley (3LP) pattern using 0 USP polypropylene. Yield, peak and failure loads, construct stiffness, loads to produce a 3 mm teno‐osseous gap, and failure modes were compared between groups. Results The only difference detected consisted of TT constructs yielding at loads 25% higher than MT constructs (P = .027). Conclusion Although yield loads were lower in MT constructs than other groups, the bone‐tunnel anchoring techniques tested here did not appear to influence the biomechanical properties or gapping characteristics of teno‐osseous repairs in this canine CCT avulsion model. Clinical significance All drilling techniques and bone‐tunnel orientations tested in the study reported here offer viable options to reattach the CCT to the calcaneus. Surgeons should evaluate how bone‐tunnel orientation may affect placement of adjunctive fixation methods to stabilize the talocrural joint after primary CCT repair in dogs.
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Affiliation(s)
- Weston L Beamon
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - George E Moore
- Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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8
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Peng Y, Wu W, Li X, Shangguan H, Diao L, Ma H, Wang G, Jia S, Zheng C. Effects of leukocyte-rich platelet-rich plasma and leukocyte-poor platelet-rich plasma on the healing of bone-tendon interface of rotator cuff in a mice model. Platelets 2022; 33:1075-1082. [PMID: 35257633 DOI: 10.1080/09537104.2022.2044462] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Platelet-rich plasma (PRP) is widely used clinically to treat tendon injuries, and often contains leukocytes. However, the debate regarding the concentration of leukocytes in PRP is still ongoing. This study aimed to evaluate the therapeutic effects of leukocyte-rich platelet-rich plasma (LR-PRP) and leukocyte-poor platelet-rich plasma (LP-PRP) on the healing of the bone-tendon interface (BTI) of the rotator cuff. A total of 102 C57BL/6 mice were used. Thirty mice were used to prepare the PRP, while 72 underwent acute supraspinatus tendon injury repair. The animals were then randomly assigned to three groups: LR-PRP, LP-PRP and control groups. The mice were euthanized at 4 and 8 weeks postoperatively, and histological, immunological and biomechanical analyses were performed. The histological results showed that the fusion effect at the bone-tendon interface at 4 and 8 weeks after surgery was greater in the PRP groups and significantly increased at 4 weeks; however, at 8 weeks, the area of the fibrocartilage layer in the LP-PRP group increased significantly. M2 macrophages were observed at the repaired insertion for all the groups at 4 weeks. At 8 weeks, M2 macrophages withdrew back to the tendon in the control group, but some M2 macrophages were retained at the repaired site in the LR-PRP and LP-PRP groups. Enzyme-linked immunoassay results showed that the concentrations of IL-1β and TNF-α in the LR-PRP group were significantly higher than those in the other groups at 4 and 8 weeks, while the concentrations of IL-1β and TNF-α in the LP-PRP group were significantly lower than those in the control group. The biomechanical properties of the BTI were significantly improved in the PRP group. Significantly higher failure load and ultimate strength were seen in the LR-PRP and LP-PRP groups than in the control group at 4 and 8 weeks postoperatively. Thus, LR-RPR can effectively enhance the early stage of bone-tendon interface healing after rotator cuff repair, and LP-PRP could enhance the later stages of healing after rotator cuff injury.
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Affiliation(s)
- Yundong Peng
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Wenxia Wu
- College of Health Science, Wuhan Sports University, Wuhan, China.,Department of Rehabilitation Therapy, Jinci College of Shanxi Medical University, Jinzhong, China
| | - Xiaomei Li
- College of Health Science, Wuhan Sports University, Wuhan, China.,Medical College, Huainan Union University, Anhui, China
| | - Hengyi Shangguan
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Luyu Diao
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Haozhe Ma
- College of International Education, Wuhan Sports University, Wuhan, China
| | - Guanglan Wang
- College of Health Science, Wuhan Sports University, Wuhan, China
| | - Shaohui Jia
- College of Health Science, Hubei Provincial Collaborative Innovation Center for Exercise and Health Promotion, Wuhan Sports University, Wuhan, China
| | - Cheng Zheng
- Department of Sports Medicine, Affiliated Hospital, Wuhan Sports University, Wuhan, China
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9
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Abdel-Mordy Kandeel A. Extra-articular Soft Arthroscopic Latarjet Technique: More Versatility and Closer Reproducibility of Classic Latarjet Procedure than Its Intra-articular Counterpart. Arthrosc Tech 2021; 10:e2061-e2072. [PMID: 34504744 PMCID: PMC8417134 DOI: 10.1016/j.eats.2021.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/13/2021] [Indexed: 02/03/2023] Open
Abstract
The recent innovative concept of dynamic anterior stabilization of the shoulder by long head of biceps tendon for anterior gleno-humeral instability management has gained growing popularity among shoulder surgeons. Different techniques using this concept have been reported. Nevertheless, these techniques share common steps of tenotomy, re-routing, trans-subscapularis transfer and bony glenoid fixation of long head of biceps. Lately, a simplified procedure of intra-articular soft arthroscopic Latarjet technique has been introduced to refer to soft tissue tenodesis of long head of biceps to subscapularis tendon by 2 simple stitches of nonabsorbable sutures following Bankart repair. For more technical simplicity and closer reproducibility of gleno-humeral restabilization mechanisms of Latarjet procedure; the current Technical Note describes the extra-articular soft arthroscopic Latarjet technique, whereby long head of biceps is retrieved to the subpectoral region following intra-articular tenotomy; whip-stitched; rerouted deep to pectoralis major; and passed within subscapularis window into the gleno-humeral joint, where it is sutured over itself around upper subscapularis tendon. The currently reported technique offers potential advantages of versatility, steep learning curve, low cost (no hardware), feasibility of concurrent gleno-humeral restabilization procedures, and technical easiness of revision management; however; it is nonanatomic and should be biomechanically and clinically investigated to validate its long-term versatile utility.
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Affiliation(s)
- Amr Abdel-Mordy Kandeel
- Address correspondence to Amr Abdel-Mordy Kandeel, M.D., Department of Orthopedics & Traumatology, Faculty of Medicine, Menoufia University, Gamal Abdel-Nasser Street, Shebien El-kom, Menoufia Governorate, Egypt.
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10
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Narez GE, Brown G, Herrick A, Ek RJ, Dejardin L, Wei F, Haut RC, Haut Donahue TL. Assessment of changes in the meniscus and subchondral bone in a novel closed-joint impact and surgical reconstruction lapine model. J Biomech 2021; 126:110630. [PMID: 34303894 DOI: 10.1016/j.jbiomech.2021.110630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 05/17/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022]
Abstract
Despite reconstruction surgery to repair a torn anterior cruciate ligament (ACL), patients often still show signs of post-traumatic osteoarthritis (PTOA) years following the procedure. The goal of this study was to document changes in the meniscus and subchondral bone due to closed-joint impact and surgical reconstruction in a lapine model. Animals received insult to the joint followed by surgical reconstruction of the ACL and partial meniscectomy. Following euthanasia of the animals at 1, 3, and 6-months post-impact, meniscal tissue was assessed for changes in morphology, mechanical properties and proteoglycan content. Femurs and tibias were scanned via micro-computed tomography to determine changes in bone quality, morphometry, and formation of osteophytes. Both the lateral and medial menisci showed severe degradation and tearing at all-time points, with higher degree of degeneration being observed at 6-months. Decreases in both the instantaneous and equilibrium modulus were documented in both menisci. Minimal changes were found in bone quality and morphometry, with most change documented in the tibia. Bones from the reconstructed limbs showed large volumes of osteophyte formations, with an increase in volume over time. The initial changes that were representative of PTOA may have been limited to the meniscus, but at later time points consistent changes due to the disease were seen in both tissues. This study, which builds on a previous study by this laboratory, suggests that the addition of surgical reconstruction of the ACL to our model was not sufficient to prevent the development of PTOA.
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Affiliation(s)
- Gerardo E Narez
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Gabriel Brown
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Ashley Herrick
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Ryan J Ek
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA
| | - Loic Dejardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - Feng Wei
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Roger C Haut
- Orthopaedic Biomechanics Laboratories, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA; Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Tammy L Haut Donahue
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA, USA.
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11
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Hanhan S, Goren K, Rivkin A, Saba F, Nevo H, Dar N, Shilo D, Liebergall M, Shoseyov O, Deutsch D, Blumenfeld A, Haze A. Regeneration of grade 3 ankle sprain, using the recombinant human amelogenin protein (rHAM + ) in a rat model. J Orthop Res 2021; 39:1540-1547. [PMID: 32410235 DOI: 10.1002/jor.24718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/03/2020] [Accepted: 05/08/2020] [Indexed: 02/04/2023]
Abstract
Lateral ligament tears, also known as high-grade ankle sprains, are common, debilitating, and usually heal slowly. Ten to thirty percent of patients continue to suffer from chronic pain and ankle instability even after 3 to 9 months. Previously, we showed that the recombinant human amelogenin (rHAM+ ) induced regeneration of fully transected rat medial collateral ligament, a common proof-of-concept model. Our aim was to evaluate whether rHAM+ can regenerate torn ankle calcaneofibular ligament (CFL), an important component of the lateral ankle stabilizers. Right CFLs of Sabra rats were transected and treated with 0, 0.5, or 1 µg/µL rHAM+ dissolved in propylene glycol alginate (PGA). Results were compared with the normal group, without surgery. Healing was evaluated 12 weeks after treatment by mechanical testing (ratio between the right and left, untransected ligaments of the same rat), and histology including immunohistochemical staining of collagen I and S100. The mechanical properties, structure, and composition of transected ligaments treated with 0.5 μg/μL rHAM+ (experimental) were similar to untransected ligaments. PGA (control) treated ligaments were much weaker, lax, and unorganized compared with untransected ligaments. Treatment with 1 μg/μL rHAM+ was not as efficient as 0.5 μg/μL rHAM+ . Normal arrangement of collagen I fibers and of proprioceptive nerve endings, parallel to the direction of the force, was detected in ligaments treated with 0.5 μg/μL rHAM+ , and scattered arrangement, resembling scar tissue, in control ligaments. In conclusion, we showed that rHAM+ induced significant mechanical and structural regeneration of torn rat CFLs, which might be translated into treatment for grades 2 and 3 ankle sprain injuries.
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Affiliation(s)
- Salem Hanhan
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Koby Goren
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Amit Rivkin
- Faculty of Agriculture, Food and Environment, Institute of Plant Sciences and Genetics in Agriculture, Hebrew University, Rehovot, Israel
| | - Faris Saba
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Hani Nevo
- Department of Orthopedics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Dar
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Dekel Shilo
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Meir Liebergall
- Department of Orthopedics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Oded Shoseyov
- Faculty of Agriculture, Food and Environment, Institute of Plant Sciences and Genetics in Agriculture, Hebrew University, Rehovot, Israel
| | - Dan Deutsch
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Anat Blumenfeld
- Faculty of Dental Medicine, Institute of Dental Sciences, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Amir Haze
- Department of Orthopedics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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12
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Bogdanov JM, Bolia IK, Benvegnu N, Michener LA, Weber AE, Petrigliano FA. Rehabilitation Following Ulnar Collateral Ligament Reconstruction in Overhead-Throwing Athletes. JBJS Rev 2021; 9:01874474-202104000-00004. [PMID: 33819204 DOI: 10.2106/jbjs.rvw.20.00154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» The prevalence of ulnar collateral ligament (UCL) injury and UCL reconstruction (UCL-R) continues to rise, causing morbidity in overhead-throwing athletes. » Postoperative rehabilitation protocols are essential for proper healing of the reconstructed ligament and safely returning athletes to competition, yet there is no uniformly accepted standard of care. » UCL-R rehabilitation has traditionally been guided by expert opinion and conventional wisdom rather than scientific studies, resulting in substantial variability in rehabilitation practices, time to return to play, and outcomes. » Current research efforts aim to closely investigate the biomechanical implications of UCL-R and overhead throwing to better guide rehabilitation and to improve competitive performance and outcomes. » Additional biomechanical and scientific studies on rehabilitation modalities and timing are warranted for systematic analysis, optimization, and standardization of UCL-R rehabilitation.
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Affiliation(s)
- Jacob M Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Neilen Benvegnu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Lori A Michener
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California
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13
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Lu J, Chamberlain CS, Ji ML, Saether EE, Leiferman EM, Li WJ, Vanderby R. Tendon-to-Bone Healing in a Rat Extra-articular Bone Tunnel Model: A Comparison of Fresh Autologous Bone Marrow and Bone Marrow-Derived Mesenchymal Stem Cells. Am J Sports Med 2019; 47:2729-2736. [PMID: 31339739 DOI: 10.1177/0363546519862284] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite widespread acceptance of fresh autologous bone marrow (BM) for use in clinical practice, limited information exists to analyze if tendon-to-bone healing could be accelerated with local use of fresh autologous BM. PURPOSE To investigate the effect of fresh autologous BM on tendon-to-bone healing with a novel rat model. STUDY DESIGN Controlled laboratory study. METHODS An extra-articular bone tunnel was created and filled with an autologous tendon graft in skeletally mature Sprague-Dawley rats (N = 60). They were then randomly divided into 3 groups: BM group (injection of fresh autologous BM into the tendon-bone interface, n = 20), BM-derived mesenchymal stem cell (BMSC) group (injection of allogenic cultured BMSCs, n = 20), and the control group (tendon-bone interface without injection of BM or BMSCs, n = 20). Biomechanical, histological, and immunohistochemical analyses were performed at 2 and 6 weeks after surgery. RESULTS The BM group showed a relatively well-organized and dense connective tissue interface with better orientation of collagen fibers as compared with the BMSC group. At 2 weeks, the tendon-bone interface tissue thickness of the BMSC group was 140 ± 25 μm (mean ± SEM), which was significantly greater than the BM group (58 ± 15 μm). The BM group showed fewer M1 macrophages at the tendon-bone interface at 2 and 6 weeks (P < .001). In contrast, there were more M2 macrophages at the interface in the BM group 2 and 6 weeks postoperatively when compared with controls and the BMSC group (P < .001). Biomechanical tests revealed significantly higher stiffness in the BM group versus the control and BMSC groups at 2 and 6 weeks after surgery (P < .05). Load to failure showed similar trends to stiffness. CONCLUSION These findings indicate that local delivery of fresh autologous BM enhances tendon-to-bone healing better than the alternative treatments in this study. This effect may be partially due to the observed modulation of inflammatory processes, especially in M2 macrophage polarization. CLINICAL RELEVANCE Fresh autologous BM could be a treatment option for this disorder.
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Affiliation(s)
- Jun Lu
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Connie S Chamberlain
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ming-Liang Ji
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Erin E Saether
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ellen M Leiferman
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Wan-Ju Li
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ray Vanderby
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
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14
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Pathy R, Sturnick DR, Blanco JS, Dodwell ER, Scher DM. Biomechanical Comparison of Suture-External Button Fixation vs Internal Suspension Fixation for Tendon Transfers of the Feet. Foot Ankle Int 2019; 40:845-852. [PMID: 30917671 DOI: 10.1177/1071100719839691] [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: 02/01/2023]
Abstract
BACKGROUND Fixation of tendon transfers in pediatric feet typically involves passing a suture that is secured to a tendon, through an intraosseous tunnel, and tying it over an external button on the plantar foot, with appropriate tension. After adequate time is allowed for bone-tendon healing, the suture and button are removed. This construct can be complicated by suture breakage with loss of fixation, and/or skin ulceration under the button. Internal suspension systems of tendons and ligaments in adults have demonstrated excellent fixation strength and minimal intraosseous tunnel displacement, with no risk of skin ulceration and no need for suture and button removal. This study compared the biomechanical properties of the suture-external button and internal suspension fixation techniques in cadavers. The primary outcome and secondary outcomes were displacement of suture-fixation construct during dynamic loading, and static loading, respectively. METHODS Nine adult cadaver feet were obtained. Both the external button and internal suspension techniques were tested once in each cadaver, in random order. Relative displacement of the fixation construct within the bone tunnel was recorded with video capture during dynamic and static loading. A custom Matlab script processed video and materials testing data. Static and cyclic displacements were analyzed between fixation groups using a paired t test (alpha value =0.05). RESULTS Internal suspension fixation had significantly less mean displacement of the tendon within the bone tunnel than the external button technique during dynamic (0.3 mm internal suspension system, 0.7 mm external button, P = .0115) and static loading (0.4 mm internal suspension system, 2.2 mm external button, P = .0019). CONCLUSIONS Internal suspension systems may provide superior fixation compared to the traditional external button for tendon transfers, with the added benefit of avoiding the risk of skin ulceration and the need for suture and button removal. CLINICAL RELEVANCE It appears internal suspension method of tendon transfer fixation would be an acceptable alternative to traditional methods of fixation with an external button.
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Affiliation(s)
- Rubini Pathy
- 1 Shriners Hospitals for Children-Springfield, Springfield, MA, USA
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15
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Hjorthaug GA, Søreide E, Nordsletten L, Madsen JE, Reinholt FP, Niratisairak S, Dimmen S. Negative effect of zoledronic acid on tendon-to-bone healing. Acta Orthop 2018; 89:360-366. [PMID: 29493345 PMCID: PMC6055777 DOI: 10.1080/17453674.2018.1440189] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Outcome after ligament reconstruction or tendon repair depends on secure tendon-to-bone healing. Increased osteoclastic activity resulting in local bone loss may contribute to delayed healing of the tendon-bone interface. The objective of this study was to evaluate the effect of the bisphosphonate zoledronic acid (ZA) on tendon-to-bone healing. Methods - Wistar rats (n = 92) had their right Achilles tendon cut proximally, pulled through a bone tunnel in the distal tibia and sutured anteriorly. After 1 week animals were randomized to receive a single dose of ZA (0.1 mg/kg IV) or control. Healing was evaluated at 3 and 6 weeks by mechanical testing, dual-energy X-ray absorptiometry and histology including immunohistochemical staining of osteoclasts. Results - ZA treatment resulted in 19% (95% CI 5-33%) lower pullout strength and 43% (95% CI 14-72%) lower stiffness of the tendon-bone interface, compared with control (2-way ANOVA; p = 0.009, p = 0.007). Administration of ZA did not affect bone mineral density (BMD) or bone mineral content (BMC). Histological analyses did not reveal differences in callus formation or osteoclasts between the study groups. Interpretation - ZA reduced pullout strength and stiffness of the tendon-bone interface. The study does not provide support for ZA as adjuvant treatment in tendon-to-bone healing.
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Affiliation(s)
- Geir Aasmund Hjorthaug
- Division of Orthopedic Surgery, Oslo University Hospital (OUS), Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Experimental Orthopedic Research, Institute for Surgical Research, OUS,Department of Orthopedic Surgery, Martina Hansen’s Hospital,Correspondence:
| | - Endre Søreide
- Division of Orthopedic Surgery, Oslo University Hospital (OUS), Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Experimental Orthopedic Research, Institute for Surgical Research, OUS
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital (OUS), Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Experimental Orthopedic Research, Institute for Surgical Research, OUS
| | - Jan Erik Madsen
- Division of Orthopedic Surgery, Oslo University Hospital (OUS), Norway,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Experimental Orthopedic Research, Institute for Surgical Research, OUS
| | | | - Sanyalak Niratisairak
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Biomechanics Laboratory, Division of Orthopedic Surgery, OUS
| | - Sigbjørn Dimmen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo (UIO),Experimental Orthopedic Research, Institute for Surgical Research, OUS,Department of Orthopedic Surgery, Lovisenberg Diaconal Hospital, Norway
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16
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Soreide E, Denbeigh JM, Lewallen EA, Samsonraj RM, Berglund LJ, Dudakovic A, Cool SM, Nordsletten L, Kakar S, van Wijnen AJ. Fibrin glue mediated delivery of bone anabolic reagents to enhance healing of tendon to bone. J Cell Biochem 2018; 119:5715-5724. [PMID: 29388702 DOI: 10.1002/jcb.26755] [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] [Received: 12/27/2017] [Accepted: 01/25/2018] [Indexed: 01/12/2023]
Abstract
Tendon graft healing in bone tunnels for the fixation of intra-articular ligament reconstructions may limit clinical outcome by delaying healing. This study assesses the effects of hydrogel-mediated delivery of bone anabolic growth factors in a validated model of tendon-to-bone tunnel healing. Forty-five Wistar rats were randomly allocated into three groups (BMP2-treated, GSK126-treated, and placebo). All animals underwent a tendon-to-bone tunnel reconstruction. Healing was evaluated at 4 weeks by biomechanical assessment, micro-computed tomography (bone mineral density, bone volume, cross sectional area of bone tunnels), and traditional histology. Adverse events associated with the hydrogel-mediated delivery of drugs were not observed. Results of our biomechanical assessment demonstrated favorable trends in animals treated with bone anabolic factors for energy absorption (P = 0.116) and elongation (P = 0.054), while results for force to failure (P = 0.691) and stiffness (P = 0.404) did not show discernible differences. Cross sectional areas for BMP2-treated animals were reduced, but neither BMP2 nor GSK126 administration altered bone mineral density (P = 0.492) or bone volume in the bone tunnel. These results suggest a novel and positive effect of bone anabolic factors on tendon-to-bone tunnel healing. Histological evaluation confirmed absence of collagen fibers crossing the soft tissue-bone interface indicating immature graft integration as expected at this time point. Our study indicates that hydrogel-mediated delivery of BMP2 and GSK126 appears to be safe and has the potential to enhance tendon-to-bone tunnel healing in ligament reconstructions.
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Affiliation(s)
- Endre Soreide
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Division of Orthopedic Surgery, Oslo University Hospital, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Janet M Denbeigh
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Eric A Lewallen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Department of Biological Sciences, Hampton University, Hampton, Virginia
| | | | | | - Amel Dudakovic
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Simon M Cool
- Institute of Medical Biology, A(∗)STAR, 8A Biomedical Grove, Immunos, Singapore
| | - Lars Nordsletten
- Division of Orthopedic Surgery, Oslo University Hospital, Norway & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andre J van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.,Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
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17
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Baicalein Accelerates Tendon-Bone Healing via Activation of Wnt/ β-Catenin Signaling Pathway in Rats. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3849760. [PMID: 29693006 PMCID: PMC5859801 DOI: 10.1155/2018/3849760] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 07/26/2017] [Indexed: 01/05/2023]
Abstract
Background Tendon-bone healing is a reconstructive procedure which requires a tendon graft healing to a bone tunnel or to the surface of bone after the junction injury between tendon, ligament, and bone. The surgical reattachment of tendon to bone often fails due to regeneration failure of the specialized tendon-bone junction. Materials and Methods An extra-articular tendon-bone healing rat model was established to discuss the effect of the baicalein 10 mg/(kg·d) in accelerating tendon-bone healing progress. Also, tendon-derived stem cells (TDSCs) were treated with various concentrations of baicalein or dickkopf-1 (DKK-1) to stimulate differentiation for 14 days. Results In vivo, tendon-bone healing strength of experiment group was obviously stronger than the control group in 3 weeks as well as in 6 weeks. And there were more mature fibroblasts, more Sharpey fibers, and larger new bone formation area treated intragastrically with baicalein compared with rats that were treated with vehicle for 3 weeks and 6 weeks. In vitro, after induction for 14 days, the expressions of osteoblast differentiation markers, that is, alkaline phosphatase (ALP), runt-related transcription factor 2 (Runx2), osteocalcin (OCN), osterix (OSX), and collagen I, were upregulated and Wnt/β-catenin signaling pathway was enhanced in TDSCs. The effect of DKK-1 significantly reduced the effect of baicalein on the osteogenic differentiation. Conclusion These data suggest that baicalein may stimulate TDSCs osteogenic differentiation via activation of Wnt/β-catenin signaling pathway to accelerate tendon-bone healing.
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18
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Rothrauff BB, Pauyo T, Debski RE, Rodosky MW, Tuan RS, Musahl V. The Rotator Cuff Organ: Integrating Developmental Biology, Tissue Engineering, and Surgical Considerations to Treat Chronic Massive Rotator Cuff Tears. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:318-335. [PMID: 28084902 DOI: 10.1089/ten.teb.2016.0446] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The torn rotator cuff remains a persistent orthopedic challenge, with poor outcomes disproportionately associated with chronic, massive tears. Degenerative changes in the tissues that comprise the rotator cuff organ, including muscle, tendon, and bone, contribute to the poor healing capacity of chronic tears, resulting in poor function and an increased risk for repair failure. Tissue engineering strategies to augment rotator cuff repair have been developed in an effort to improve rotator cuff healing and have focused on three principal aims: (1) immediate mechanical augmentation of the surgical repair, (2) restoration of muscle quality and contractility, and (3) regeneration of native enthesis structure. Work in these areas will be reviewed in sequence, highlighting the relevant pathophysiology, developmental biology, and biomechanics, which must be considered when designing therapeutic applications. While the independent use of these strategies has shown promise, synergistic benefits may emerge from their combined application given the interdependence of the tissues that constitute the rotator cuff organ. Furthermore, controlled mobilization of augmented rotator cuff repairs during postoperative rehabilitation may provide mechanotransductive cues capable of guiding tissue regeneration and restoration of rotator cuff function. Present challenges and future possibilities will be identified, which if realized, may provide solutions to the vexing condition of chronic massive rotator cuff tears.
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Affiliation(s)
- Benjamin B Rothrauff
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Thierry Pauyo
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Richard E Debski
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Mark W Rodosky
- 3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Rocky S Tuan
- 1 Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, University of Pittsburgh , Pittsburgh, Pennsylvania.,2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania
| | - Volker Musahl
- 2 McGowan Institute for Regenerative Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.,3 Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania.,4 Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh , Pittsburgh, Pennsylvania
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19
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Xu K, Kuntz LA, Foehr P, Kuempel K, Wagner A, Tuebel J, Deimling CV, Burgkart RH. Efficient decellularization for tissue engineering of the tendon-bone interface with preservation of biomechanics. PLoS One 2017; 12:e0171577. [PMID: 28170430 PMCID: PMC5295703 DOI: 10.1371/journal.pone.0171577] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/22/2017] [Indexed: 02/07/2023] Open
Abstract
Interfaces between tendon/ligament and bone (“entheses”) are highly specialized tissues that allow for stress transfer between mechanically dissimilar materials. Entheses show very low regenerative capacity resulting in high incidences of failure after surgical repair. Tissue engineering is a promising approach to recover functionality of entheses. Here, we established a protocol to decellularize porcine entheses as scaffolds for enthesis tissue engineering. Chemical detergents as well as physical treatments were investigated with regard to their efficiency to decellularize 2 mm thick porcine Achilles tendon entheses. A two-phase approach was employed: study 1 investigated the effect of various concentrations of sodium dodecyl sulfate (SDS) and t-octylphenoxypolyethoxy-ethanol (Triton X-100) as decellularization agents. The most efficient combination of SDS and Triton was then carried forward into study 2, where different physical methods, including freeze-thaw cycles, ultrasound, perfusion, and hydrostatic washing were used to enhance the decellularization effect. Cell counts, DNA quantification, and histology showed that washing with 0.5% SDS + 1% Triton X-100 for 72 h at room temperature could remove ~ 98% cells from the interface. Further investigation of physical methods proved that washing under 200 mmHg hydrostatic pressure shortened the detergent exposing time from 72 h to 48 h. Biomechanical tensile testing showed that the biomechanical features of treated samples were preserved. Washing under 200 mmHg hydrostatic pressure with 0.5% SDS + 1% Triton X-100 for 48 h efficiently decellularized entheses with preservation of matrix structure and biomechanical features. This protocol can be used to efficiently decellularize entheses as scaffolds for tissue engineering.
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Affiliation(s)
- Kai Xu
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.,Department of Orthopedics, Tongji Hospital, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Lara A Kuntz
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Peter Foehr
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Katharina Kuempel
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Alexandra Wagner
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Jutta Tuebel
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Constantin V Deimling
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Rainer H Burgkart
- Department of Orthopaedics and Sportsorthopaedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
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20
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Zhou Y, Zhang J, Yang J, Narava M, Zhao G, Yuan T, Wu H, Zheng N, Hogan MV, Wang JHC. Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface. J Tissue Eng Regen Med 2017; 11:3445-3456. [DOI: 10.1002/term.2258] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/11/2016] [Accepted: 07/03/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Yiqin Zhou
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
- Joint Surgery and Sports Medicine Department; Shanghai Changzheng Hospital, Second Military Medical University; 415 Fengyang Road, Huangpu Shanghai 200003 China
| | - Jianying Zhang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Jinsong Yang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Manoj Narava
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Guangyi Zhao
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Ting Yuan
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - Haishan Wu
- Joint Surgery and Sports Medicine Department; Shanghai Changzheng Hospital, Second Military Medical University; 415 Fengyang Road, Huangpu Shanghai 200003 China
| | - Nigel Zheng
- Department of Mechanical Engineering and Engineering Science, Center for Biomedical Engineering and Science; University of North Carolina at Charlotte; Charlotte NC USA
| | - MaCalus V. Hogan
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
| | - James H.-C. Wang
- MechanoBiology Laboratory, Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh PA USA
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21
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Preparation and Characterization of a Novel Decellularized Fibrocartilage "Book" Scaffold for Use in Tissue Engineering. PLoS One 2015; 10:e0144240. [PMID: 26636672 PMCID: PMC4670224 DOI: 10.1371/journal.pone.0144240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/16/2015] [Indexed: 01/18/2023] Open
Abstract
At the tendon-to-bone insertion, there is a unique transitional structure: tendon, non-calcified fibrocartilage, calcified fibrocartilage, and bone. The reconstruction of this special graded structure after defects or damage is an important but challenging task in orthopedics. In particular, reconstruction of the fibrocartilage zone has yet to be successfully achieved. In this study, the development of a novel book-shape scaffold derived from the extracellular matrix of fibrocartilage was reported. Specifically, fibrocartilage from the pubic symphysis was obtained from rabbits and sliced into the shape of a book (dimensions: 10 mm × 3 mm × 1 mm) with 10 layers, each layer (akin to a page of a book) with a thickness of 100-μm. These fibrocartilage “book” scaffolds were decellularized using sequentially 3 freeze-thaw cycles, 0.1% Triton X-100 with 1.5 M KCl, 0.25% trypsin, and a nuclease. Histology and DNA quantification analysis confirmed substantial removal of cells from the fibrocartilage scaffolds. Furthermore, the quantities of DNA, collagen, and glycosaminoglycan in the fibrocartilage were markedly reduced following decellularization. Scanning electron microscopy confirmed that the intrinsic ultrastructure of the fibrocartilage tissue was well preserved. Therefore, the results of this study suggest that the novel “book” fibrocartilage scaffold could have potential applications in tissue engineering.
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Bone morphogenetic protein-7 enhances bone-tendon integration in a murine in vitro co-culture model. INTERNATIONAL ORTHOPAEDICS 2015; 39:799-805. [PMID: 25667050 DOI: 10.1007/s00264-015-2688-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/18/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Bone-tendon healing following anterior cruciate ligament reconstruction is reportedly enhanced by bone morphogenetic protein (BMP)-7. To improve our understanding of the underlying biologic processes, we examined the effects of BMP-7 on region-specific gene expression in vitro. METHODS A murine in vitro co-culture model simulating the osteoblast, interface and fibroblast regions was established. The dose- and time-dependent region-specific effects of BMP-7 exposure on gene expression of Alpl, Bglap, Col1a1, Runx2 and Spp1 were analysed by quantitative PCR. RESULTS At the osteoblast region, BMP-7 significantly increased Alp, Bglap, Col1a1, and Runx2 expression, while Spp1 expression was suppressed. At the interface region, BMP-7 exposure resulted in a trend towards increased expression rates of Alpl and Col1a1, whereas Bglap (P < 0.001) and Runx2 (P < 0.01) were significantly upregulated without any detectable effect on Spp1 expression. At the fibroblast region, BMP-7 increased Alpl (P < 0.001), Bglap (P < 0.001) and Runx2 (P < 0.001) expression, but no significant effects were seen on Col1a1 or Spp1. Exposure to BMP-7 (100 ng/ml) had its most pronounced biologic impact on day ten. CONCLUSION BMP-7 stimulation showed beneficial region-specific effects on bone-tendon healing in vitro, such as enhanced expression of parameters for ossification and fibroblast transdifferentiation, both key processes during successful graft integration.
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