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Snow F, O'Connell C, Yang P, Kita M, Pirogova E, Williams RJ, Kapsa RMI, Quigley A. Engineering interfacial tissues: The myotendinous junction. APL Bioeng 2024; 8:021505. [PMID: 38841690 PMCID: PMC11151436 DOI: 10.1063/5.0189221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
The myotendinous junction (MTJ) is the interface connecting skeletal muscle and tendon tissues. This specialized region represents the bridge that facilitates the transmission of contractile forces from muscle to tendon, and ultimately the skeletal system for the creation of movement. MTJs are, therefore, subject to high stress concentrations, rendering them susceptible to severe, life-altering injuries. Despite the scarcity of knowledge obtained from MTJ formation during embryogenesis, several attempts have been made to engineer this complex interfacial tissue. These attempts, however, fail to achieve the level of maturity and mechanical complexity required for in vivo transplantation. This review summarizes the strategies taken to engineer the MTJ, with an emphasis on how transitioning from static to mechanically inducive dynamic cultures may assist in achieving myotendinous maturity.
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Guizzi A, Collin P, Zbinden J, Hurtado JA, Amiri A, Lädermann A. Calcaneum-Achilles Tendon Allograft for Massive Posterosuperior Rotator Cuff Lesion With Bony Deficiency. Arthrosc Tech 2024; 13:102919. [PMID: 38690347 PMCID: PMC11056741 DOI: 10.1016/j.eats.2024.102919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/10/2023] [Indexed: 05/02/2024] Open
Abstract
Dealing with massive and irreparable rotator cuff tears presents intricate challenges. Concerning elder patients, either conservative management or reverse shoulder arthroplasty could be the most appropriate treatment. On the other hand, in younger patients, there is a wide spectrum of solutions, most of them being under evaluation and not completely validated. The complexity increases when a greater tuberosity avulsion occurs at the same time. Regardless of whether surgical fixation is performed, there is a risk for bone resorption, which would result in the posterosuperior cuff's insertion spot loss. In this case, the surgeon is expected to simultaneously manage the bone loss and the tendon tear. The Calcaneum-Achilles Tendon Allograft (CalATA) therefore appears to play an interesting role due to its solid bone-tendon structure. This Technical Note aims to present the CalATA technique, which consists in both tendon and bone deficiency restoration in massive rotator cuff tears with greater tuberosity resorption.
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Affiliation(s)
- Alberto Guizzi
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Philippe Collin
- CHP Saint-Gregoire, Saint-Grégoire, France
- Clinique Victor Hugo, Paris, France
- American Hospital of Paris, Neuilly-sur-Seine, France
| | - Jeanni Zbinden
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
| | - Juan Arturo Hurtado
- Clínica San Pablo Surco, Lima, Perú
- Clínica San Gabriel, Lima, Perú
- Clínica Providencia, Lima, Perú
| | - Arash Amiri
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Marchese RM, Al-Humadi S, Ruland C, Komatsu DE, Khan F. Elbow sarcoma resection and triceps reconstruction with Achilles allograft: an overview, case report, and technique guide. JSES Int 2024; 8:217-221. [PMID: 38312285 PMCID: PMC10837695 DOI: 10.1016/j.jseint.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Affiliation(s)
- Richard M Marchese
- Department of Orthopaedics and Rehabilitation, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Samer Al-Humadi
- Department of Orthopaedics and Rehabilitation, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Christopher Ruland
- Department of Orthopaedics and Rehabilitation, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - David E Komatsu
- Department of Orthopaedics and Rehabilitation, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Fazel Khan
- Department of Orthopaedics and Rehabilitation, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Almutairi MK, Hunter GR, Lein DH, Kim S, Bryan DR, Inacio M, Hurt CP, Reed W, Singh H. Enhancement of Muscle Shortening Torque Preloaded with Muscle Lengthening is Joint-Specific. J Hum Kinet 2023; 87:11-21. [PMID: 37229413 PMCID: PMC10203843 DOI: 10.5114/jhk/161729] [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: 10/20/2021] [Accepted: 07/24/2022] [Indexed: 05/27/2023] Open
Abstract
Our cross-sectional study aimed to investigate joint specificity of concentric muscle torque enhancement after a maximum eccentric contraction for the knee versus ankle joints across two different movement velocities (120°/s and 180°/s). After a familiarization session, 22 healthy young adults randomly performed concentric (CONC) and maximum eccentric preloaded concentric (EccCONC) muscle strength tests of the knee extensors and ankle plantar flexors of the non-dominant leg on an isokinetic strength testing device. We calculated the ratio between EccCONC and CONC (EccCONC/CONC) for all the conditions as the marker of concentric muscle torque enhancement. Separate two-way (joints x velocity) within repeated measures ANOVAs were used to determine joint-specific torque differences at 120°/s and 180°/s. CONC and EccCONC were greater for the knee extensors versus ankle plantar flexors at 120°/s and 180°/s (32.86%-102%; p < 0.001 for both); however, EccCONC/CONC was greater for the ankle plantar flexors than knee extensors at 120°/s (52.4%; p < 0.001) and 180°/s (41.9%; p < 0.001). There was a trend of greater EccCONC/CONC for the knee extensors at 180°/s than 120°/s (6.6%; p = 0.07). Our results show that greater concentric muscle torque enhancement after a maximal eccentric contraction occurs for the ankle plantar flexors versus knee extensors. Whether the joint- specificity of concentric muscle torque enhancement after a maximal eccentric contraction differentially affects sports performance is unknown. Our data provide a reference framework to investigate joint-specific concentric muscle torque enhancement for general and clinical athletic populations.
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Affiliation(s)
- Marzouq K. Almutairi
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Physical Therapy, Qassim University, Qassim, Saudi Arabia
| | - Gary R. Hunter
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Donald H. Lein
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - SoJung Kim
- Department of Kinesiology, Rowan University, Glassboro, NJ, USA
| | - David R. Bryan
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mario Inacio
- Department of Physical Education and Sports Science, University of Maia-ISMAI, Maia, Portugal
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Christopher P. Hurt
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Reed
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harshvardhan Singh
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players. Arthrosc Sports Med Rehabil 2022; 4:e2073-e2078. [PMID: 36579031 PMCID: PMC9791805 DOI: 10.1016/j.asmr.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play. Methods Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player's preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play. Results Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player's preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P = .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P = .042). When compared with controls, only the decrease in games played was significant (-31.3 ± 7.6 vs 1.4 ± 8.2, P = .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs -28.4 ± 5.4, P = .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P = .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury. Conclusion NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season. Level of Evidence IV, therapeutic case series.
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Malige A, Baghdadi S, Hast MW, Schmidt EC, Shea KG, Ganley TJ. Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: A systematic review. Clin Biomech (Bristol, Avon) 2022; 95:105636. [PMID: 35428007 DOI: 10.1016/j.clinbiomech.2022.105636] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions. Studies were excluded if performed on both skeletally immature and mature or non-human grafts, or if the grafts were tested after fixation in a cadaveric knee. For each graft, failure load, stiffness, Young's modulus, maximum stress, and maximum strain were recorded. FINDINGS Twenty-six articles were included. Most studies reported equal or increased biomechanical failure load and stiffness of their tested bone-patellar tendon-bone, hamstring, quadriceps, peroneus longus, tibialis anterior and posterior, Achilles, tensor fascia lata, and iliotibial band grafts compared to the native ACL. All recorded biomechanical properties had similar values between graft types. INTERPRETATION Most grafts used for ACL reconstruction are biomechanically superior to the native ACL. Utilizing a proper graft, combined with a standard surgical technique and a rigorous rehabilitation before and after surgery, will improve outcomes of ACL reconstruction.
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Affiliation(s)
- Ajith Malige
- St. Luke's University Health Network, Department of Orthopaedic Surgery, 801 Ostrum Street, Bethlehem, PA 18015, USA.
| | - Soroush Baghdadi
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Michael W Hast
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Elaine C Schmidt
- Biedermann Laboratory for Orthopaedic Research, University of Pennsylvania Department of Orthopaedic Surgery, 3737 Market Street 10th Floor, Suite 1050, Philadelphia, PA 19104, USA
| | - Kevin G Shea
- Stanford University Department of Orthopaedic Surgery 450 Broadway, Redwood City, CA 94063, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia Department of Orthopaedic Surgery 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Full thickness quadriceps tendon grafts with bone had similar material properties to bone-patellar tendon-bone and a four-strand semitendinosus grafts: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 2022; 30:1786-1794. [PMID: 34591124 DOI: 10.1007/s00167-021-06738-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Despite increasing interest in utilizing quadriceps tendon (QT) grafts in anterior cruciate ligament reconstruction (ACLR), data on the optimal quadriceps graft thickness are limited. The purpose of this study was to characterize the mechanical properties for the quadriceps tendon, comparing full-thickness (FT) QT grafts with and without bone to a partial-thickness (PT) QT graft, and comparing the three QT grafts to four-stranded semitendinosus (4-SST) and bone-patellar tendon-bone (BTB) grafts and one experimental graft, the two-stranded rectus femoris (RF). METHODS Forty-eight (n = 48) young cadaveric grafts (mean age 32 ± 6 years) were utilized for testing with N = 8 specimens in each of the following groups; (1) FT QT with bone, (2) FT QT without bone, (3) PT QT without bone, (4) BTB, (5) RF, and (6) 4-SST. Each specimen was harvested and rigidly fixed in custom clamps to a dynamic tensile testing machine for biomechanical evaluation. Graft ultimate load and stiffness were recorded. Independent groups one-factor ANOVAs and Tukey's pairwise comparisons were performed for statistical analyses. RESULTS FT QT with bone and 4-SST grafts demonstrated similar ultimate loads to BTB grafts (both n.s), whereas PT QT demonstrate statistically significantly lower ultimate loads to BTB grafts (n.s) and 4-SST grafts (n.s). Furthermore, no statistically significant differences were observed between the ultimate loads of FT QT vs. PT QT grafts without bone (n.s) or between FT QT with vs. without bone (n.s). FT QT grafts with bone did not demonstrate statistically significantly greater ultimate loads than PT QT grafts without bone (n.s). The RF graft demonstrated statistically significantly lower ultimate loads to BTB grafts (p < 0.005) and 4-SST grafts (p < 0.014). CONCLUSIONS Full thickness QT grafts with bone had similar material properties to BTB and a 4-SST grafts, while Partial thickness QT graft without bone had significantly lower material properties than BTB and 4-SST, in a biomechanical setting.
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Peixoto T, Carneiro S, Pereira F, Santos C, Fangueiro R, Duarte I, Paiva MC, Lopes MA, Guedes RM. Hybrid structures for Achilles' tendon repair. POLYM ADVAN TECHNOL 2022. [DOI: 10.1002/pat.5693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tânia Peixoto
- REQUIMTE‐LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia Universidade do Porto Porto Portugal
- Instituto de Polímeros e Compósitos, Departamento de Engenharia de Polímeros Universidade do Minho Guimarães Portugal
| | - Sofia Carneiro
- REQUIMTE‐LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia Universidade do Porto Porto Portugal
| | - Fábio Pereira
- CITAB, Escola de Ciência e Tecnologia Universidade de Trás‐os‐Montes e Alto Douro Vila Real Portugal
| | - Cristóvão Santos
- LAETA – Laboratório Associado em Energia Transportes e Aeronáutica – INEGI Porto Portugal
| | - Raúl Fangueiro
- Centro de Ciência e Tecnologia Têxtil Universidade do Minho Guimarães Portugal
| | - Isabel Duarte
- Centro de Tecnologia Mecânica e Automação (TEMA), Departamento de Engenharia Mecânica Universidade de Aveiro Aveiro Portugal
| | - Maria C. Paiva
- Instituto de Polímeros e Compósitos, Departamento de Engenharia de Polímeros Universidade do Minho Guimarães Portugal
| | - Maria A. Lopes
- REQUIMTE‐LAQV, Departamento de Engenharia Metalúrgica e Materiais, Faculdade de Engenharia Universidade do Porto Porto Portugal
| | - Rui M. Guedes
- INEGI, Departamento de Engenharia Mecânica, Faculdade de Engenharia Universidade do Porto Porto Portugal
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The Development of a Gracilis and Quadriceps Tendons Calibration Device for Uniaxial Tensile Tests. MACHINES 2021. [DOI: 10.3390/machines9120364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To determine the biomechanical properties of the distal tendon of the gracilis muscle and the upper third of the quadriceps femoris muscle used for reconstruction of the medial patellofemoral ligament (MPFL), it is necessary to develop a calibration device for specimen preparation for uniaxial tensile tests. The need to develop this device also stems from the fact that there is currently no suitable regulatory or accurate protocol by which soft tissues such as tendons should be tested. In recent studies, various methods have been used to prepare test specimens, such as the use of different ratios of gauge lengths, different gripping techniques, etc., with the aim of obtaining measurable and comparable biomechanical tissue properties. Since tendons, as anisotropic materials, have viscoelastic properties, the guideline for manufacturing calibrator devices was the ISO 527-1:1993 standard, used for testing polymers, since they also have viscoelastic behaviour. The functionality of a calibrator device was investigated by preparing gracilis and quadriceps tendon samples. Fused deposition modeling (FDM) technology was used for the manufacturing of parts with complex geometry. The proposed calibrator could operate in two positions, horizontal and vertical. The maximum gauge length to be achieved was 60 mm, with the maximum tendon length of 120 mm. The average preparation time was 3 min per tendon. It was experimentally proven that it is possible to use a calibrator to prepare tendons for tensile tests. This research can help in the further development of soft tissue testing devices and also in the establishment of standards and exact protocols for their testing.
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Grgić I, Wertheimer V, Karakašić M, Ivandić Ž. Development of a 3D Printed Double-Acting Linear Pneumatic Actuator for the Tendon Gripping. Polymers (Basel) 2021; 13:2528. [PMID: 34372130 PMCID: PMC8347838 DOI: 10.3390/polym13152528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 01/11/2023] Open
Abstract
The lack of standardization in tissue testing procedures results in a variety of custom-made devices. In the case of the determination of the mechanical properties of tendons, it is sometimes necessary to adapt the existing laboratory equipment for conducting experiments when specific commercial equipment is not applicable to solve issues such as proper gripping to prevent tendon slipping and rupturing, gripping control and manoeuvrability in case of tendon submerging and without contamination of the testing liquid. This paper presents the systematic development, design, and fabrication using 3D printing technology and the application of the double-acting linear pneumatic actuator to overcome such issues. It is designed to do its work submerged in the Ringers' solution while gripping the tendon along with the clamps. The pneumatic foot valve unit of the Shimadzu AGS-X tensile testing machine controls the actuator thus preventing Ringers' solution to be contaminated by the machine operator during specimen set-up. The actuator has a length of 60 mm, a bore of 50 mm, and a stroke length of 20 mm. It is designed to operate with an inlet pressure of up to 0.8 MPa. It comprises the cylinder body with the integrated thread, the piston, the piston head, and the gripper jaw. Fused deposition modeling (FDM) has been used as the 3D printing technique, along with polylactic acid (PLA) as the material for 3D printing. The 3D printed double-acting linear pneumatic actuator was developed into an operating prototype. This study could open new frontiers in the field of tissue testing and the development of similar specialized devices for medical purposes.
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Affiliation(s)
- Ivan Grgić
- Mechanical Engineering Faculty in Slavonski Brod, University of Slavonski Brod, Trg Ivane Brlić Mažuranić 2, 35000 Slavonski Brod, Croatia; (M.K.); (Ž.I.)
| | - Vjekoslav Wertheimer
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Joispa Hutlera 4, 31000 Osijek, Croatia;
- Department of Orthopedics and Traumatology, Osijek University Hospital, 31000 Osijek, Croatia
| | - Mirko Karakašić
- Mechanical Engineering Faculty in Slavonski Brod, University of Slavonski Brod, Trg Ivane Brlić Mažuranić 2, 35000 Slavonski Brod, Croatia; (M.K.); (Ž.I.)
| | - Željko Ivandić
- Mechanical Engineering Faculty in Slavonski Brod, University of Slavonski Brod, Trg Ivane Brlić Mažuranić 2, 35000 Slavonski Brod, Croatia; (M.K.); (Ž.I.)
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Wu S, Liu J, Qi Y, Cai J, Zhao J, Duan B, Chen S. Tendon-bioinspired wavy nanofibrous scaffolds provide tunable anisotropy and promote tenogenesis for tendon tissue engineering. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 126:112181. [PMID: 34082981 DOI: 10.1016/j.msec.2021.112181] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/23/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
The development of tendon-biomimetic nanofibrous scaffolds with mesenchymal stem cells may represent a promising strategy to improve the unsatisfactory outcomes of traditional treatments in tendon repair. In the present study, the nanofibrous scaffolds comprised of poly(p-dioxanone) (PPDO) and silk fibroin (SF) composites were fabricated by using electrospinning technique and subsequent thermal ethanol treatment. The PPDO/SF composite scaffolds presented parallel fiber arrangement with crimped features and nonlinear mechanical properties, which mimic the structure-function relationship of native tendon tissue mechanics. We demonstrated that the fiber crimp degree and mechanical properties of as-prepared PPDO/SF wavy nanofibrous scaffolds (WNSs) could be tunable by adjusting the mass ratio of PPDO/SF. The biological tests revealed that the addition of SF obviously promoted the cell adhesion, proliferation, and phenotypic maintenance of human tenocytes on the WNSs. A preliminary study on the subcutaneous implantation showed that the PPDO/SF WNSs notably decreased the inflammatory response compared with pure PPDO WNSs. More importantly, a combination of growth factor induction and mechanical stimulation was found to notably enhance the tenogenic differentiation of human adipose derived mesenchymal stem cells on the PPDO/SF WNSs by upregulating the expressions of tendon-associated protein and gene markers. Overall, this study demonstrated that our PPDO/SF WNSs could provide a beneficial microenvironment for various cell activities, making them an attractive candidate for tendon tissue engineering research.
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Affiliation(s)
- Shaohua Wu
- College of Textiles & Clothing, Qingdao University, Qingdao, China.
| | - Jiao Liu
- College of Textiles & Clothing, Qingdao University, Qingdao, China
| | - Ye Qi
- College of Textiles & Clothing, Qingdao University, Qingdao, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program and Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Shaojuan Chen
- College of Textiles & Clothing, Qingdao University, Qingdao, China.
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Zhang H, Pei Z, Wang C, Li M, Zhang H, Qu J. Electrohydrodynamic 3D Printing Scaffolds for Repair of Achilles Tendon Defect in Rats. Tissue Eng Part A 2021; 27:1343-1354. [PMID: 33573468 DOI: 10.1089/ten.tea.2020.0290] [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] [Indexed: 11/12/2022] Open
Abstract
Tissue engineering (TE) studies for Achilles tendon (AT) defects are a difficult and popular field in orthopedic medical practice. In this study, we applied electrohydrodynamic three-dimensional (3D) printing technology to construct scaffolds made of poly-(ɛ-ɛ-caprolactone) (PCL) and Pluronic F127 (F127) with different mass-volume ratios. The fibers and porous capabilities of the scaffolds were controlled using this technology. We found that F127 improved the hydrophilicity and degradation of PCL in vitro. The PCL scaffolds with 5% F127 were mostly favorable for cell adhesion and growth, suggesting that the scaffolds had good biocompatibility in vitro. Scaffolds with 5% F127 seeded with C3H10T1/2 cells were transplanted into AT defects in rats. A histological analysis indicated that the TE scaffolds were beneficial for the accumulation and arrangement of collagen fibers. Thus, this study provides fundamental experimental data for future clinical applications regarding TE for ATs.
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Affiliation(s)
- Hang Zhang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zijie Pei
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Changbao Wang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mingshan Li
- Department of Cell Biology, Medical College of Soochow University, Soochow University, Suzhou, China
| | - Hongtao Zhang
- Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Qu
- Department of Cell Biology, Medical College of Soochow University, Soochow University, Suzhou, China
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Chivot M, Pioger C, Cognault J, Sharma A, Pailhé R, Cavaignac E, Ollivier M, Jacquet C. Every layer of quadriceps tendon's central and medial portion offers similar tensile properties than Hamstrings or Ilio-Tibial Band Grafts. J Exp Orthop 2020; 7:50. [PMID: 32651731 PMCID: PMC7351916 DOI: 10.1186/s40634-020-00261-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/11/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE The aim of our cadaveric study was to compare the mechanical properties of different parts of the quadriceps' tendon in a load to failure analysis as compared to three other, and most common types of grafts that are used to perform ligament's reconstruction. METHODS Ten fresh-frozen cadavers (5 women, 5 men) were selected from our anatomical department. Mean age at death was 64 years (48-87 years). Tendons were harvested to prepare (1) different quadriceps tendon's specimens: lateral portion (QTlat), medial portion superficial layer (QTMsup) and deep layer (QTMdeep) and central portion superficial (QTCsup) and deep layers (QTCdeep) (2) Patellar Tendon (PT), (3) Gracilis+Semi-Tendinosus specimens (GST). Specimens were stored at - 40 °C in a freezing solution. Specimens were securely attached to a dedicated loading platform, measurements were done using a validated software. Load to failure testing was then carried out. Young's Elastic moduli, ultimate Stress (MPa) and Deformation (%) were analysed. RESULTS The elastic moduli of the PT was significantly higher than all other grafts, all medial and central QT layers (superficial and deep) were significantly higher than its lateral part (QTlat). In terms of Ultimate Stress, all grafts were significantly greater than QTlat, PT and GST were significantly superior to QT central portions and to ITB but there did not differ with the medial portion of QT. ITB ultimate stress values were significantly higher than QTlat. The ultimate deformations of all grafts were similar. CONCLUSIONS This study provides reference values in in order to characterize different parts of the QT that presents anatomically and Mechanically with complex characteristics. Every Layer of Quadriceps Tendon's Central and Medial Portion Offered Similar Mechanical Properties than Two Strand Hamstrings or Ilio-Tibial Band.
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Affiliation(s)
- Matthieu Chivot
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France
| | - Charles Pioger
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
| | | | - Akash Sharma
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
| | - Regis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, 38130, Echirolles, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Matthieu Ollivier
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France. .,Department of Orthopedic surgery and Traumatology, University institute of movement and locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, 29 13274, Marseille, BP, France.
| | - Christophe Jacquet
- Aix-Marseille University, CNRS, ISM UMR 7287, 13288, Cedex 09, Marseille, France.,Clinique du Parc, 69006, Lyon, France
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14
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吴 市, 林 文, 徐 伟, 李 洪. [Clinical study on reconstruction of posterior cruciate ligament with platelet rich plasma combined with 3-strand peroneus longus tendons]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:713-719. [PMID: 32538561 PMCID: PMC8171524 DOI: 10.7507/1002-1892.201910115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope. METHODS Between June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups ( P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation. RESULTS The operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups ( P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months ( P<0.05); the scores in the trial group were significantly better than those of the control group ( P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant ( Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group ( t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group ( P<0.05). CONCLUSION PRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.
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Affiliation(s)
- 市春 吴
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 文祥 林
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 伟华 徐
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
| | - 洪瀚 李
- 福建医科大学附属漳州市医院骨科(福建漳州 363000)Department of Orthopaedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou Fujian, 363000, P.R.China
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15
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El Khatib M, Mauro A, Di Mattia M, Wyrwa R, Schweder M, Ancora M, Lazzaro F, Berardinelli P, Valbonetti L, Di Giacinto O, Polci A, Cammà C, Schnabelrauch M, Barboni B, Russo V. Electrospun PLGA Fiber Diameter and Alignment of Tendon Biomimetic Fleece Potentiate Tenogenic Differentiation and Immunomodulatory Function of Amniotic Epithelial Stem Cells. Cells 2020; 9:cells9051207. [PMID: 32413998 PMCID: PMC7290802 DOI: 10.3390/cells9051207] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022] Open
Abstract
Injured tendons are challenging in their regeneration; thus, tissue engineering represents a promising solution. This research tests the hypothesis that the response of amniotic epithelial stem cells (AECs) can be modulated by fiber diameter size of tendon biomimetic fleeces. Particularly, the effect of electrospun poly(lactide-co-glycolide) (PLGA) fleeces with highly aligned microfibers possessing two different diameter sizes (1.27 and 2.5 µm: ha1- and ha2-PLGA, respectively) was tested on the ability of AECs to differentiate towards the tenogenic lineage by analyzing tendon related markers (Collagen type I: COL1 protein and mRNA Scleraxis: SCX, Tenomodulin: TNMD and COL1 gene expressions) and to modulate their immunomodulatory properties by investigating the pro- (IL-6 and IL-12) and anti- (IL-4 and IL-10) inflammatory cytokines. It was observed that fiber alignment and not fiber size influenced cell morphology determining the morphological change of AECs from cuboidal to fusiform tenocyte-like shape. Instead, fleece mechanical properties, cell proliferation, tenogenic differentiation, and immunomodulation were regulated by changing the ha-PLGA microfiber diameter size. Specifically, higher DNA quantity and better penetration within the fleece were found on ha2-PLGA, while ha1-PLGA fleeces with small fiber diameter size had better mechanical features and were more effective on AECs trans-differentiation towards the tenogenic lineage by significantly translating more efficiently SCX into the downstream effector TNMD. Moreover, the fiber diameter of 1.27 µm induced higher expression of pro-regenerative, anti-inflammatory interleukins mRNA expression (IL-4 and IL-10) with favorable IL-12/IL-10 ratio with respect to the fiber diameter of 2.5 µm. The obtained results demonstrate that fiber diameter is a key factor to be considered when designing tendon biomimetic fleece for tissue repair and provide new insights into the importance of controlling matrix parameters in enhancing cell differentiation and immunomodulation either for the cells functionalized within or for the transplanted host tissue.
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Affiliation(s)
- Mohammad El Khatib
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Annunziata Mauro
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
- Correspondence:
| | - Miriam Di Mattia
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Ralf Wyrwa
- Department of Biomaterials, INNOVENT e. V., 07745 Jena, Germany; (R.W.); (M.S.)
| | - Martina Schweder
- Department of Surface Engineering, INNOVENT e. V., 07745 Jena, Germany;
| | - Massimo Ancora
- Laboratory of Molecular Biology and Genomic, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy; (M.A.); (C.C.)
| | - Francesco Lazzaro
- Research & Development Department, Assut Europe S.p.A., Magliano dei Marsi, 67062 L’Aquila, Italy;
| | - Paolo Berardinelli
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Luca Valbonetti
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Oriana Di Giacinto
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Andrea Polci
- Laboratory of Diagnosis and surveillance of foreign diseases, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy;
| | - Cesare Cammà
- Laboratory of Molecular Biology and Genomic, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy; (M.A.); (C.C.)
| | | | - Barbara Barboni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
| | - Valentina Russo
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (M.E.K.); (M.D.M.); (P.B.); (L.V.); (O.D.G.); (B.B.); (V.R.)
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16
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Abstract
Superior capsular reconstruction (SCR) has become an increasingly popular choice in the treatment of massive, irreparable rotator cuff tears, pseudoparalysis, and in cases in which revision of previous rotator cuff repair is indicated. The SCR procedure is intended to restore the superior stabilizing forces of a deficient rotator cuff. This technique is accomplished by substituting an autograft or allograft between the superior glenoid and the greater tuberosity of the humerus, thus keeping the humeral head centered in the glenoid during shoulder forward flexion and abduction. Since its advent, numerous techniques have been described for this procedure. A fascia lata autograft was initially described; however, many surgeons in the United States have advocated for the use of a humeral dermal allograft. Yet, biomechanical studies have demonstrated elongation and thinning of this material. Thus, the Achilles tendon allograft may be an attractive choice for SCR, given its previous success with ligamentous and tendinous reconstructions. In this article, we present our technique of SCR using an Achilles tendon allograft.
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17
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Russo V, El Khatib M, di Marcantonio L, Ancora M, Wyrwa R, Mauro A, Walter T, Weisser J, Citeroni MR, Lazzaro F, Di Federico M, Berardinelli P, Cammà C, Schnabelrauch M, Barboni B. Tendon Biomimetic Electrospun PLGA Fleeces Induce an Early Epithelial-Mesenchymal Transition and Tenogenic Differentiation on Amniotic Epithelial Stem Cells. Cells 2020; 9:E303. [PMID: 32012741 PMCID: PMC7072418 DOI: 10.3390/cells9020303] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 01/08/2023] Open
Abstract
Background. The design of tendon biomimetic electrospun fleece with Amniotic Epithelial Stem Cells (AECs) that have shown a high tenogenic attitude may represent an alternative strategy to overcome the unsatisfactory results of conventional treatments in tendon regeneration. Methods. In this study, we evaluated AEC-engineered electrospun poly(lactide-co-glycolide) (PLGA) fleeces with highly aligned fibers (ha-PLGA) that mimic tendon extracellular matrix, their biocompatibility, and differentiation towards the tenogenic lineage. PLGA fleeces with randomly distributed fibers (rd-PLGA) were generated as control. Results. Optimal cell infiltration and biocompatibility with both PLGA fleeces were shown. However, only ha-PLGA fleeces committed AECs towards an Epithelial-Mesenchymal Transition (EMT) after 48 h culture, inducing their cellular elongation along the fibers' axis and the upregulation of mesenchymal markers. AECs further differentiated towards tenogenic lineage as confirmed by the up-regulation of tendon-related genes and Collagen Type 1 (COL1) protein expression that, after 28 days culture, appeared extracellularly distributed along the direction of ha-PLGA fibers. Moreover, long-term co-cultures of AEC-ha-PLGA bio-hybrids with fetal tendon explants significantly accelerated of half time AEC tenogenic differentiation compared to ha-PLGA fleeces cultured only with AECs. Conclusions. The fabricated tendon biomimetic ha-PLGA fleeces induce AEC tenogenesis through an early EMT, providing a potential tendon substitute for tendon engineering research.
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Affiliation(s)
- Valentina Russo
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
| | - Mohammad El Khatib
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
| | - Lisa di Marcantonio
- Laboratory of Bacteriology, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale”, 64100 Teramo, Italy;
| | - Massimo Ancora
- Laboratory of Molecular Biology and Genomic, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy; (M.A.); (C.C.)
| | - Ralf Wyrwa
- Department of Biomaterials, INNOVENT e. V, J-07749 Jena, Germany; (R.W.); (T.W.); (J.W.); (M.S.)
| | - Annunziata Mauro
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
| | - Torsten Walter
- Department of Biomaterials, INNOVENT e. V, J-07749 Jena, Germany; (R.W.); (T.W.); (J.W.); (M.S.)
| | - Jürgen Weisser
- Department of Biomaterials, INNOVENT e. V, J-07749 Jena, Germany; (R.W.); (T.W.); (J.W.); (M.S.)
| | - Maria Rita Citeroni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
| | - Francesco Lazzaro
- Research & Development Department, Assut Europe S.p.A., Magliano dei Marsi, 67062 L’Aquila, Italy;
| | - Marta Di Federico
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
- Laboratory of Molecular Biology and Genomic, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy; (M.A.); (C.C.)
| | - Paolo Berardinelli
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
| | - Cesare Cammà
- Laboratory of Molecular Biology and Genomic, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “Giuseppe Caporale, 64100 Teramo, Italy; (M.A.); (C.C.)
| | - Matthias Schnabelrauch
- Department of Biomaterials, INNOVENT e. V, J-07749 Jena, Germany; (R.W.); (T.W.); (J.W.); (M.S.)
| | - Barbara Barboni
- Unit of Basic and Applied Biosciences, Faculty of Bioscience and Agro-Food and Environmental Technology, University of Teramo, 64100 Teramo, Italy; (V.R.); (A.M.); (M.R.C.); (M.D.F.); (P.B.); (B.B.)
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Sawadkar P, Sibbons P, Ahmed T, Bozec L, Mudera V. Engineering of a Functional Tendon Using Collagen As a Natural Polymer. ACS Biomater Sci Eng 2019; 5:5218-5228. [PMID: 33455227 DOI: 10.1021/acsbiomaterials.8b01544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Reconstruction of a tendon rupture is surgically challenging as each end of the tendon retracts, leaving a substantial gap and direct repair is often not feasible. A tendon graft is required to bridge this defect and restore function. Presently, these gaps are filled with auto-, allo-, or synthetic grafts, but they all have clinical limitations. To address this issue, we developed tissue-engineered grafts by a rapid process using compressed type I collagen, which is the most dominant protein in the tendon. However, biomechanical properties were found to be unsuitable to withstand complete load-bearing in vivo. Hence, a modified suture technique was previously developed to reduce the load on the engineered collagen graft to aid integration in vivo. Using this technique, we tested engineered collagen grafts in vivo on a lapine model in three groups up to 12 weeks without immobilization. Gross observation at 3 and 12 weeks showed the bridge integrated without adhesions with a significant increase in the mechanical, structural and histological properties as compared to 1 week. Insertion of a tissue-engineered collagen graft using a novel load-bearing suture technique which partially loads in vivo showed integration, greater mechanical strength and no adhesion formation in the time period tested. This collagen graft has inherent advantages as compared to the present-day tendon grafts.
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Affiliation(s)
- Prasad Sawadkar
- Division of Surgery and interventional Science, University College London Stanmore Campus, London HA7 4LP, United Kingdom
| | - Paul Sibbons
- Department of Surgical Research, Northwick Park Institute of Medical Research, London HA1 3UJ, United Kingdom
| | - Tarek Ahmed
- Division of Biomaterials and Tissue Engineering, University College London Eastman Dental Institute, London WC1X 8LD, United Kingdom
| | - Laurent Bozec
- Division of Biomaterials and Tissue Engineering, University College London Eastman Dental Institute, London WC1X 8LD, United Kingdom
| | - Vivek Mudera
- Division of Surgery and interventional Science, University College London Stanmore Campus, London HA7 4LP, United Kingdom
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Biomechanical considerations are crucial for the success of tendon and meniscus allograft integration-a systematic review. Knee Surg Sports Traumatol Arthrosc 2019; 27:1708-1716. [PMID: 30291394 DOI: 10.1007/s00167-018-5185-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/27/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE This systematic review intends to give an overview of the current knowledge on how allografts used for the reconstruction of cruciate ligaments and menisci are integrated and specifically perform regarding their biomechanical function. METHODS Two reviewers reviewed the PubMed and Central Cochrane library with focus on the biomechanical integration of tendon ligament and meniscus allografts. The literature search was conducted in accordance with the PRISMA statement for reporting systematic reviews and meta-analyses. RESULTS The analysed literature on tendon allografts shows that they are more vulnerable to overstretching in the phase of degradation compared to autografts as the revascularization process starts later and takes longer. Therefore, to avoid excessive graft loads, allografts for cruciate ligament replacement should be selected that exhibit much higher failure loads than the native ligaments to counteract the detrimental effect of degradation. Further, placement techniques should be considered that result in a minimum of strain differences during knee joint motion, which is best achieved by near-isometric placement. The most important biomechanical parameters for meniscus allograft transplantation are secure fixation and proper graft sizing. Allograft attachment by bone plugs or by a bone block is superior to circumferential suturing and enables the allograft to restore the chondroprotective biomechanical function. Graft sizing is also of major relevance, because too small grafts are not able to compensate the knee joint incongruity and too large grafts may fail due to extrusion. Only adequate sizing and fixation together can lead to a biomechanically functioning allograft. The objective assessment of the biomechanical quality of allografts in a clinical setting is challenging, but would be highly desirable for monitoring the remodelling and incorporation process. CONCLUSIONS Currently, indicators like ap-stability after ACL reconstruction or meniscal extrusion represent only indirect measures for biomechanical graft integration. These parameters are at best clinical indicators of allograft function, but the overall integration properties comprising e.g. fixation and graft stiffness remain unknown. Therefore, future research should e.g. focus on advanced imaging techniques or other non-invasive methods allowing for in vivo assessment of biomechanical allograft properties.
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Tisherman R, Wilson K, Horvath A, Byrne K, De Groot J, Musahl V. Allograft for knee ligament surgery: an American perspective. Knee Surg Sports Traumatol Arthrosc 2019; 27:1882-1890. [PMID: 30888445 DOI: 10.1007/s00167-019-05425-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/15/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Allografts are frequently use for ligamentous reconstruction at the knee. In the United States, tissue donation and distribution are highly regulated processes with thorough oversight from private and government entities. Allograft is widely available in the United States and allograft procurement is a large industry with varying procurement, sterilization, processing, and distribution procedures. It is important to understand allograft regulation and processing which may affect graft mechanical properties and biological graft integration. METHODS English-language literature, United States government and regulatory agency statues pertaining to allograft procurement, distribution, and usage were reviewed and the findings summarized. RESULTS During the processing of allograft, multiple factors including sterilization procedures, irradiation, storage conditions, and graft type all affect the biomechanical properties of the allograft tissue. Biological incorporation and ligamentization of allograft does occur, but at a slower rate compared with autograft. For ligamentous reconstruction around the knee, allograft offers shorter operative time, no donor-site morbidity, but has shown an increased risk for graft failure compared to autograft. CONCLUSION This article reviews the regulations on graft tissue within the United States, factors affecting the biomechanics of allograft tissue, differences in allograft tissue choices, and the use of allograft for anterior cruciate ligament reconstruction and multiligamentous knee injury reconstruction. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Robert Tisherman
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA.
| | - Kevin Wilson
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Alexandra Horvath
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Kevin Byrne
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Joseph De Groot
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue Suite 1010, Pittsburgh, PA, 15213, USA
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21
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Yao S, Xie Y, Xiao L, Cai L, Ma Z. Porous and nonporous silk fibroin (SF) membranes wrapping for Achilles tendon (AT) repair: Which one is a better choice? J Biomed Mater Res B Appl Biomater 2018; 107:733-740. [PMID: 30308113 DOI: 10.1002/jbm.b.34167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/13/2018] [Accepted: 05/08/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Shiyi Yao
- Department of Orthopaedics; Zhongnan Hospital of Wuhan University; Wuhan, 430071 China
| | - Yuanlong Xie
- Department of Orthopaedics; Zhongnan Hospital of Wuhan University; Wuhan, 430071 China
| | - Lingfei Xiao
- Department of Orthopaedics; Zhongnan Hospital of Wuhan University; Wuhan, 430071 China
| | - Lin Cai
- Department of Orthopaedics; Zhongnan Hospital of Wuhan University; Wuhan, 430071 China
| | - Zhaocheng Ma
- College of Horticulture and Forestry Sciences; Huazhong Agricultural University, Key Laboratory of Horticultural Plant Biology, Ministry of Education; Wuhan, 430070 China
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Kwak YH, Lee S, Lee MC, Han HS. Anterior cruciate ligament reconstruction with quadriceps tendon-patellar bone allograft: matched case control study. BMC Musculoskelet Disord 2018; 19:45. [PMID: 29426312 PMCID: PMC5807733 DOI: 10.1186/s12891-018-1959-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/30/2018] [Indexed: 02/07/2023] Open
Abstract
Background Quadriceps tendon-patellar bone (QTPB) autograft is an excellent graft option with good clinical outcome. Use of QTPB autografts have increased because they minimize donor-site morbidity including anterior knee pain, while providing adequate mechanical strength. Although, there were many clinical results about allografts that used in anterior cruciate ligament (ACL) reconstruction, it have never been reported about the clinical outcome of ACL reconstruction with QTPB allograft. The purpose of this study is to evaluate the clinical outcome of ACL reconstruction with QTPB allograft and to compare with QTPB autograft. We hypothesized that ACL reconstruction with QTPB allograft had good functional outcomes and stability and no significant difference compared to the ACL reconstruction with QTPB autograft. Methods From February 2009 to January 2014, 213 cases who received ACL reconstruction with QTPB grafts were included. Forty-five patients who received ACL reconstruction with QTPB allograft were individually matched in age, sex, direction of the injured knee and body mass index (BMI) to a control group of 45 patients who received QTPB autograft. Clinical results were evaluated using International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner scale, Knee injury and Osteoarthritis Outcome Score (KOOS) and ligament laxity. An average follow-up time was 31.2 months. Results The functional scores and ligament laxity improved from initial to the last visit in those with ACL reconstruction with QTPB allograft (p < 0.05). No significant statistical difference was found in clinical outcomes and complications including re-rupture between the QTPB allograft and autograft groups (p > 0.05). Laxity using anterior drawer test, Lachman test and KT-2000 showed no significant difference. No significant difference was found between the two groups in quadriceps peak extension torque, except at 60° per second at 6 months. Conclusion QTPB allograft achieved good clinical outcome with no difference compared with QTPB autograft. QTPB allograft for ACL reconstruction is promising alternative to selected and compliant patients. Long-term follow-up needs to further evaluate the clinical outcomes and complications including re-rupture rate.
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Affiliation(s)
- Yoon-Ho Kwak
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Sahnghoon Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung Chul Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk-Soo Han
- Seoul National University Hospital, Seoul, Republic of Korea.
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What Factors Influence the Biomechanical Properties of Allograft Tissue for ACL Reconstruction? A Systematic Review. Clin Orthop Relat Res 2017; 475:2412-2426. [PMID: 28353048 PMCID: PMC5599386 DOI: 10.1007/s11999-017-5330-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Allograft tissue is used in 22% to 42% of anterior cruciate ligament (ACL) reconstructions. Clinical outcomes have been inconsistent with allograft tissue, with some series reporting no differences in outcomes and others reporting increased risk of failure. There are numerous variations in processing and preparation that may influence the eventual performance of allograft tissue in ACL reconstruction. We sought to perform a systematic review to summarize the factors that affect the biomechanical properties of allograft tissue for use in ACL reconstruction. Many factors might impact the biomechanical properties of allograft tissue, and these should be understood when considering using allograft tissue or when reporting outcomes from allograft reconstruction. QUESTIONS/PURPOSES What factors affect the biomechanical properties of allograft tissue used for ACL reconstruction? METHODS We performed a systematic review to identify studies on factors that influence the biomechanical properties of allograft tissue through PubMed and SCOPUS databases. We included cadaveric and animal studies that reported on results of biomechanical testing, whereas studies on fixation, histologic evaluation, and clinical outcomes were excluded. There were 319 unique publications identified through the search with 48 identified as relevant to answering the study question. For each study, we recorded the type of tissue tested, parameters investigated, and the effects on biomechanical behavior, including load to failure and stiffness. Primary factors identified to influence allograft tissue properties were graft tissue type, sterilization methods (irradiation and chemical processing), graft preparation, donor parameters, and biologic adjuncts. RESULTS Load to failure and graft stiffness varied across different tissue types, with nonlooped tibialis grafts exhibiting the lowest values. Studies on low-dose irradiation showed variable effects, whereas high-dose irradiation consistently produced decreased load to failure and stiffness values. Various chemical sterilization measures were also associated with negative effects on biomechanical properties. Prolonged freezing decreased load to failure, ultimate stress, and ultimate strain. Up to eight freeze-thaw cycles did not lead to differences in biomechanical properties of cadaveric grafts. Regional differences were noted in patellar tendon grafts, with the central third showing the highest load to failure and stiffness. Graft diameter strongly contributed to load-to-failure measurements. Age older than 40 years, and especially older than 65 years, negatively impacted biomechanical properties, whereas gender had minimal effect on the properties of allograft tissue. Biologic adjuncts show potential for improving in vivo properties of allograft tissue. CONCLUSIONS Future clinical studies on allograft ACL reconstruction should investigate in vivo graft performance with standardized allograft processing and preparation methods that limit the negative effects on the biomechanical properties of tissue. Additionally, biologic adjuncts may improve the biomechanical properties of allograft tissue, although future preclinical and clinical studies are necessary to clarify the role of these treatments. CLINICAL RELEVANCE Based on the findings of this systematic review that emphasize biomechanical properties of ACL allografts, surgeons should favor the use of central third patellar tendon or looped soft tissue grafts, maximize graft cross-sectional area, and favor grafts from donors younger than 40 years of age while avoiding grafts subjected to radiation doses > 20 kGy, chemical processing, or greater than eight freeze-thaw cycles.
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Smeets K, Bellemans J, Scheys L, Eijnde BO, Slane J, Claes S. Mechanical Analysis of Extra-Articular Knee Ligaments. Part two: Tendon grafts used for knee ligament reconstruction. Knee 2017; 24:957-964. [PMID: 28789872 DOI: 10.1016/j.knee.2017.07.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/19/2017] [Accepted: 07/20/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The aim of this study was to provide information about the mechanical properties of grafts used for knee ligament reconstructions and to compare those results with the mechanical properties of native knee ligaments. METHODS Eleven cadaveric knees were dissected for the semitendinosus, gracilis, iliotibial band (ITB), quadriceps and patellar tendon. Uniaxial testing to failure was performed using a standardized method and mechanical properties (elastic modulus, ultimate stress, ultimate strain, strain energy density) were determined. RESULTS The elastic modulus of the gracilis tendon (1458±476MPa) (P<0.001) and the semitendinosus tendon (1036±312MPa) (P<0.05) was significantly higher than the ITB (610±171MPa), quadriceps tendon (568±194MPa), and patellar tendon (417±107MPa). In addition, the ultimate stress of the hamstring tendons (gracilis 155.0±30.7MPa and semitendinosus 120.1±30.0MPa) was significantly higher (P<0.001, respectively P<0.05), relative to the ITB (75.0±11.8MPa), quadriceps tendon (81.0±27.6MPa), and patellar tendon (76.2±25.1MPa). A significant difference (P<0.05) could be noticed between the ultimate strain of the patellar tendon (24.6±5.9%) and the hamstrings (gracilis 14.5±3.1% and semitendinosus 17.0±4.0%). No significant difference in strain energy density between the grafts was observed. CONCLUSIONS Material properties of common grafts used for knee ligament reconstructions often differ significantly from the original knee ligament which the graft is supposed to emulate.
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Affiliation(s)
- Kristof Smeets
- Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Orthopedic Surgery, Ziekenhuis Oost-, Limburg, Genk, Belgium.
| | - Johan Bellemans
- Department of Orthopedic Surgery, Ziekenhuis Oost-, Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training, Division of Orthopaedics, University Hospitals Leuven/Department of Development and Regenartion, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Bert O Eijnde
- Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joshua Slane
- Institute for Orthopaedic Research and Training, Division of Orthopaedics, University Hospitals Leuven/Department of Development and Regenartion, Faculty of Medicine, KULeuven, Leuven, Belgium
| | - Steven Claes
- Department of Orthopedic Surgery, AZ Herentals Hospital, Herentals, Belgium; Department of Orthopedic Surgery, University Hospitals Leuven, Pellenberg, Belgium
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Miller RM, Rahnemai-Azar AA, Sürer L, Arilla FV, Fu FH, Debski RE, Musahl V. Tensile properties of a split quadriceps graft for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1249-1254. [PMID: 26869030 DOI: 10.1007/s00167-016-4019-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/20/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE Anatomic double-bundle ACL reconstruction can be performed using different grafts, such as quadriceps tendon. Grafts can be split in either coronal or sagittal planes to approximate the two bundles of the native ACL, but it is unknown whether a difference exists in the graft tensile properties depending on splitting plane. The purpose of this study was to evaluate the tensile properties of split human quadriceps tendon-bone grafts. METHODS Twenty full-thickness quadriceps tendon-bone grafts were prepared to mimic grafts for double-bundle ACL reconstruction. Ten grafts were split in the sagittal plane, and ten were split in the coronal plane. Each graft underwent cyclic creep testing and load-to-failure testing to compare creep, ultimate load, ultimate elongation, stiffness, and tangent modulus between splitting planes. All parameters were compared between splitting groups (significance p < 0.05). RESULTS Lateral halves of grafts split in the sagittal plane exhibited a percent creep of 42.5 ± 12.4 %, ultimate load of 445 ± 210 N, ultimate elongation of 7.3 ± 1.9 mm, stiffness of 75.7 ± 19.9 N/mm, and tangent modulus of 174.0 ± 99.8 MPa. No differences were found between halves within split tendons or between splitting planes (n.s.). CONCLUSIONS Overall, splitting quadriceps tendon grafts for anatomic double-bundle ACL reconstruction results in similar tensile properties regardless of splitting plane. Surgeons can split quadriceps tendon in either splitting plane, but should take care to preserve fibres as much as possible. This study provides data that support the use of both coronal and sagittal splits of quadriceps tendons for anatomic double-bundle ACL reconstruction.
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Affiliation(s)
- R Matthew Miller
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
| | - Amir Ata Rahnemai-Azar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Levent Sürer
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Fabio V Arilla
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA.
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA.
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 300 Technology Drive, 306 CNBIO, Pittsburgh, PA, 15219, USA
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA
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Hangody G, Szebényi G, Abonyi B, Kiss R, Hangody L, Pap K. Does a different dose of gamma irradiation have the same effect on five different types of tendon allografts? - a biomechanical study. INTERNATIONAL ORTHOPAEDICS 2016; 41:357-365. [PMID: 27847977 DOI: 10.1007/s00264-016-3336-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The goals of our study were to evaluate the biomechanical differences between five tendons and the changes in biomechanical properties caused by irradiation. METHODS Achilles, quadriceps, semitendinosus + gracilis (STG), tibialis anterior (TA) and the peroneus longus (PL) were harvested from 30 donors. Group A contained 50 tendons without gamma irradiation. The groups were irradiated with a dose of 21 kGy (group B 50 tendons) and with a dose of 42 kGy (group C 50 tendons). The grafts were soaked in a radio-protectant solution and frozen at -80 °C. Cyclic loading tests were performed followed by load to failure tests. Young modulus of elasticity, maximum force, strain at tensile strength and strain at rupture were calculated. RESULTS The Achilles tendons had significantly lower Young modulus than the TA (p = 0.0036) in group A. The Achilles showed significantly lower than PL (p = 0.000042) and TA (p = 0.00142) in group B and C. The quadriceps and the ST (p = 0.0037) provided poorer values than the TA (p = 0.0432) in group C. We found no difference in maximum loads among the tendons in group A. The maximum load of the Achilles and quadriceps showed better results than the PL (p = 0.0016), (p = 0.0018) and the STG (p = 0.0066), (p = 0.0019) in group C. The TA had similar results like the Achilles and quadriceps. DISCUSSION AND CONCLUSIONS The vulnerability of gamma irradiation of TA was less than Achilles and quadriceps tendons.
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Affiliation(s)
- Gyorgy Hangody
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Gábor Szebényi
- Cooperation Research Center for Biomechanics, Budapest University of Technology and Economics, Bertalan Lajos Street 2, 1111, Budapest, Hungary
| | - Bence Abonyi
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Rita Kiss
- Cooperation Research Center for Biomechanics, Budapest University of Technology and Economics, Bertalan Lajos Street 2, 1111, Budapest, Hungary
| | - László Hangody
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary
- Department of Traumatology, Semmelweis University, Uzsoki Street 29-41, 1145, Budapest, Hungary
| | - Károly Pap
- Department of Orthopedics and Traumatology, Uzsoki Hospital, Uzsoki Street 29-41, 1145, Budapest, Hungary.
- Department of Traumatology, Semmelweis University, Uzsoki Street 29-41, 1145, Budapest, Hungary.
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DiBartola AC, Everhart JS, Kaeding CC, Magnussen RA, Flanigan DC. Maximum load to failure of high dose versus low dose gamma irradiation of anterior cruciate ligament allografts: A meta-analysis. Knee 2016; 23:755-62. [PMID: 27297938 DOI: 10.1016/j.knee.2016.05.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 05/16/2016] [Accepted: 05/22/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to systematically evaluate the existing literature to compare the biomechanical effects of low dose and high dose gamma irradiation on commonly used ACL allografts. METHODS A systematic search was performed in PubMed, Cumulative Index for Nursing and Allied Health Literature (CINAHL), Cochrane Reviews, SCOPUS, and SportDiscus. Nine studies were identified that met the following inclusion criteria: 1) controlled laboratory study, 2) investigation of standard allografts for anterior cruciate ligament reconstruction (ACLR), 3) gamma irradiation (dose reported) and a negative control group, and 4) mechanical loading (results reported). RESULTS Nine studies met all inclusion and exclusion criteria. There was a dose-dependent relationship between radiation and decreased mechanical tendon integrity. Low dose radiation (<2.5Mrad [Mrad]) showed graft weakening with an average of 4.3% decrease in load to failure (standardized mean difference [SMD], 0.23; 95% CI 0.216, 0.68; p=0.31), whereas high-dose radiation showed a significantly larger (32.4% average) decrease in load to failure (SMD, 1.79; 95% CI 1.194, 2.38; p<0.001). CONCLUSIONS Gamma irradiation has a negative effect on tendon allograft strength that is dose-dependent, with particularly large effects noted at irradiation doses of ≥2.5Mrad.
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Affiliation(s)
- Alex C DiBartola
- The Ohio State University College of Medicine, Columbus, OH, USA; Division of Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joshua S Everhart
- Division of Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher C Kaeding
- Division of Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Robert A Magnussen
- Division of Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David C Flanigan
- Division of Sports Medicine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Forsythe B, Haro MS, Bogunovic L, Collins MJ, Arns TA, Trella KJ, Shewman EF, Verma NN, Bach BR. Biomechanical Evaluation of Posterior Cruciate Ligament Reconstruction With Quadriceps Versus Achilles Tendon Bone Block Allograft. Orthop J Sports Med 2016; 4:2325967116660068. [PMID: 27570784 PMCID: PMC4984316 DOI: 10.1177/2325967116660068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Long-term studies of posterior cruciate ligament (PCL) reconstruction suggest that normal stability is not restored in the majority of patients. The Achilles tendon allograft is frequently utilized, although recently, the quadriceps tendon has been introduced as an alternative option due to its size and high patellar bone density. PURPOSE/HYPOTHESIS The purpose of this study was to compare the biomechanical strength of PCL reconstructions using a quadriceps versus an Achilles allograft. The hypothesis was that quadriceps bone block allograft has comparable mechanical properties to those of Achilles bone block allograft. STUDY DESIGN Controlled laboratory study. METHODS Twenty-nine fresh-frozen cadaveric knees were assigned to 1 of 3 groups: (1) intact PCL, (2) PCL reconstruction with Achilles tendon allograft, or (3) PCL reconstruction with quadriceps tendon allograft. After reconstruction, all supporting capsular and ligamentous tissues were removed. Posterior tibial translation was measured at neutral and 20° external rotation. Each specimen underwent a preload, 2 cyclic loading protocols of 500 cycles, then load to failure. RESULTS Construct creep deformation was significantly lower in the intact group compared with both Achilles and quadriceps allograft (P = .008). The intact specimens reached the greatest ultimate load compared with both reconstructions (1974 ± 752 N, P = .0001). The difference in ultimate load for quadriceps versus Achilles allograft was significant (P = .048), with the quadriceps group having greater maximum force during failure testing. No significant differences were noted between quadriceps versus Achilles allograft for differences in crosshead excursion during cyclic testing (peak-valley [P-V] extension stretch), creep deformation, or stiffness. Construct stiffness measured during the failure test was greatest in the intact group (117 ± 9 N/mm, P = .0001) compared with the Achilles (43 ± 11 N/mm) and quadriceps (43 ± 7 N/mm) groups. CONCLUSION While the quadriceps trended to be a stronger construct with a greater maximum load and stiffness required during load to failure, only maximum force in comparison with the Achilles reached statistical significance. Quadriceps and Achilles tendon allografts had similar other biomechanical characteristics when used for a PCL reconstruction, but both were inferior to the native PCL. CLINICAL RELEVANCE The quadriceps tendon is a viable graft option in PCL reconstruction as it exhibits a greater maximum force and is otherwise comparable to the Achilles allograft. These findings expand allograft availability in PCL reconstruction.
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Affiliation(s)
- Brian Forsythe
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Marc S Haro
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ljiljana Bogunovic
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael J Collins
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas A Arns
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Katie J Trella
- Department of Bioengineering, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Elizabeth F Shewman
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Lomas A, Ryan C, Sorushanova A, Shologu N, Sideri A, Tsioli V, Fthenakis G, Tzora A, Skoufos I, Quinlan L, O'Laighin G, Mullen A, Kelly J, Kearns S, Biggs M, Pandit A, Zeugolis D. The past, present and future in scaffold-based tendon treatments. Adv Drug Deliv Rev 2015; 84:257-77. [PMID: 25499820 DOI: 10.1016/j.addr.2014.11.022] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 11/08/2014] [Accepted: 11/12/2014] [Indexed: 02/07/2023]
Abstract
Tendon injuries represent a significant clinical burden on healthcare systems worldwide. As the human population ages and the life expectancy increases, tendon injuries will become more prevalent, especially among young individuals with long life ahead of them. Advancements in engineering, chemistry and biology have made available an array of three-dimensional scaffold-based intervention strategies, natural or synthetic in origin. Further, functionalisation strategies, based on biophysical, biochemical and biological cues, offer control over cellular functions; localisation and sustained release of therapeutics/biologics; and the ability to positively interact with the host to promote repair and regeneration. Herein, we critically discuss current therapies and emerging technologies that aim to transform tendon treatments in the years to come.
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