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Liang W, Zhou C, Deng Y, Fu L, Zhao J, Long H, Ming W, Shang J, Zeng B. The current status of various preclinical therapeutic approaches for tendon repair. Ann Med 2024; 56:2337871. [PMID: 38738394 PMCID: PMC11095292 DOI: 10.1080/07853890.2024.2337871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/27/2024] [Indexed: 05/14/2024] Open
Abstract
Tendons are fibroblastic structures that link muscle and bone. There are two kinds of tendon injuries, including acute and chronic. Each form of injury or deterioration can result in significant pain and loss of tendon function. The recovery of tendon damage is a complex and time-consuming recovery process. Depending on the anatomical location of the tendon tissue, the clinical outcomes are not the same. The healing of the wound process is divided into three stages that overlap: inflammation, proliferation, and tissue remodeling. Furthermore, the curing tendon has a high re-tear rate. Faced with the challenges, tendon injury management is still a clinical issue that must be resolved as soon as possible. Several newer directions and breakthroughs in tendon recovery have emerged in recent years. This article describes tendon injury and summarizes recent advances in tendon recovery, along with stem cell therapy, gene therapy, Platelet-rich plasma remedy, growth factors, drug treatment, and tissue engineering. Despite the recent fast-growing research in tendon recovery treatment, still, none of them translated to the clinical setting. This review provides a detailed overview of tendon injuries and potential preclinical approaches for treating tendon injuries.
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Affiliation(s)
- Wenqing Liang
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Chao Zhou
- Department of Orthopedics, Zhoushan Guanghua Hospital, Zhoushan, China
| | - Yongjun Deng
- Department of Orthopedics, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Lifeng Fu
- Department of Orthopedics, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Jiayi Zhao
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Hengguo Long
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Wenyi Ming
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
| | - Jinxiang Shang
- Department of Orthopedics, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Bin Zeng
- Department of Orthopedics, Zhoushan Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Chinese Medical University, Zhoushan, China
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Yu C, Feng S, Li Y, Chen J. Application of Nondegradable Synthetic Materials for Tendon and Ligament Injury. Macromol Biosci 2023; 23:e2300259. [PMID: 37440424 DOI: 10.1002/mabi.202300259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/15/2023]
Abstract
Tendon and ligament injuries, prevalent requiring surgical intervention, significantly impact joint stability and function. Owing to excellent mechanical properties and biochemical stability, Nondegradable synthetic materials, including polyethylene terephthalate (PET) and polytetrafluoroethylene (PTFE), have demonstrated significant potential in the treatment of tendon and ligament injuries. These above materials offer substantial mechanical support, joint mobility, and tissue healing promotion of the shoulder, knee, and ankle joint. This review conclude the latest development and application of nondegradable materials such as artificial patches and ligaments in tendon and ligament injuries including rotator cuff tears (RCTs), anterior cruciate ligament (ACL) injuries, and Achilles tendon ruptures.
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Affiliation(s)
- Chengxuan Yu
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Sijia Feng
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Yunxia Li
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University; Sports Medicine Institute of Fudan University, Shanghai, 200040, China
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Permutt A, Tsamados S, Patel A. Chronic Quadricep Tendon Rupture Reconstruction with Poly-Tape and Achilles' Tendon Allograft: A Case Report and Review of the Literature. J Orthop Case Rep 2023; 13:4-9. [PMID: 37753133 PMCID: PMC10519307 DOI: 10.13107/jocr.2023.v13.i09.3854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/18/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Chronic rupture of the quadriceps tendon is an uncommon but debilitating injury, seen only in 1.37/100,000 patients per annum. The problems associated with this injury are the inability to walk due to disruption of the extensor mechanism and pain. There is limited literature on the reconstruction methods for this injury. This study aims to provide a case report and review of similar cases, using artificial tape and allograft. Case Report A 60-year-old male patient was operated on for chronic quadriceps tendon rupture after falling on his knee with forced flexion. The surgical management in our case consisted of mobilization of the proximal quadriceps tendon and muscle belly with a V-Y tendon plasty, advancement of the tendon, and repair using the Krakow technique through intraosseous patellar tunnels, augmented with Poly-Tape (Neoligaments©) and an Achilles' tendon allograft. This was used due to poor patient tissue quality and the extent of the defect. We also searched the literature for chronic quadriceps tendon ruptures reconstruction using poly tape or Achilles' tendon allograft. Conclusion Chronic quadriceps tendon rupture repairs have relatively poor outcomes, and no surgical procedure has been proven to be the gold standard treatment. We believe the novel combination of Poly-Tape supplemented with Achilles' tendon allograft produces a structurally competent reconstruction in patients with poor tissue quality and large defects and produced good results in our case report.
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Affiliation(s)
- Anabelle Permutt
- Department of Orthopaedics, University College London, London, United Kingdom
| | | | - Akash Patel
- Department of Orthopaedics, Royal Free Hospital, London, United Kingdom
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Wang Y, Zhu JX. Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability. World J Clin Cases 2022; 10:8893-8905. [PMID: 36157669 PMCID: PMC9477045 DOI: 10.12998/wjcc.v10.i25.8893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/04/2021] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.
AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.
METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.
RESULTS A total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.
CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jun-Xu Zhu
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
- Department of Orthopaedics, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang 441000, Hubei Province, China
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[Core techniques and adverse events in anterior cruciate ligament reconstruction using a new generation of artificial ligaments: the consensus of Chinese specialists based on a modified Delphi method (Part 2)]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1047-1055. [PMID: 36111464 PMCID: PMC9626301 DOI: 10.7507/1002-1892.202206026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Anterior cruciate ligament (ACL) reconstruction using a new generation of artificial ligaments (NGAL) gained popularity in China owing to its good effectiveness and early functional recovery, but iatrogenic surgical failures and preconceived misconceptions have seriously affected its standardized clinical application. A specialist consensus is now developed to provide guidance and reference for orthopaedic sports medicine doctors when adopting or considering the NGAL for ACL reconstruction. METHODS The consensus on the core techniques and adverse events in ACL reconstruction using the NGAL was developed by a modified Delphi method, referring exclusively to the NGAL for ACL reconstruction approved by the National Medical Products Administration (NMPA). Consensus specialists were selected from the members of the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM). The drafting team summarized the draft consensus terms based on medical evidence and organized rounds of investigation: two rounds of online questionnaire investigation and the final round of face-to-face meeting. After discussion, revision, and voting, a consensus on the draft consensus term was reached when the agreement rate exceeded 85%. The consensus terms were categorized as "strong" (agreement rate: 95.0%-100%), "moderate" (agreement rate: 90.0%-94.9%), and "basic" (agreement rate: 85.0%-89.9%). RESULTS Thirty-one specialists completed the questionnaire investigation. They all practiced in university teaching hospitals (Grade-A tertiary hospitals) from 16 provinces, autonomous regions, and municipalities in China. Among them, 28 were chief physicians and 3 were associate chief physicians; 22 were professors and 7 were associate professors; the average seniority in orthopedic sports medicine was 25.2 years (range, 12-40 years); the average seniority in performing ACL reconstruction procedures was 13.2 years (range, 7-23 years); in terms of the number of ACL reconstruction using the NGAL, 18 completed more than 100 cases, of which 6 had more than 300 cases; in terms of research, 28 had published more than 1 related paper in the past 5 years, of which 13 had published more than 3 related papers. Twenty-six specialists attended the face-to-face meeting and reached a consensus on 9 terms, including 8 strong terms and 1 moderate term. CONCLUSION ACL reconstruction using the NGAL must deploy "isometric" or "near-isometric" reconstruction and should preserve the natural ACL remnants as much as possible. Bone tunnel positioning can be performed using intraoperative radiographic measurements or the lateral femoral intercondylar ridge as reference marks. Incorrect positioning of the bone tunnel is the main reason of surgical failure, and there is a lack of consensus on handling interference screws during revision. Bone tunnel enlargement exists after reconstruction but rarely causes related symptoms. Synovitis and infection are uncommon complications. The aging effect of polyethylene terephthalate fiber on the long-term clinical outcomes is unknown and deserves attention.
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Li ZJ, Yang QQ, Zhou YL. Basic Research on Tendon Repair: Strategies, Evaluation, and Development. Front Med (Lausanne) 2021; 8:664909. [PMID: 34395467 PMCID: PMC8359775 DOI: 10.3389/fmed.2021.664909] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/30/2021] [Indexed: 01/07/2023] Open
Abstract
Tendon is a fibro-elastic structure that links muscle and bone. Tendon injury can be divided into two types, chronic and acute. Each type of injury or degeneration can cause substantial pain and the loss of tendon function. The natural healing process of tendon injury is complex. According to the anatomical position of tendon tissue, the clinical results are different. The wound healing process includes three overlapping stages: wound healing, proliferation and tissue remodeling. Besides, the healing tendon also faces a high re-tear rate. Faced with the above difficulties, management of tendon injuries remains a clinical problem and needs to be solved urgently. In recent years, there are many new directions and advances in tendon healing. This review introduces tendon injury and sums up the development of tendon healing in recent years, including gene therapy, stem cell therapy, Platelet-rich plasma (PRP) therapy, growth factor and drug therapy and tissue engineering. Although most of these therapies have not yet developed to mature clinical application stage, with the repeated verification by researchers and continuous optimization of curative effect, that day will not be too far away.
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Affiliation(s)
- Zhi Jie Li
- Research for Frontier Medicine and Hand Surgery Research Center, The Nanomedicine Research Laboratory, Research Center of Clinical Medicine, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China.,Medical School of Nantong University, Nantong, China
| | - Qian Qian Yang
- Research for Frontier Medicine and Hand Surgery Research Center, The Nanomedicine Research Laboratory, Research Center of Clinical Medicine, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China.,Medical School of Nantong University, Nantong, China
| | - You Lang Zhou
- Research for Frontier Medicine and Hand Surgery Research Center, The Nanomedicine Research Laboratory, Research Center of Clinical Medicine, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China.,Medical School of Nantong University, Nantong, China
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Nguyen TN, Rangel A, Grainger DW, Migonney V. Influence of spin finish on degradation, functionalization and long-term storage of polyethylene terephthalate fabrics dedicated to ligament prostheses. Sci Rep 2021; 11:4258. [PMID: 33608601 PMCID: PMC7895958 DOI: 10.1038/s41598-021-83572-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Polyethylene terephthalate (PET) fibers and fabrics are widely used for medical device applications such as vascular and anterior cruciate ligament prostheses. Several years ago, we began functionalizing PET fabrics using anionic polymers to enhance their biocompatibility, cell adhesion, proliferation and functional performance as PET ligament prostheses. Polymer functionalization followed a grafting-from process from virgin PET surfaces subject to spin-finish oil additive removal under Soxhlet extraction to remove residual fiber manufacturing oil. Nevertheless, with increasing time from manufacture, PET fabrics stored without a spin finish removal step exhibited degradation of spin finish oil, leading to (1) incomplete surface cleaning, and (2) PET surface degradation. Moreover, oxidizing agents present in the residual degraded oil prevented reliable functionalization of the prosthesis fibers in these PET fabrics. This study compares effects of PET fabric/spin finish oil storage on PET fabric anionic polymer functionalization across two PET fabric ligament storage groups: (1) 2- and 10- year old ligaments, and (2) 26-year old ligaments. Strong interactions between degraded spin finish oil and PET fiber surfaces after long storage times were demonstrated via extraction yield; oil chemistry changed assessed by spectral analysis. Polymer grafting/functionalization efficiency on stored PET fabrics was correlated using atomic force microscopy, including fiber surface roughness and relationships between grafting degree and surface Young’s modulus. New PET fabric Young’s modulus significantly decreased by anionic polymer functionalization (to 96%, grafting degree 1.6 µmol/g) and to reduced modulus and efficiency (29%) for 10 years storage fabric (grafting degree ~ 1 µmol/g). As fiber spin finish is mandatory in biomedically applicable fiber fabrication, assessing effects of spin finish oil on commercial polymer fabrics after longer storage under various conditions (UV light, temperature) is necessary to understand possible impacts on fiber degradation and surface functionalization.
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Affiliation(s)
- Tuan Ngoc Nguyen
- Chemistry, Structures and Properties of Biomaterials and Therapeutic Agents Laboratory, LBPS-CSPBAT, UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France
| | - Andre Rangel
- Chemistry, Structures and Properties of Biomaterials and Therapeutic Agents Laboratory, LBPS-CSPBAT, UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France
| | - David W Grainger
- Department of Biomedical Engineering, and Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT, USA
| | - Véronique Migonney
- Chemistry, Structures and Properties of Biomaterials and Therapeutic Agents Laboratory, LBPS-CSPBAT, UMR CNRS 7244, Université Sorbonne Paris Nord, Villetaneuse, France.
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Barajaa MA, Nair LS, Laurencin CT. Bioinspired Scaffold Designs for Regenerating Musculoskeletal Tissue Interfaces. REGENERATIVE ENGINEERING AND TRANSLATIONAL MEDICINE 2020; 6:451-483. [PMID: 33344758 PMCID: PMC7747886 DOI: 10.1007/s40883-019-00132-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/14/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
Abstract
The musculoskeletal system works at a very advanced level of synchrony, where all the physiological movements of the body are systematically performed through well-organized actions of bone in conjunction with all the other musculoskeletal soft tissues, such as ligaments, tendons, muscles, and cartilage through tissue-tissue interfaces. Interfaces are structurally and compositionally complex, consisting of gradients of extracellular matrix components, cell phenotypes as well as biochemical compositions and are important in mediating load transfer between the distinct orthopedic tissues during body movement. When an injury occurs at interface, it must be re-established to restore its function and stability. Due to the structural and compositional complexity found in interfaces, it is anticipated that they presuppose a concomitant increase in the complexity of the associated regenerative engineering approaches and scaffold designs to achieve successful interface regeneration and seamless integration of the engineered orthopedic tissues. Herein, we discuss the various bioinspired scaffold designs utilized to regenerate orthopedic tissue interfaces. First, we start with discussing the structure-function relationship at the interface. We then discuss the current understanding of the mechanism underlying interface regeneration, followed by discussing the current treatment available in the clinic to treat interface injuries. Lastly, we comprehensively discuss the state-of-the-art scaffold designs utilized to regenerate orthopedic tissue interfaces.
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Affiliation(s)
- Mohammed A Barajaa
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Lakshmi S Nair
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, USA
- Department of Chemical & Bimolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
| | - Cato T Laurencin
- Connecticut Convergence Institute for Translation in Regenerative Engineering, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Raymond & Beverly Sackler Center for Biomedical, Biological, Physical & Engineering Sciences, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Orthopedic Surgery, University of Connecticut Health Center, Farmington, CT, 06030, USA
- Department of Materials Science & Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Institute of Materials Science, University of Connecticut, Storrs, CT, USA
- Department of Chemical & Bimolecular Engineering, University of Connecticut, Storrs, CT, 06269, USA
- Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut Health Center, Farmington, CT, 06030, USA
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No YJ, Castilho M, Ramaswamy Y, Zreiqat H. Role of Biomaterials and Controlled Architecture on Tendon/Ligament Repair and Regeneration. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2020; 32:e1904511. [PMID: 31814177 DOI: 10.1002/adma.201904511] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 11/10/2019] [Indexed: 06/10/2023]
Abstract
Engineering synthetic scaffolds to repair and regenerate ruptured native tendon and ligament (T/L) tissues is a significant engineering challenge due to the need to satisfy both the unique biological and biomechanical properties of these tissues. Long-term clinical outcomes of synthetic scaffolds relying solely on high uniaxial tensile strength are poor with high rates of implant rupture and synovitis. Ideal biomaterials for T/L repair and regeneration need to possess the appropriate biological and biomechanical properties necessary for the successful repair and regeneration of ruptured tendon and ligament tissues.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
- Australian Research Council Training Centre for Innovative BioEngineering, Sydney, NSW, 2006, Australia
| | - Miguel Castilho
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - Yogambha Ramaswamy
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
- Australian Research Council Training Centre for Innovative BioEngineering, Sydney, NSW, 2006, Australia
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney, NSW, 2006, Australia
- Australian Research Council Training Centre for Innovative BioEngineering, Sydney, NSW, 2006, Australia
- Radcliffe Institute for Advanced Study, Harvard University, Cambridge, MA, 02138, USA
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No YJ, Tarafder S, Reischl B, Ramaswamy Y, Dunstan C, Friedrich O, Lee CH, Zreiqat H. High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material. ACS Biomater Sci Eng 2020; 6:1887-1898. [PMID: 33455306 DOI: 10.1021/acsbiomaterials.9b01716] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of suitable synthetic scaffolds for use as human tendon grafts to repair tendon ruptures remains a significant engineering challenge. Previous synthetic tendon grafts have demonstrated suboptimal tissue ingrowth and synovitis due to wear particles from fiber-to-fiber abrasion. In this study, we present a novel fiber-reinforced hydrogel (FRH) that mimics the hierarchical structure of the native human tendon for synthetic tendon graft material. Ultrahigh molecular weight polyethylene (UHMWPE) fibers were impregnated with either biosynthetic polyvinyl alcohol/gelatin hydrogel (FRH-PG) or with polyvinyl alcohol/gelatin + strontium-hardystonite (Sr-Ca2ZnSi2O7, Sr-HT) composite hydrogel (FRH-PGS). The scaffolds were fabricated and assessed to evaluate their suitability for tendon graft applications. The microstructure of both FRH-PG and FRH-PGS showed successful impregnation of the hydrogel component, and the tendon scaffolds exhibited equilibrium water content of ∼70 wt %, similar to the values reported for native human tendon, compared to ∼50 wt % water content retained in unmodified UHMWPE fibers. The tensile strength of FRH-PG and FRH-PGS (77.0-81.8 MPa) matched the range of human Achilles' tendon tensile strengths reported in the literature. In vitro culture of rat tendon stem cells showed cell and tissue infiltration into both FRH-PG and FRH-PGS after 2 weeks, and the presence of Sr-HT ceramic particles influenced the expression of tenogenic markers. On the other hand, FRH-PG supported the proliferation of murine C2C12 myoblasts, whereas FRH-PGS seemingly did not support it under static culture conditions. In vivo implantation of FRH-PG and FRH-PGS scaffolds into full-thickness rat patellar tendon defects showed good collagenous tissue ingrowth into these scaffolds after 6 weeks. This study demonstrates the potential viability for our FRH-PG and FRH-PGS scaffolds to be used for off-the-shelf biosynthetic tendon graft material.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Solaiman Tarafder
- Regenerative Engineering Laboratory, Columbia University, New York 10032, New York, United States
| | - Barbara Reischl
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Yogambha Ramaswamy
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Colin Dunstan
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Chang Hun Lee
- Regenerative Engineering Laboratory, Columbia University, New York 10032, New York, United States
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
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Lim WL, Liau LL, Ng MH, Chowdhury SR, Law JX. Current Progress in Tendon and Ligament Tissue Engineering. Tissue Eng Regen Med 2019; 16:549-571. [PMID: 31824819 PMCID: PMC6879704 DOI: 10.1007/s13770-019-00196-w] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/07/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023] Open
Abstract
Background Tendon and ligament injuries accounted for 30% of all musculoskeletal consultations with 4 million new incidences worldwide each year and thus imposed a significant burden to the society and the economy. Damaged tendon and ligament can severely affect the normal body movement and might lead to many complications if not treated promptly and adequately. Current conventional treatment through surgical repair and tissue graft are ineffective with a high rate of recurrence. Methods In this review, we first discussed the anatomy, physiology and pathophysiology of tendon and ligament injuries and its current treatment. Secondly, we explored the current role of tendon and ligament tissue engineering, describing its recent advances. After that, we also described stem cell and cell secreted product approaches in tendon and ligament injuries. Lastly, we examined the role of the bioreactor and mechanical loading in in vitro maturation of engineered tendon and ligament. Results Tissue engineering offers various alternative ways of treatment from biological tissue constructs to stem cell therapy and cell secreted products. Bioreactor with mechanical stimulation is instrumental in preparing mature engineered tendon and ligament substitutes in vitro. Conclusions Tissue engineering showed great promise in replacing the damaged tendon and ligament. However, more study is needed to develop ideal engineered tendon and ligament.
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Affiliation(s)
- Wei Lee Lim
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Ling Ling Liau
- Department of Physiology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, JalanYaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Min Hwei Ng
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Shiplu Roy Chowdhury
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
| | - Jia Xian Law
- Tissue Engineering Centre, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, 56000 Kuala Lumpur, Malaysia
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Sinagra ZP, Kop A, Pabbruwe M, Parry J, Clark G. Foreign Body Reaction Associated With Artificial LARS Ligaments: A Retrieval Study. Orthop J Sports Med 2018; 6:2325967118811604. [PMID: 30547043 PMCID: PMC6287308 DOI: 10.1177/2325967118811604] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Artificial ligaments have been developed and used in the treatment of ligamentous injuries since the 1970s. The early generation of artificial ligaments showed promising short-term results but resulted in high rates of rupture and inflammatory reaction in the surrounding tissues. Purpose: To determine whether the use of Ligament Augmentation and Reconstruction System (LARS) ligaments is associated with the development of intra-articular foreign body reaction. Study Design: Case series; Level of evidence, 4. Methods: LARS ligaments were explanted from 15 patients under 6 consultant orthopaedic surgeons at 8 surgical centers. Of these, 14 explanted samples were sent for macroscopic and histological analysis, with the 1 remaining sample sent for scanning electron microscopy, to assess for inflammatory change as well as the degree of fibrous tissue ingrowth. Results: We observed a foreign body reaction in 10 of 14 explanted LARS ligaments. Seven samples demonstrated fibrous tissue ingrowth, with 5 producing only focal or incomplete ingrowth. The 2 samples with extensive fibrous coverage were completely free of any foreign body reaction, while all 5 remaining samples with only focal or partial fibrous ingrowth were associated with at least some degree of harmful immune response. Conclusion: The LARS ligament is still associated with a clinically significant degree of foreign body reaction despite the LARS Company’s efforts to reduce complications through improved design. The development and completion of fibrous tissue ingrowth may work to reduce the occurrence of a foreign body reaction.
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Affiliation(s)
| | - Alan Kop
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Moreica Pabbruwe
- Centre for Implant Technology and Retrieval Analysis, Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia
| | - Jeremy Parry
- Pathwest Laboratory Medicine WA, Fiona Stanley Hospital, Perth, Australia
| | - Gavin Clark
- St John of God Hospital, Subiaco, Perth, Australia
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Cengiz IF, Pereira H, de Girolamo L, Cucchiarini M, Espregueira-Mendes J, Reis RL, Oliveira JM. Orthopaedic regenerative tissue engineering en route to the holy grail: disequilibrium between the demand and the supply in the operating room. J Exp Orthop 2018; 5:14. [PMID: 29790042 PMCID: PMC5964057 DOI: 10.1186/s40634-018-0133-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
Orthopaedic disorders are very frequent, globally found and often partially unresolved despite the substantial advances in science and medicine. Their surgical intervention is multifarious and the most favourable treatment is chosen by the orthopaedic surgeon on a case-by-case basis depending on a number of factors related with the patient and the lesion. Numerous regenerative tissue engineering strategies have been developed and studied extensively in laboratory through in vitro experiments and preclinical in vivo trials with various established animal models, while a small proportion of them reached the operating room. However, based on the available literature, the current strategies have not yet achieved to fully solve the clinical problems. Thus, the gold standards, if existing, remain unchanged in the clinics, notwithstanding the known limitations and drawbacks. Herein, the involvement of regenerative tissue engineering in the clinical orthopaedics is reviewed. The current challenges are indicated and discussed in order to describe the current disequilibrium between the needs and solutions made available in the operating room. Regenerative tissue engineering is a very dynamic field that has a high growth rate and a great openness and ability to incorporate new technologies with passion to edge towards the Holy Grail that is functional tissue regeneration. Thus, the future of clinical solutions making use of regenerative tissue engineering principles for the management of orthopaedic disorders is firmly supported by the clinical need.
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Affiliation(s)
- Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal. .,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Hélder Pereira
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Madrid, Spain.,Orthopedic Department Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr Bldg 37, D-66421, Homburg/Saar, Germany
| | - João Espregueira-Mendes
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopedic Department, University of Minho, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
| | - Joaquim Miguel Oliveira
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
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Anterior Longitudinal Ligament Reconstruction to Reduce Hypermobility of Cervical and Lumbar Disc Arthroplasty. Asian Spine J 2017; 11:943-950. [PMID: 29279750 PMCID: PMC5738316 DOI: 10.4184/asj.2017.11.6.943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/28/2017] [Accepted: 03/23/2017] [Indexed: 12/21/2022] Open
Abstract
Study Design Retrospective case series Purpose This study aims to present the early clinical and radiological outcomes of anterior longitudinal ligament (ALL) reconstruction following disc arthroplasty. Overview of Literature Although cervical and lumbar disc arthroplasty have entered the clinical setting, there are still concerns regarding the short and long term complications arising from hypermobility of current prosthesis designs. Reconstruction of the ALL is a potential solution to disc arthroplasty hypermobility. Methods ALL reconstruction following disc arthroplasty have been performed by the senior author over a 24 month period. Ligament replacements used include allograft and synthetic, ligament advanced reinforcement system (LARS) ligaments. Methods of fixation used include titanium staples, bone anchors and suture fixation. Radiological follow-up pre- and postoperative Oswestry disability index, Neck Disability Index, Patient Satisfaction index scores were recorded on all patients. Results A total of 18 ALL reconstructions were performed. There have been no cases of early complications, revision surgery for recurrent symptoms or implant failure. Of the 6 patients receiving a minimum of 15 months follow-up, 4 patients received an allograft, 2 patients received the LARS ligament. Favourable, postoperative clinical and radiographic outcomes have been demonstrated. Conclusions ALL reconstruction following cervical and lumbar disc arthroplasty is a promising solution to addressing non-physiological kinematics of current disc arthroplasty devices. Randomized, controlled studies with larger study samples and long-term follow-up are required to establish these conclusions.
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