1
|
Liu N, Jiang J, Liu T, Chen H, Jiang N. Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue-Hard Tissue Insertions: A Comparative Review. ACS Biomater Sci Eng 2024; 10:2659-2679. [PMID: 38697939 DOI: 10.1021/acsbiomaterials.3c01796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Connective tissue attaches to bone across an insertion with spatial gradients in components, microstructure, and biomechanics. Due to regional stress concentrations between two mechanically dissimilar materials, the insertion is vulnerable to mechanical damage during joint movements and difficult to repair completely, which remains a significant clinical challenge. Despite interface stress concentrations, the native insertion physiologically functions as the effective load-transfer device between soft tissue and bone. This review summarizes tendon, ligament, and meniscus insertions cross-sectionally, which is novel in this field. Herein, the similarities and differences between the three kinds of insertions in terms of components, microstructure, and biomechanics are compared in great detail. This review begins with describing the basic components existing in the four zones (original soft tissue, uncalcified fibrocartilage, calcified fibrocartilage, and bone) of each kind of insertion, respectively. It then discusses the microstructure constructed from collagen, glycosaminoglycans (GAGs), minerals and others, which provides key support for the biomechanical properties and affects its physiological functions. Finally, the review continues by describing variations in mechanical properties at the millimeter, micrometer, and nanometer scale, which minimize stress concentrations and control stretch at the insertion. In summary, investigating the contrasts between the three has enlightening significance for future directions of repair strategies of insertion diseases and for bioinspired approaches to effective soft-hard interfaces and other tough and robust materials in medicine and engineering.
Collapse
Affiliation(s)
- Nian Liu
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610207, China
| | - Jialing Jiang
- West China School of Stomatology, Sichuan University, Chengdu, Sichuan 610207, China
| | - Tiancheng Liu
- West China Hospital, Sichuan University, Chengdu, Sichuan 610207, China
| | - Haozhe Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, China
| | - Nan Jiang
- State Key Laboratory of Oral Diseases, & National Clinical Research Center for Oral Disease, & West China Hospital of Stomatology and the Research Center for Nano Biomaterials, Analytical & Testing Center, Sichuan University, Chengdu, Sichuan 610041, China
| |
Collapse
|
2
|
Sánchez-Losilla C, Ferré-Aniorte A, Álvarez-Díaz P, Barastegui-Fernández D, Cugat R, Alentorn-Geli E. Efficacy of platelet-rich plasma in rotator cuff repair: systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:296-305. [PMID: 37270058 DOI: 10.1016/j.recot.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/17/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To analyze the efficacy and safety after the application of platelet-rich-plasma (PRP) as an adjuvant in arthroscopic rotator cuff repairs. MATERIAL AND METHODS A bibliographic search of the literature of prospective studies with level of evidence one or two was carried out from January 2004 to December 2021, including studies that compare the functional and re-tear results after arthroscopic cuff repair rotator with or without PRP. RESULTS A total of 281 articles were identified, of which 14 met the inclusion criteria. The overall re-rupture rate was 24%. In the PRP group, a decrease in the re-rupture rate and better functional results were demonstrated, although these differences were not significant. CONCLUSIONS Adjuvant treatment with PRP has shown promising results, although there is not yet enough evidence to provide a clear advantage for routine use in clinical practice.
Collapse
Affiliation(s)
| | - A Ferré-Aniorte
- Instituto Cugat, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - P Álvarez-Díaz
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - D Barastegui-Fernández
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España
| | - R Cugat
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
| | - E Alentorn-Geli
- Instituto Cugat, Barcelona, España; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, España; Fundación García-Cugat, Barcelona, España
| |
Collapse
|
3
|
Sánchez-Losilla C, Ferré-Aniorte A, Álvarez-Díaz P, Barastegui-Fernández D, Cugat R, Alentorn-Geli E. [Translated article] Efficacy of platelet-rich plasma in rotator cuff repair: Systematic review and meta-analysis. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T296-T305. [PMID: 38232930 DOI: 10.1016/j.recot.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/30/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE To analyse the efficacy and safety after the application of platelet-rich-plasma (PRP) as an adjuvant in arthroscopic rotator cuff repairs. MATERIAL AND METHODS A bibliographic search of the literature of prospective studies with level of evidence one or two was carried out from January 2004 to December 2021, including studies that compare the functional and re-tear results after arthroscopic cuff repair rotator with or without PRP. RESULTS A total of 281 articles were identified, of which 14 met the inclusion criteria. The overall re-rupture rate was 24%. In the PRP group, a decrease in the re-rupture rate and better functional results were demonstrated, although these differences were not significant. CONCLUSIONS Adjuvant treatment with PRP has shown promising results, although there is not yet enough evidence to provide a clear advantage for routine use in clinical practice.
Collapse
Affiliation(s)
| | - A Ferré-Aniorte
- Instituto Cugat, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - P Álvarez-Díaz
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - D Barastegui-Fernández
- Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain
| | - R Cugat
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| | - E Alentorn-Geli
- Instituto Cugat, Barcelona, Spain; Mutualidad de Futbolistas, Federación Española de Fútbol - Delegación Cataluña, Barcelona, Spain; Fundación García-Cugat, Barcelona, Spain
| |
Collapse
|
4
|
Shin KH, Kim JU, Jang IT, Han SB. Effect of Bone Marrow Stimulation on Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2024; 12:23259671231224482. [PMID: 38282788 PMCID: PMC10812110 DOI: 10.1177/23259671231224482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/16/2023] [Indexed: 01/30/2024] Open
Abstract
Background Arthroscopic rotator cuff repair (RCR) is a common orthopaedic procedure, but it has a high rate of retears that can negatively affect the functional outcomes. Bone marrow stimulation (BMS) has been suggested as an additional treatment to improve the outcomes of RCR. Purpose To compare the effectiveness of the BMS procedure during RCR with conventional RCR. Study Design Systematic review; Level of evidence, 2. Methods A systematic literature search was conducted in MEDLINE/PubMed, Embase, Cochrane Library, and Scopus, on March 1, 2023, for studies comparing postoperative retear rates and functional outcomes between patients who underwent primary arthroscopic RCR with and without the BMS procedure. Only level 1 and 2 randomized controlled trials with a minimum 12-month follow-up were included. The primary outcomes were retear rates and functional outcomes as measured by the Constant; American Shoulder and Elbow Surgeons (ASES); and University of California, Los Angeles (UCLA) scores and by postoperative range of motion. Subgroup analyses were performed based on repair technique (single-row repair vs double-row or suture-bridge repair). The standardized mean difference (SMD) and odds ratio (OR) were utilized to synthesize continuous and dichotomous outcomes, respectively. Homogeneity was evaluated using the chi-square test and I2 statistic. Results The literature search yielded 661 articles, of which 6 studies (522 patients; 261 with BMS, 261 without BMS) met the eligibility criteria. The combined analysis showed no significant decrease in retear rates with the utilization of the BMS procedure during RCR (OR, 0.60; 95% CI, 0.35 to 1.03; P = .07; I2 = 24%). There was no significant intergroup difference in functional outcomes (Constant score: SMD, 0.13; 95% CI, -0.04 to 0.31; P = .13; I2 = 0%; ASES score: SMD, 0.04; 95% CI, -0.20 to 0.28; P = .73; I2 = 0%; UCLA score: SMD, -0.13; 95% CI, -0.50 to 0.23; P = .47; I2 = 0%). Subgroup analyses revealed no significant differences in postoperative retear risk or total Constant score according to the repair technique. Conclusion Based on the available evidence, this systematic review did not find a significant benefit of the BMS procedure at the footprint during arthroscopic RCR compared with conventional RCR in terms of retear rates and functional outcomes at short-term follow-up.
Collapse
Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Jin-Uk Kim
- Department of Orthopedic Surgery, Incheon Nanoori Hospital, Incheon, South Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul, South Korea
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| |
Collapse
|
5
|
Malavolta EA, Miceli VL, Assunção JH, Andrade-Silva FB, Gracitelli MEC, Tatsui NH, Espirandelli LC, Ferreira AA. MESENCHYMAL CELLS IN ROTATOR CUFF REPAIR - TECHNIQUE DESCRIPTION AND CASE REPORTS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e268392. [PMID: 38115873 PMCID: PMC10726706 DOI: 10.1590/1413-785220233105e268392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/17/2023] [Indexed: 12/21/2023]
Abstract
Objective To describe a protocol of obtention of mesenchymal stem cells and to report their use as a biological adjuvant in three patients undergoing arthroscopic rotator cuff repair. Methods Case series of patients who underwent arthroscopic repair of isolated full-thickness supraspinatus tear using mesenchymal stem cells obtained from the bone marrow as a biological adjuvant. All patients were operated on at the same institution, by a surgeon with 13 years of experience. The cells were applied at the end of the procedure, at the tendon-bone interface, at an approximate concentration of 2,000,000 mesenchymal cells/mm3 and a total volume of 5 ml. Results All patients improved with the procedure, with one excellent and two good results. All cases overcame the minimally important clinical difference. All cases reached tendon healing, without partial or complete re-tears. We observed no complications. Conclusion Arthroscopic rotator cuff repair with added mesenchymal cells obtained from bone marrow and submitted to a cell expansion process led to good functional results and healing in all cases in the sample, with no complications. Level of Evidence IV, Case Series.
Collapse
Affiliation(s)
- Eduardo Angeli Malavolta
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, São Paulo, SP, Brazil
- Hcor, São Paulo, SP, Brazil
| | - Vinicius Lamboglia Miceli
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, São Paulo, SP, Brazil
| | - Jorge Henrique Assunção
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, São Paulo, SP, Brazil
| | | | | | - Nelson Hidekazu Tatsui
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, São Paulo, SP, Brazil
- Criogenesis Biotecnologia Ltda, São Paulo, SP, Brazil
| | | | - Arnaldo Amado Ferreira
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas HC-FMUSP, São Paulo, SP, Brazil
| |
Collapse
|
6
|
Taniguchi N. Editorial Commentary: Bone Marrow Stimulation and Losartan Augmentation of Shoulder Rotator Cuff Repair. Arthroscopy 2023; 39:2420-2422. [PMID: 37981385 DOI: 10.1016/j.arthro.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 11/21/2023]
Abstract
Rotator cuff retear rates after repair have been variously reported as ranging from 5% to 40% for small to mediums tears and as high as 40% to 94% for large to massive tears. Thus strategies to enhance structural healing are relevant. In rabbits, combining oral losartan (which has antifibrotic effects by downregulating transforming growth factor-β1) and bone marrow stimulation (BMS) of the greater tuberosity, showed improved rotator cuff repair pull-out strength and highly organized tendon matrix in a chronic injury model, whereas BMS alone did not improve the mechanical properties. However, clinical studies show that BMS techniques have a positive impact on healing and retear rates. BMS stimulates migration of mesenchymal stem cells from bone marrow to the lesion, and this approach has been widely used to fill cartilage defects by fibrocartilage metaplasia. BMS is a straightforward and cost-effective technique; the use of multiple deeper bone tunnels is recommended.
Collapse
|
7
|
Sethi P, Fares MY, Murthi A, Tokish JM, Abboud JA. The long head of the biceps tendon: a valuable tool in shoulder surgery. J Shoulder Elbow Surg 2023; 32:1801-1811. [PMID: 37245621 DOI: 10.1016/j.jse.2023.04.009] [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: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/05/2023] [Indexed: 05/30/2023]
Abstract
ANATOMY AND FUNCTION The long head of the biceps tendon (LHBT) has different properties and characteristics that render it a valuable tool in the hands of shoulder surgeons. Its accessibility, biomechanical strength, regenerative capabilities, and biocompatibility allow it to be a valuable autologous graft for repairing and augmenting ligamentous and muscular structures in the glenohumeral joint. SHOULDER SURGERY APPLICATIONS Numerous applications of the LHBT have been described in the shoulder surgery literature, including augmentation of posterior-superior rotator cuff repair, augmentation of subscapularis peel repair, dynamic anterior stabilization, anterior capsule reconstruction, post-stroke stabilization, and superior capsular reconstruction. Some of these applications have been described meticulously in technical notes and case reports, whereas others may require additional research to confirm clinical benefit and efficacy. CONCLUSION This review examines the role of the LHBT as a source of local autograft, with biological and biomechanical properties, in aiding outcomes of complex primary and revision shoulder surgery procedures.
Collapse
Affiliation(s)
- Paul Sethi
- Orthopedic and Neurosurgical Specialists, ONS Foundation, Greenwich, CT, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Anand Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
| |
Collapse
|
8
|
Velasquez Garcia A, Ingala Martini L, Franco Abache A, Abdo G. Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy. World J Orthop 2023; 14:505-515. [PMID: 37485430 PMCID: PMC10359750 DOI: 10.5312/wjo.v14.i7.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/15/2023] [Indexed: 07/18/2023] Open
Abstract
Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.
Collapse
Affiliation(s)
| | - Liborio Ingala Martini
- Department of Orthopedic Surgery, Hospital IVSS Dr. Luis Ortega, Porlamar 6301, Venezuela
- Department of Orthopedic Surgery, Hospital Clinicas del Este, Los Robles 6301, Venezuela
| | - Andres Franco Abache
- Department of Orthopedic Surgery, Hospital de Especialidades Guayaquil MSP, Guayaquil 090101, Ecuador
| | - Glen Abdo
- Department of Graduate Medical Education, Internal Medicine Residence Program, New York Medical College at St. Mary’s and St. Clare’s, Passaic, NJ 07055, United States
| |
Collapse
|
9
|
Kim MS, Rhee SM, Cho NS. Increased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates. Arthroscopy 2023; 39:176-182. [PMID: 36049586 DOI: 10.1016/j.arthro.2022.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/02/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether glycemic control affects the integrity of the repaired rotator cuff during the postoperative healing period after arthroscopic double-row suture bridge rotator cuff repair (RCR) METHODS: We retrospectively reviewed patients with diabetes mellitus (DM) who underwent arthroscopic double-row suture bridge RCR at our institution between March 2016 and November 2019. We included the patients who evaluated for serum glycosylated hemoglobin (HbA1c) levels within 1 month before and 3-6 months after surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were categorized into two groups based on comparison between preoperative and postoperative HbA1c values: Group I (increased postoperative HbA1c) and Group D (same or decreased postoperative HbA1c). The correlation between preoperative/postoperative HbA1c, HbA1c increase/same or decrease (during the healing period), and post-RCR integrity was evaluated, including various demographic and radiologic factors. RESULTS A total of 103 patients were analyzed, group I was 47, and group D was 56, respectively. The retear rate of 51.1% (24/47) in Group I was significantly higher than 14.3% (8/56) in Group D (P < .001). HbA1c levels measured 3-6 months after surgery (mean: 6.9; 95% CI: 6.6-7.3 vs mean: 6.5; 95% CI: 6.3-6.7, P = .034), and the proportion of group I and group D were significantly different (75%/25% vs 32.4%/67.6%, P < .001) between the retear and healing groups. Multivariable logistic regression analysis identified increased HbA1c as an independent risk factor for retear (odds ratio: 5.402; 95% CI: 2.072-14.086; P < .001). CONCLUSIONS The glycemic control within 3-6 months after surgery when the healing process of the tendon was in progress had a significant effect on retear rate. In particular, the retear rate was higher when the HbA1c level increased at postoperative 3-6 months compared to before surgery. LEVEL OF EVIDENCE Retrospective case-control comparative study, Level III.
Collapse
Affiliation(s)
- Myung Seo Kim
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea; College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Nam Su Cho
- Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Republic of Korea.
| |
Collapse
|
10
|
Miescher I, Rieber J, Calcagni M, Buschmann J. In Vitro and In Vivo Effects of IGF-1 Delivery Strategies on Tendon Healing: A Review. Int J Mol Sci 2023; 24:ijms24032370. [PMID: 36768692 PMCID: PMC9916536 DOI: 10.3390/ijms24032370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/18/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023] Open
Abstract
Tendon injuries suffer from a slow healing, often ending up in fibrovascular scar formation, leading to inferior mechanical properties and even re-rupture upon resumption of daily work or sports. Strategies including the application of growth factors have been under view for decades. Insulin-like growth factor-1 (IGF-1) is one of the used growth factors and has been applied to tenocyte in vitro cultures as well as in animal preclinical models and to human patients due to its anabolic and matrix stimulating effects. In this narrative review, we cover the current literature on IGF-1, its mechanism of action, in vitro cell cultures (tenocytes and mesenchymal stem cells), as well as in vivo experiments. We conclude from this overview that IGF-1 is a potent stimulus for improving tendon healing due to its inherent support of cell proliferation, DNA and matrix synthesis, particularly collagen I, which is the main component of tendon tissue. Nevertheless, more in vivo studies have to be performed in order to pave the way for an IGF-1 application in orthopedic clinics.
Collapse
|
11
|
Liu X, Li Y, Wang S, Lu M, Zou J, Shi Z, Xu B, Wang W, Hu B, Jin T, Wu F, Liu S, Fan C. PDGF-loaded microneedles promote tendon healing through p38/cyclin D1 pathway mediated angiogenesis. Mater Today Bio 2022; 16:100428. [PMID: 36238965 PMCID: PMC9552114 DOI: 10.1016/j.mtbio.2022.100428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/15/2022] Open
Abstract
Tendon injury is one of the most serious orthopedic diseases often leading to disability of patients. Major shortages of tendon healing are due to its multiple comorbidities, uncertainty of therapeutic efficacy and insufficient of angiogenesis. With a deeper understanding of angiogenic mechanism of tendon healing, we investigated an innovative microneedle patch loaded with platelet derived growth factor (PDGF) to achieve a constant systemic administration of PDGF to enhance topical tendon healing. Rat achilles tendon injury model was performed as in vivo animal models. Histological staining showed an enhancement of tendon healing quality, especially angiogenesis. Biomechanical studies demonstrated an increase of tendon stiffness, maximum load and maximum stress with treatment of PDGF-loaded microneedles. Furthermore, MAPK/p38/Cyclin D1 pathway and angiogenesis were found to play an important role in tendon healing process by using a biological high throughput RNA-sequence method and bioinformatic analysis. The high throughput RNA-seq tendon healing results were confirmed by histochemical staining and western blot. These results suggest the novel therapeutic potential of PDGF-loaded microneedle patch in tendon surgery.
Collapse
Affiliation(s)
- Xuanzhe Liu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Yuange Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Shuo Wang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Mingkuan Lu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Jian Zou
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Binbin Xu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Wei Wang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
| | - Bo Hu
- Department of Spine Surgery, Changzheng Hospital, Naval Medical University, China
| | - Tuo Jin
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
| | - Fei Wu
- School of Pharmacy, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, China
- Corresponding author.
| | - Shen Liu
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Corresponding author.
| | - Cunyi Fan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Corresponding author. Cunyi Fan,
| |
Collapse
|
12
|
Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
Collapse
|
13
|
Colbath G, Murray A, Siatkowski S, Pate T, Krussig M, Pill S, Hawkins R, Tokish J, Mercuri J. Autograft Long Head Biceps Tendon Can Be Used as a Scaffold for Biologically Augmenting Rotator Cuff Repairs. Arthroscopy 2022; 38:38-48. [PMID: 34126215 PMCID: PMC8665938 DOI: 10.1016/j.arthro.2021.05.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We create a viable, mechanically expanded autograft long head biceps tendon (LHBT) scaffold for biologically augmenting the repair of torn rotator cuffs. METHODS The proximal aspect of the tenotomized LHBTs was harvested from patients during rotator cuff repair surgery and was mechanically formed into porous scaffolds using a surgical graft expander. LHBT scaffolds were evaluated for change in area, tensile properties, and tenocyte viability before and after expansion. The ability of endogenous tenocytes derived from the LHBT scaffold to promote tenogenic differentiation of human adipose-derived mesenchymal stromal cells (ADMSCs) was also determined. RESULTS Autograft LHBTs were successfully expanded using a modified surgical graft expander to create a porous scaffold containing viable resident tenoctyes from patients undergoing rotator cuff repair. LHBT scaffolds had significantly increased area (length: 24.91 mm [13.91, 35.90] × width: 22.69 mm [1.87, 34.50]; P = .011) compared with the native LHBT tendon (length: 27.16 mm [2.70, 33.62] × width: 6.68 mm [5.62, 7.74]). The structural properties of the autograft were altered, including the ultimate tensile strength (LHBT scaffold: .56 MPa [.06, 1.06] vs. native LHBT: 2.35 MPa [1.36, 3.33]; P = .002) and tensile modulus (LHBT scaffold: 4.72 MPa [-.80, 1.24] versus native LHBT: 37.17 MPa [24.56, 49.78]; P = .001). There was also a reduction in resident tenocyte percent viability (LHBT scaffold: 38.52% [17.94, 59.09] vs. native LHBT: 68.87% [63.67, 74.37]; P =.004). Tenocytes derived from the LHBT scaffold produced soluble signals that initiated ADMSC differentiation into an immature tenocyte-like phenotype, as indicated by an 8.7× increase in scleraxis (P = .040) and a 3.6× increase in collagen type III mRNA expression (P = .050) compared with undifferentiated ADMSC controls. CONCLUSIONS The ability to produce a viable autologous scaffold from the proximal biceps tendon having dimensions, porosity, mechanical characteristics, native ECM components, and viable tenocytes that produce bioactive signals conducive to supporting the biologic augmentation of rotator cuff repair surgery has been demonstrated. CLINICAL RELEVANCE This biologically active construct may help to improve the quality of healing and regeneration at the repair site of rotator cuff tears, especially those at high risk for retear.
Collapse
Affiliation(s)
- Gregory Colbath
- Medical Group of the Carolinas, Department of Orthopaedic Surgery, Spartanburg Regional, Spartanburg, SC
| | - Alison Murray
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Sandra Siatkowski
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Taylor Pate
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Mario Krussig
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| | - Stephan Pill
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - Richard Hawkins
- Steadman Hawkins Clinic of the Carolinas, Department of Orthopaedic Surgery, Prisma Health, Greenville, SC
| | - John Tokish
- Mayo Clinic, Department of Orthopaedic Surgery, Phoenix, AZ
| | - Jeremy Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, SC,Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, SC
| |
Collapse
|
14
|
Electrospun tube reduces adhesion in rabbit Achilles tendon 12 weeks post-surgery without PAR-2 overexpression. Sci Rep 2021; 11:23293. [PMID: 34857838 PMCID: PMC8639666 DOI: 10.1038/s41598-021-02780-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/22/2021] [Indexed: 01/12/2023] Open
Abstract
One great challenge in surgical tendon repair is the minimization of peritendinous adhesions. An electrospun tube can serve as a physical barrier around a conventionally sutured tendon. Six New Zealand White rabbits had one Achilles tendon fully transsected and sutured by a 4-strand suture. Another six rabbits had the same treatment, but with the additional electrospun DegraPol tube set around the sutured tendon. The adhesion formation to the surrounding tissue was investigated 12 weeks post-operation. Moreover, inflammation-related protease-activated receptor-2 (PAR-2) protein expression was assessed. Finally, rabbit Achilles tenocyte cultures were exposed to platelet-derived growth factor-BB (PDGF-BB), which mimicks the tendon healing environment, where PAR-2 gene expression was assessed as well as immunofluorescent staining intensity for F-actin and α-tubulin, respectively. At 12 weeks post-operation, the partially degraded DegraPol tube exhibited significantly lower adhesion formation (- 20%). PAR-2 protein expression was similar for time points 3 and 6 weeks, but increased at 12 weeks post-operation. In vitro cell culture experiments showed a significantly higher PAR-2 gene expression on day 3 after exposure to PDGF-BB, but not on day 7. The cytoskeleton of the tenocytes changed upon PDGF-BB stimulation, with signs of reorganization, and significantly decreased F-actin intensity. An electrospun DegraPol tube significantly reduces adhesion up to twelve weeks post-operation. At this time point, the tube is partially degraded, and a slight PAR-2 increase was detected in the DP treated tendons, which might however arise from particles of degrading DegraPol that were stained dark brown. PAR-2 gene expression in rabbit tenocytes reveals sensitivity at around day 10 after injury.
Collapse
|
15
|
Jiang X, Wojtkiewicz M, Patwardhan C, Greer S, Kong Y, Kuss M, Huang X, Liao J, Lu Y, Dudley A, Gundry RL, Fuchs M, Streubel P, Duan B. The effects of maturation and aging on the rotator cuff tendon-to-bone interface. FASEB J 2021; 35:e22066. [PMID: 34822203 DOI: 10.1096/fj.202101484r] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 12/19/2022]
Abstract
Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area, with a high prevalence for the elderly population, but the underlying reason for this phenomenon is still unknown. The objective of this study is to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging in a mouse model. Four different age groups of mice (newborn, young, adult, and old) were studied. Striking variations of the entheses were observed between the newborn and other matured groups, with collagen content, proteoglycan deposition, collagen fiber dispersion was significantly higher in the newborn group. The compositional and histological features of young, adult, and old groups did not show significant differences, except having increased proteoglycan deposition and thinner collagen fibers at the insertion sites in the old group. Nanoindentation testing showed that the old group had a smaller compressive modulus at the insertion site when compared with other groups. However, tensile mechanical testing reported that the old group demonstrated a significantly higher failure stress when compared with the young and adult groups. The proteomics analysis detected dramatic differences in protein content between newborn and young groups but minor changes among young, adult, and old groups. These results demonstrated: (1) the significant alterations of the enthesis composition and structure occur from the newborn to the young time period; (2) the increased risk of rotator cuff tendon injuries in the elderly population is not solely because of old age alone in the rodent model.
Collapse
Affiliation(s)
- Xiping Jiang
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Molecular Genetics and Cell Biology Program, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melinda Wojtkiewicz
- CardiOmics Program, Center for Heart and Vascular Research, Division of Cardiovascular Medicine, and Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Chinmay Patwardhan
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Sydney Greer
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Molecular Genetics and Cell Biology Program, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Yunfan Kong
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mitchell Kuss
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Xi Huang
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Jun Liao
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas, USA
| | - Yongfeng Lu
- Department of Electrical and Computer Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Andrew Dudley
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Molecular Genetics and Cell Biology Program, Department of Genetics, Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rebekah L Gundry
- CardiOmics Program, Center for Heart and Vascular Research, Division of Cardiovascular Medicine, and Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Matthias Fuchs
- Department of Physics and Astronomy, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Philipp Streubel
- Department of Orthopedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Bin Duan
- Mary & Dick Holland Regenerative Medicine Program, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| |
Collapse
|
16
|
Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
Collapse
Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
17
|
Liu B, Jeong HJ, Yeo JH, Oh JH. Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial. Orthop J Sports Med 2021; 9:23259671211006100. [PMID: 34159208 PMCID: PMC8182201 DOI: 10.1177/23259671211006100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Platelet-rich plasma (PRP) has been applied as an adjuvant treatment for
arthroscopic rotator cuff repair (ARCR) to enhance rotator cuff healing.
However, it remains debatable whether PRP enhances tendon-to-bone
healing. Purpose: To assess the efficacy of intraoperative augmentation and postoperative
injection of PRP that was prepared using the double-spin method and calcium
activation without thrombin in patients with ARCR. Study Design: Randomized controlled trial; Level of evidence, 1; and cohort study; Level of
evidence, 3. Methods: A total of 58 patients underwent ARCR using intraoperative PRP augmentation.
Half of the patients were randomly assigned to receive an additional
ultrasound-guided PRP injection at the repair site at 2 weeks
postoperatively (PRP-booster group); the other half did not receive the
booster injection (PRP-only group). A control group that did not receive any
PRP treatment was retrospectively matched using propensity score matching.
Structural integrity was assessed using magnetic resonance imaging at 1 year
postoperatively, and healing rates were compared between patients with tear
sizes ≤2 cm versus >2 cm. Functional outcomes were assessed using the
visual analog scale (VAS) for pain; VAS for satisfaction; shoulder range of
motion; and Constant, American Shoulder and Elbow Surgeons, and Simple
Shoulder Test scores at minimum 2-year follow-up. Results: In patients with tears >2 cm, the rate of healing failure at 1-year
follow-up was significantly less in the overall PRP group than in the
control group (12.9% vs 35.7%, respectively; P = .040),
however, the PRP-booster group did not present a better healing rate than
did the PRP-only group. The overall PRP group had lower VAS for pain scores
compared with the control group (0.5 ± 1.1 vs 1.3 ± 1.8, respectively;
P = .016) and higher VAS for satisfaction scores (9.2 ±
1.2 vs 8.6 ± 1.7; P = .023) at the final follow-up, whereas
no statistical difference was found between the PRP-only and PRP-booster
groups in functional outcomes. Conclusion: Intraoperative PRP augmentation during ARCR demonstrated superior anatomic
healing results in patients with rotator cuff tears >2 cm as well as
reduced pain and increased subjective satisfaction. PRP booster injection
provided no additional benefit to tendon integrity or functional
recovery.
Collapse
Affiliation(s)
- Bei Liu
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Hyeon Jang Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Ji Hyun Yeo
- Department of Orthopaedic Surgery, Dongguk University College of Medicine, Dongguk University Ilsan Hospital, Goyangsi, Republic of Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| |
Collapse
|
18
|
Xiao H, Chen Y, Li M, Shi Q, Xu Y, Hu J, Li X, Chen C, Lu H. Cell-Free Book-Shaped Decellularized Tendon Matrix Graft Capable of Controlled Release of BMP-12 to Improve Tendon Healing in a Rat Model. Am J Sports Med 2021; 49:1333-1347. [PMID: 33667134 DOI: 10.1177/0363546521994555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Achilles tendon (AT) defects often occur in traumatic and chronic injuries. Currently, no graft can satisfactorily regenerate parallel tendinous tissue at the defect site to completely restore AT function. PURPOSE To develop a cell-free functional graft by tethering bone morphogenetic protein 12 (BMP-12) on a book-shaped decellularized tendon matrix (BDTM) and to determine whether this graft is more beneficial for AT defect healing than an autograft. STUDY DESIGN Controlled laboratory study. METHODS Canine patellar tendon was sectioned into a book shape and decellularized to fabricate a BDTM. The collagen-binding domain (CBD) was fused into the N-terminus of BMP-12 to synthesize a recombinant BMP-12 (CBD-BMP-12), which was tethered to the BDTM to prepare a cell-free functional graft (CBD-BMP-12/BDTM). After its tensile resistance, tenogenic inducibility, and BMP-12 release dynamics were evaluated, the efficacy of the graft for tendon regeneration was determined in a rat model. A total of 140 mature male Sprague-Dawley rats underwent AT tenotomy. The defect was reconstructed with reversed AT (autograft group), native BMP-12 tethered to an intact decellularized tendon matrix (IDTM; NAT-BMP-12/IDTM group), native BMP-12 tethered to a BDTM (NAT-BMP-12/BDTM group), CBD-BMP-12 tethered on an IDTM (CBD-BMP-12/IDTM group), and CBD-BMP-12 tethered on a BDTM (CBD-BMP-12/BDTM group). The rats were sacrificed 4 or 8 weeks after surgery to harvest AT specimens. Six specimens from each group at each time point were used for histological evaluation; the remaining 8 specimens were used for biomechanical testing. RESULTS In vitro CBD-BMP-12/BDTM was noncytotoxic, showed high biomimetics with native tendons, was suitable for cell adhesion and growth, and had superior tenogenic inducibility. In vivo the defective AT in the CBD-BMP-12/BDTM group regenerated more naturally than in the other groups, as indicated by more spindle-shaped fibroblasts embedded in a matrix of parallel fibers. The biomechanical properties of the regenerated AT in the CBD-BMP-12/BDTM group also increased more significantly than in the other groups. CONCLUSION CBD-BMP-12/BDTM is more beneficial than autograft for healing AT defects in a rat model. CLINICAL RELEVANCE The findings of this study demonstrate that CBD-BMP-12/BDTM can serve as a practical graft for reconstructing AT defects.
Collapse
Affiliation(s)
- Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Muzhi Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Qiang Shi
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Yan Xu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xing Li
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Can Chen
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Hunan Engineering Research Center of Sports and Health, Central South University, Changsha, China
- Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, Changsha, China
| |
Collapse
|
19
|
Muench LN, Tamburini L, Kriscenski D, Landry A, Berthold DP, Kia C, Cote MP, McCarthy MB, Mazzocca AD. The Effect of Insulin and Insulin-like Growth Factor 1 (IGF-1) on Cellular Proliferation and Migration of Human Subacromial Bursa Tissue. Arthrosc Sports Med Rehabil 2021; 3:e781-e789. [PMID: 34195645 PMCID: PMC8220627 DOI: 10.1016/j.asmr.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose To evaluate the effect of a one-time dose of insulin or insulin-like growth factor 1 (IGF-1) on cellular proliferation and migration of subacromial bursa tissue (SBT) over time. Methods SBT was harvested from over the rotator cuff tendon in 4 consecutive patients undergoing primary arthroscopic rotator cuff repair. SBT was cultured for 3 weeks in complete media until reaching confluence. The culture dishes were stored in a humidified, low oxygen tension (5% CO2) incubator at 37°C. SBT of each patient underwent treatment with a one-time dose of insulin or IGF-1, whereas nontreated SBT served as a negative control. Cellular proliferation and migration were evaluated after 24, 48, 72, and 96 hours of incubation. SBT-derived cells migrated in the detection field were visualized using fluorescent microscopy. Results Cellular proliferation at 24, 48, 72, and 96 hours was 1.40 ± 0.27, 1.00 ± 0.20, 1.47 ± 0.31, and 1.68 ± 0.28 for IGF-1; 1.44 ± 0.24, 1.15 ± 0.27, 1.60 ± 0.36, and 1.61 ± 0.32 for insulin; and 1.51 ± 0.35, 1.29 ± 0.33, 1.53 ± 0.35, and 1.57 ± 0.38 for nontreated SBT. Untreated SBT demonstrated a significantly greater proliferation when compared with IGF-1 and insulin within the first 48 hours, although this effect was found to subside by 96 hours. Cellular migration at 24, 48, 72, and 96 hours was 575.7 ± 45.0, 641.6 ± 77.7, 728.3 ± 122.9, and 752.3 ± 114.5 for IGF-1; 528.4 ± 31.3, 592.5 ± 69.8, 664.2 ± 115.2, and 695.6 ± 148.2 for insulin; and 524.4 ± 41.9, 564.4 ± 49.8, 653.2 ± 81.5, and 685.7 ± 115.5 for nontreated SBT. Insulin showed no difference in migration at each timepoint compared to nontreated SBT (P > .05, respectively). Conclusions Insulin and IGF-1 initially inhibit cellular proliferation of human SBT, although this effect was found to subside by 96 hours. Further, neither insulin nor IGF-1 changed the slope of cellular migration over time. However, each treatment group demonstrated a significant increase in cellular proliferation and migration. Clinical Relevance In the setting of biologic augmentation of rotator cuff repair, the compatibility and synergistic effect of insulin on human SBT is highly limited.
Collapse
Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Arthur Landry
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| |
Collapse
|
20
|
Huang C, Zhang X, Luo H, Pan J, Cui W, Cheng B, Zhao S, Chen G. Effect of kartogenin-loaded gelatin methacryloyl hydrogel scaffold with bone marrow stimulation for enthesis healing in rotator cuff repair. J Shoulder Elbow Surg 2021; 30:544-553. [PMID: 32650072 DOI: 10.1016/j.jse.2020.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Strategies involving microfracture, biomaterials, growth factors, and chemical agents have been evaluated for improving enthesis healing. Kartogenin (KGN) promotes selective differentiation of bone marrow mesenchymal stem cells (BMSCs) into chondrocytes. Gelatin methacryloyl (GelMA) is a promising biomaterial for engineering scaffolds and drug carriers. Herein, we investigated KGN-loaded GelMA hydrogel scaffolds with a bone marrow-stimulating technique for the repair of rotator cuff tear. METHODS KGN-loaded GelMA hydrogel scaffolds were obtained by ultraviolet GelMA crosslinking and vacuum freeze-drying. Fifty-four New Zealand rabbits were randomly divided into (1) repair only (control), (2) microfracture + repair (BMS), and (3) microfracture + repair augmentation with a KGN-loaded GelMA hydrogel scaffold (combined) groups. Tendons were repaired by transosseous sutures. The structure, degradation, and in vitro KGN release of the scaffolds were characterized. Animals were euthanized 4, 8, and 12 weeks after repair. Enthesis healing was evaluated by macroscopy, microcomputed tomography, histology, and biomechanical tests. RESULTS The KGN-loaded GelMA hydrogel scaffolds are porous with a 60.4 ± 28.2-μm average pore size, and they degrade quickly in 2.5 units/mL collagenase solution. Nearly 81% of KGN was released into phosphate-buffered saline within 12 hours, whereas the remaining KGN was released in 7 days. Macroscopically, the repaired tendons were attached to the footprint. No differences were detected postoperatively in microcomputed tomography analysis among groups. Fibrous scar tissue was the main component at the tendon-to-bone interface in the control group. Disorderly arranged cartilage formation was observed at the tendon-to-bone interface in the BMS and combined groups 4 weeks after repair; the combined group exhibited relatively more cartilage. The combined group showed improved cartilage regeneration 8 and 12 weeks after repair. Similar results were found in tendon maturation scores. The ultimate load to failure and stiffness of the repaired tendon increased in all 3 groups. At 4 weeks after repair, the BMS and combined groups exhibited greater ultimate load to failure than the control group, although there was no difference in stiffness among groups. The BMS and combined groups exhibited greater ultimate load to failure and stiffness than the control group, and the combined group exhibited better values than the BMS group at 8 and 12 weeks after repair. CONCLUSION Compared with the bone marrow-stimulating technique, the KGN-loaded GelMA hydrogel scaffold with bone marrow stimulation improved enthesis healing by promoting fibrocartilage formation and improving the mechanical properties.
Collapse
Affiliation(s)
- Chenglong Huang
- Department of Orthopedics, Clinical Medical School, The Affiliated Shanghai No. 10 People's Hospital, Nanjing Medical University, Shanghai, China; Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Xuancheng Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Huanhuan Luo
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Jieen Pan
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Wenguo Cui
- Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Biao Cheng
- Department of Orthopedics, Clinical Medical School, The Affiliated Shanghai No. 10 People's Hospital, Nanjing Medical University, Shanghai, China.
| | - Song Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Gang Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
| |
Collapse
|
21
|
Kraus NR, Garvey KD, Higgins LD, Matzkin E. Ibuprofen Use Did Not Affect Outcome Metrics After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e491-e497. [PMID: 34027460 PMCID: PMC8129460 DOI: 10.1016/j.asmr.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/15/2020] [Indexed: 01/02/2023] Open
Abstract
Purpose To determine whether patients who are prescribed ibuprofen after arthroscopic rotator cuff repair have significantly different patient-reported outcomes for pain, function, and overall health at baseline and 1 and 2 years after operation relative to patients only prescribed opioids. Methods Patients who underwent a rotator cuff repair by a total of 3 surgeons and participated in the outcomes registry from 2012 to 2016 were screened for inclusion in this study. Inclusion criteria were primary arthroscopic rotator cuff repair, at least 2 years from the date of surgery and over the age of 18. Exclusion criteria were revision and open rotator cuff repair. All patients followed the standard postoperative rehabilitation protocol for rotator cuff repair. Patients were divided into 2 cohorts. Group I included patients who received ibuprofen/nonsteroidal anti-inflammatory agents (NSAID) after surgery (n = 281), and Group II consisted of patients who did not receive ibuprofen/NSAID after surgery (n = 182). Patient-reported outcome measures for Visual Analogue Scale, American Shoulder Elbow Surgeons score, Single Assessment Numeric Evaluation score, Simple Shoulder Test and The Veterans Rand 12-Item Health Survey were collected preoperatively and at 3 and 6 months, 1 year, and 2 years after surgery. Statistical analysis was performed to compare patient-reported outcome measures between Group I and II. Results This study consisted of 463 patients who underwent arthroscopic rotator cuff repair, and patients were divided into 2 cohorts. There were 281 patients who did not receive ibuprofen/NSAID after operation in Group I and 182 patients who did receive ibuprofen in Group II. There were no statistically significant differences between the 2 groups in age at treatment, mean body mass index, gender, ethnicity, diabetes, and number of rotator cuff tendons involved; however, there was a statistically significant difference in receiving worker’s compensation (P = .005), and this was subsequently adjusted for in our analysis. There were no significant differences in patient-reported outcomes for all metrics between the group prescribed ibuprofen and the group that was not prescribed ibuprofen at 1 and 2 years after surgery or in change from baseline. Conclusion Patients receiving ibuprofen did as well as patients who did not receive ibuprofen after arthroscopic rotator cuff repair on patient-reported outcome measures assessing shoulder pain, function, and overall health. Level of Evidence Level III, retrospective comparative study.
Collapse
Affiliation(s)
- Nicholas R Kraus
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kirsten D Garvey
- Tufts University School of Medicine, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Laurence D Higgins
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
22
|
Tsiapalis D, Kearns S, Kelly JL, Zeugolis DI. Growth factor and macromolecular crowding supplementation in human tenocyte culture. BIOMATERIALS AND BIOSYSTEMS 2021; 1:100009. [PMID: 36825160 PMCID: PMC9934496 DOI: 10.1016/j.bbiosy.2021.100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 01/20/2023] Open
Abstract
Cell-assembled tissue engineering strategies hold great potential in regenerative medicine, as three-dimensional tissue-like modules can be produced, even from a patient's own cells. However, the development of such implantable devices requires prolonged in vitro culture time, which is associated with cell phenotypic drift. Considering that the cells in vivo are subjected to numerous stimuli, multifactorial approaches are continuously gaining pace towards controlling cell fate during in vitro expansion. Herein, we assessed the synergistic effect of simultaneous and serial growth factor supplementation (insulin growth factor-1, platelet-derived growth factor ββ, growth differentiation factor 5 and transforming growth factor β3) to macromolecular crowding (carrageenan) in human tenocyte function; collagen synthesis and deposition; and gene expression. TGFβ3 supplementation (without/with carrageenan) induced the highest (among all groups) DNA content. In all cases, tenocyte proliferation was significantly increased as a function of time in culture, whilst metabolic activity was not affected. Carrageenan supplementation induced significantly higher collagen deposition than groups without carrageenan (without/with any growth factor). Of all the growth factors used, TGFβ3 induced the highest collagen deposition when used together with carrageenan in both simultaneous and serial fashion. At day 13, gene expression analysis revealed that TGFβ3 in serial supplementation to carrageenan upregulated the most and downregulated the least collagen- and tendon- related genes and upregulated the least and downregulated the most osteo-, chondro-, fibrosis- and adipose- related trans-differentiation genes. Collectively, these data clearly advocate the beneficial effects of multifactorial approaches (in this case, growth factor and macromolecular crowding supplementation) in the development of functional cell-assembled tissue surrogates.
Collapse
Affiliation(s)
- Dimitrios Tsiapalis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | | | | | - Dimitrios I. Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Corresponding authors.
| |
Collapse
|
23
|
Bianchi E, Ruggeri M, Rossi S, Vigani B, Miele D, Bonferoni MC, Sandri G, Ferrari F. Innovative Strategies in Tendon Tissue Engineering. Pharmaceutics 2021; 13:89. [PMID: 33440840 PMCID: PMC7827834 DOI: 10.3390/pharmaceutics13010089] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/31/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022] Open
Abstract
The tendon is a highly aligned connective tissue that transmits force from muscle to bone. Each year, more than 32 million tendon injuries have been reported, in fact, tendinopathies represent at least 50% of all sports injuries, and their incidence rates have increased in recent decades due to the aging population. Current clinical grafts used in tendon treatment are subject to several restrictions and there is a significant demand for alternative engineered tissue. For this reason, innovative strategies need to be explored. Tendon replacement and regeneration are complex since scaffolds need to guarantee an adequate hierarchical structured morphology and mechanical properties to stand the load. Moreover, to guide cell proliferation and growth, scaffolds should provide a fibrous network that mimics the collagen arrangement of the extracellular matrix in the tendons. This review focuses on tendon repair and regeneration. Particular attention has been devoted to the innovative approaches in tissue engineering. Advanced manufacturing techniques, such as electrospinning, soft lithography, and three-dimensional (3D) printing, have been described. Furthermore, biological augmentation has been considered, as an emerging strategy with great therapeutic potential.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Giuseppina Sandri
- Department of Drug Sciences, University of Pavia, Viale Taramelli 12, 27100 Pavia, Italy; (E.B.); (M.R.); (S.R.); (B.V.); (D.M.); (M.C.B.); (F.F.)
| | | |
Collapse
|
24
|
Pogorzelski J, Erber B, Themessl A, Rupp MC, Feucht MJ, Imhoff AB, Degenhardt H, Irger M. Definition of the terms "acute" and "traumatic" in rotator cuff injuries: a systematic review and call for standardization in nomenclature. Arch Orthop Trauma Surg 2021; 141:75-91. [PMID: 33130936 PMCID: PMC7815591 DOI: 10.1007/s00402-020-03656-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings. METHODS Four different internet databases were searched in February 2020 using the terms ("acute" OR "traumatic" OR "trauma" OR "athlete" OR "young") AND ("rotator cuff tears" OR "rotator cuff tear" OR "rotator cuff" OR "rotator cuff rupture" OR "supraspinatus" OR "infraspinatus" OR "subscapularis" OR "teres minor"). Prospective, retrospective, cohort and case-control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded. RESULTS The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term "acute" nor on "traumatic" in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging. CONCLUSION The term "acute" should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term "traumatic" should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany.
| | - Bernd Erber
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Alexander Themessl
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Matthias J Feucht
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| | - Markus Irger
- Department of Orthopedic Sports Medicine, Hospital Rechts Der Isar, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany
| |
Collapse
|
25
|
Taylor BL, Kim DH, Huegel J, Raja HA, Burkholder SJ, Weiss SN, Nuss CA, Soslowsky LJ, Mauck RL, Kuntz AF, Bernstein J. Localized delivery of ibuprofen via a bilayer delivery system (BiLDS) for supraspinatus tendon healing in a rat model. J Orthop Res 2020; 38:2339-2349. [PMID: 32215953 PMCID: PMC7529744 DOI: 10.1002/jor.24670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/15/2020] [Accepted: 02/29/2020] [Indexed: 02/04/2023]
Abstract
The high prevalence of tendon retear following rotator cuff repair motivates the development of new therapeutics to promote improved tendon healing. Controlled delivery of non-steroidal anti-inflammatory drugs to the repair site via an implanted scaffold is a promising option for modulating inflammation in the healing environment. Furthermore, biodegradable nanofibrous delivery systems offer an optimized architecture and surface area for cellular attachment, proliferation, and infiltration while releasing soluble factors to promote tendon regeneration. To this end, we developed a bilayer delivery system (BiLDS) for localized and controlled release of ibuprofen (IBP) to temporally mitigate inflammation and enhance tendon remodeling following surgical repair by promoting organized tissue formation. In vitro evaluation confirmed the delayed and sustained release of IBP from Labrafil-modified poly(lactic-co-glycolic) acid microspheres within sintered poly(ε-caprolactone) electrospun scaffolds. Biocompatibility of the BiLDS was demonstrated with primary Achilles tendon cells in vitro. Implantation of the IBP-releasing BiLDS at the repair site in a rat rotator cuff injury and repair model led to decreased expression of proinflammatory cytokine, tumor necrotic factor-α, and increased anti-inflammatory cytokine, transforming growth factor-β1. The BiLDS remained intact for mechanical reinforcement and recovered the tendon structural properties by 8 weeks. These results suggest the therapeutic potential of a novel biocompatible nanofibrous BiLDS for localized and tailored delivery of IBP to mitigate tendon inflammation and improve repair outcomes. Future studies are required to define the mechanical implications of an optimized BiLDS in a rat model beyond 8 weeks or in a larger animal model.
Collapse
Affiliation(s)
- Brittany L. Taylor
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Dong Hwa Kim
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Julianne Huegel
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Harina A. Raja
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Sophie J. Burkholder
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Stephanie N. Weiss
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Courtney A. Nuss
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Louis J. Soslowsky
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Robert L. Mauck
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Andrew F. Kuntz
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| | - Joseph Bernstein
- Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104,University of Pennsylvania, McKay Orthopaedic Research Laboratory, 3450 Hamilton Walk, Pennsylvania Philadelphia PA 19104
| |
Collapse
|
26
|
Yang FA, Liao CD, Wu CW, Shih YC, Wu LC, Chen HC. Effects of applying platelet-rich plasma during arthroscopic rotator cuff repair: a systematic review and meta-analysis of randomised controlled trials. Sci Rep 2020; 10:17171. [PMID: 33057143 PMCID: PMC7560855 DOI: 10.1038/s41598-020-74341-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/25/2020] [Indexed: 02/07/2023] Open
Abstract
Because of its healing properties, platelet-rich plasma (PRP) has been applied to the bone-tendon interface during arthroscopic rotator cuff repair to improve surgical outcomes. However, its effects remain ambiguous. Therefore, we conducted this systematic review and meta-analysis to assess the effects of PRP on retear rate and functional outcomes. Randomised control trials were identified and extracted. Data collection was completed on 15 February 2020. The results are expressed as the risk ratio (RR) for the categorical variables and weighted mean difference for the continuous variables, with 95% confidence intervals (CIs). Analyses were performed using RevMan 5.3 software. Seven randomised controlled trials published from 2013 to 2018, with 541 patients in total, were included. The results revealed a significant decrease in retear rate [RR 0.38, 95% CI (0.22, 0.68), P = 0.0009). Furthermore, a significant improvement was observed regarding short-term Constant score [mean difference = 3.28, 95% CI (1.46, 5.11), P = 0.0004), short-term University of California at Los Angeles activity score [mean difference = 1.60, 95% CI (0.79, 2.42), P = 0.0001], and short-term visual analogue scale score [mean difference = - 0.14, 95% CI (- 0.23, - 0.05), P = 0.002]. This systematic review indicates the efficacy of PRP when applied to the bone-tendon interface during arthroscopic rotator cuff repair.
Collapse
Affiliation(s)
- Fu-An Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Jhongjheng Road, Jhonghe District, New Taipei City, 235, Taiwan
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Jhongjheng Road, Jhonghe District, New Taipei City, 235, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ya-Chu Shih
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Lien-Chen Wu
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291 Jhongjheng Road, Jhonghe District, New Taipei City, 235, Taiwan.
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| |
Collapse
|
27
|
黄 成, 赵 松, 程 飚, 陈 刚, 潘 界. [Effect of microfracture combined with biomimetic hydrogel scaffold on rotator cuff tendon-to-bone healing in rabbits]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1177-1183. [PMID: 32929913 PMCID: PMC8171741 DOI: 10.7507/1002-1892.202001029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/26/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the effect of microfracture and biomimetic hydrogel scaffold on tendon-to-bone healing in a rabbit rotator cuff tear model. METHODS Gelatin and methacrylic anhydride were used to synthesize gelatin methacryloyl (GelMA). Then the GelMA were treated with ultraviolet rays and vacuum freeze-drying method to obtain a biomimetic hydrogel scaffold. The morphology of the scaffold was observed by gross observation and scanning electron microscope. Degradation of the scaffold was determined at different time points. Twenty-four adult New Zealand rabbits, weighting 2.8-3.5 kg and male or female, were surgically created the bilateral acute rotator cuff tear models. One shoulder was treated with microfractures on the footprint and transosseous suture (control group, n=24). The other shoulder was treated with the same way, except for putting the scaffold on the footprint before transosseous suture (experimental group, n=24). The general conditions of rabbits were observed postoperatively. Tendon-to-bone healing was evaluated by gross observation, Micro-CT, HE staining, and bio-mechanical testing at 4 and 8 weeks after operation. RESULTS The scaffold was white and has a porous structure with pore size of 31.7-89.9 μm, which degraded slowly in PBS solution. The degradation rate was about 95% at 18 days. All the rabbits survived to the completion of the experiment. Micro-CT showed that there was no obvious defect and re-tear at the tendon-to-bone interface in both groups. No difference was found in bone mineral density (BMD), tissue mineral density (TMD), and bone volume/total volume (BV/TV) between the two groups at 4 and 8 weeks postoperatively ( P>0.05). HE staining showed that the fibrous scar tissue was the main component at the tendon-to-bone interface in the control group at 4 and 8 weeks postoperatively; the disorderly arranged mineralized cartilage and fibrocartilage formation were observed at the tendon-to-bone interface in the experimental group at 4 weeks, and the orderly arranged cartilage formation was observed at 8 weeks. Besides, the tendon maturation scores of the experimental group were significantly higher than those of the control group at 4 and 8 weeks ( P<0.05). There was no significant difference in the ultimate load to failure and stiffness between the two groups at 4 weeks ( P>0.05); the ultimate load to failure at 8 weeks was significantly higher in the experiment group than in the control group ( t=4.162, P=0.009), and no significant difference was found in stiffness between the two groups at 8 weeks ( t=2.286, P=0.071). CONCLUSION Compared with microfracture alone, microfracture combined with biomimetic hydrogel scaffold can enhance tendon-to-bone healing and improve the ultimate load to failure in rabbits.
Collapse
Affiliation(s)
- 成龙 黄
- 南京医科大学上海十院临床医学院骨科(上海 200072)Department of Orthopedics, Clinical Medical School, the Affiliated Shanghai No.10 People’s Hospital, Nanjing Medical University, Shanghai, 200072, P.R.China
| | - 松 赵
- 南京医科大学上海十院临床医学院骨科(上海 200072)Department of Orthopedics, Clinical Medical School, the Affiliated Shanghai No.10 People’s Hospital, Nanjing Medical University, Shanghai, 200072, P.R.China
| | - 飚 程
- 南京医科大学上海十院临床医学院骨科(上海 200072)Department of Orthopedics, Clinical Medical School, the Affiliated Shanghai No.10 People’s Hospital, Nanjing Medical University, Shanghai, 200072, P.R.China
| | - 刚 陈
- 南京医科大学上海十院临床医学院骨科(上海 200072)Department of Orthopedics, Clinical Medical School, the Affiliated Shanghai No.10 People’s Hospital, Nanjing Medical University, Shanghai, 200072, P.R.China
| | - 界恩 潘
- 南京医科大学上海十院临床医学院骨科(上海 200072)Department of Orthopedics, Clinical Medical School, the Affiliated Shanghai No.10 People’s Hospital, Nanjing Medical University, Shanghai, 200072, P.R.China
| |
Collapse
|
28
|
Chen XT, Fang WH, Vangsness CT. Efficacy of Biologics for Ligamentous and Tendon Healing. OPER TECHN SPORT MED 2020. [DOI: 10.1016/j.otsm.2020.150755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
29
|
Abstract
Hip abductor tendon tear is a difficult problem to manage. The hip abductor mechanism is made up of the gluteus medius and minimus muscles, both of which contribute to stabilising the pelvis through the gait cycle. Tears of these tendons are likely due to iatrogenic injury during arthroplasty and chronic degenerative tendinopathy. Ultrasound and magnetic resonance imaging have provided limited clues regarding the pattern of disease and further work is required to clarify both the macro and microscopic pattern of disease. While surgery has been attempted over the last 2 decades, the outcomes are variable and the lack of high-quality studies have limited the uptake of surgical repair. Hip abductor tendon tears share many features with rotator cuff tears, hence, innovations in surgical techniques, materials and biologics may apply to both pathologies.
Collapse
Affiliation(s)
- Mark F Zhu
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| | | | | | - Simon W Young
- The University of Auckland, Auckland, New Zealand.,North Shore Hospital, Auckland, New Zealand
| | - Jacob T Munro
- The University of Auckland, Auckland, New Zealand.,Auckland City Hospital, Auckland, New Zealand
| |
Collapse
|
30
|
Snow M, Hussain F, Pagkalos J, Kowalski T, Green M, Massoud S, James S. The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial. Arthroscopy 2020; 36:648-657. [PMID: 31784365 DOI: 10.1016/j.arthro.2019.09.026] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of delayed application of leukocyte-rich platelet-rich plasma (PRP) on rotator cuff repair results as assessed by outcome scores and imaging at one year. METHODS Patients with a symptomatic rotator cuff tear awaiting arthroscopic repair were approached to take part in the study. Final eligibility for the study was confirmed at the time of surgery. A total of 97 patients were randomized to an ultrasound guided injection of leukocyte-rich PRP or normal saline between 10 and 14 days postsurgery. A total of 87 patients completed clinical evaluation and underwent magnetic resonance imaging imaging at 1 year. Outcome scores included the American Shoulder and Elbow Score, Constant score, Western Ontario Rotator Cuff Index, and the Disabilities of the Arm, Shoulder and Hand Score. Structural integrity of the repair was assessed according to the Sugaya grading. Muscle fatty infiltration was assessed on magnetic resonance imaging using the Goutallier classification. RESULTS At 1 year postsurgery, there was no significant difference between the treatment groups on any of the patient-reported outcome measures or Constant score. On postoperative imaging analysis, there was no difference in the retear rates (Sugaya 4 and 5) between the groups (21% in control group vs 15.3% in PRP group). Fatty infiltration on postoperative imaging was found to be significantly higher in the normal saline group compared with the PRP group (Kendall's tau-b P = .032). CONCLUSIONS The delayed application of PRP postrotator cuff repair did not improve function as measured by patient-reported outcome measures and Constant score at 1 year postoperatively. LEVEL OF EVIDENCE Level II, prospective randomized therapeutic trial.
Collapse
Affiliation(s)
- Martyn Snow
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom; Department of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Faisal Hussain
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Joseph Pagkalos
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Tomasz Kowalski
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Marcus Green
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Samir Massoud
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| | - Steven James
- Royal Orthopaedic Hospital NHS Foundation Trust, Northfield, United Kingdom
| |
Collapse
|
31
|
Yang Y, Chen J, Shang X, Feng Z, Chen C, Lu J, Cai J, Chen Y, Zhang J, Hao Y, Yang X, Li Y, Chen S. Visualizing the Fate of Intra-Articular Injected Mesenchymal Stem Cells In Vivo in the Second Near-Infrared Window for the Effective Treatment of Supraspinatus Tendon Tears. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2019; 6:1901018. [PMID: 31592419 PMCID: PMC6774022 DOI: 10.1002/advs.201901018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/29/2019] [Indexed: 05/13/2023]
Abstract
Mesenchymal stem cells (MSCs) are capable of exerting strong therapeutic potential for the treatment of supraspinatus tendon tear. However, MSC therapy remains underutilized and perhaps underrated due to the limited evidence of dynamic visualization of cellular behavior in vivo. Here, second near-infrared fluorescence imaging with biocompatible PbS quantum dots (QDs) provides a cellular migration map and information on the biodistribution and clearance processes of three densities of intra-articularly injected, labeled MSCs to treat supraspinatus tendon tear in mice. Intra-articular injection avoids entrapment of MSCs by filter organs and reduces the QD-induced organ toxicity. Notably, the MSCs share a similar migration direction, but the moderate density group is somewhat more efficient, showing the longest residence time and highest cell retention rate around the footprint during the repair stage. Furthermore, quantitative kinetic investigation demonstrates that labeled MSCs are cleared by feces and urine. Histomorphometric analysis demonstrates that the moderate density group achieves maximum therapeutic effect and labeled MSCs do not induce any injury or inflammation to major organs, which suggests that administration of too many or few MSCs may decrease their effectiveness. Such an imaging approach provides spatiotemporal evidence for response to MSC therapy in vivo, facilitating the optimization of MSC therapy.
Collapse
Affiliation(s)
- Yimeng Yang
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Jun Chen
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Xiliang Shang
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Zhujun Feng
- Department of Anatomy and PhysiologySchool of MedicineShanghai Jiao Tong UniversityShanghai200025China
| | - Chen Chen
- Department of Sports MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai200233China
| | - Jingyi Lu
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Jiangyu Cai
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Yuzhou Chen
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Jian Zhang
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Yuefeng Hao
- Department of OrthopedicsAffiliated Suzhou Hospital of Nanjing Medical UniversitySuzhouJiangsu215500China
| | - Xing Yang
- Department of OrthopedicsAffiliated Suzhou Hospital of Nanjing Medical UniversitySuzhouJiangsu215500China
| | - Yunxia Li
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| | - Shiyi Chen
- Department of Sports MedicineHuashan HospitalFudan UniversityShanghai200040China
| |
Collapse
|
32
|
|
33
|
Ramos DM, Abdulmalik S, Arul MR, Rudraiah S, Laurencin CT, Mazzocca AD, Kumbar SG. Insulin immobilized PCL-cellulose acetate micro-nanostructured fibrous scaffolds for tendon tissue engineering. POLYM ADVAN TECHNOL 2019; 30:1205-1215. [PMID: 30956516 PMCID: PMC6448803 DOI: 10.1002/pat.4553] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022]
Abstract
Use of growth factors as biochemical molecules to elicit cellular differentiation is a common strategy in tissue engineering. However, limitations associated with growth factors, such as short half-life, high effective physiological doses, and high costs, have prompted the search for growth factor alternatives, such as growth factor mimics and other proteins. This work explores the use of insulin protein as a biochemical factor to aid in tendon healing and differentiation of cells on a biomimetic electrospun micro-nanostructured scaffold. Dose response studies were conducted using human mesenchymal stem cells (MSCs) in basal media supplemented with varied insulin concentrations. A dose of 100-ng/mL insulin showed increased expression of tendon markers. Synthetic-natural blends of various ratios of polycaprolactone (PCL) and cellulose acetate (CA) were used to fabricate micro-nanofibers to balance physicochemical properties of the scaffolds in terms of mechanical strength, hydrophilicity, and insulin delivery. A 75:25 ratio of PCL:CA was found to be optimal in promoting cellular attachment and insulin immobilization. Insulin insulin deliveryimmobilized fiber matrices also showed increased expression of tendon phenotypic markers by MSCs similar to findings with insulin supplemented media, indicating preservation of insulin bioactivity. Insulin functionalized scaffolds may have potential applications in tendon healing and regeneration.
Collapse
Affiliation(s)
- Daisy M. Ramos
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Sama Abdulmalik
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Michael R. Arul
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Swetha Rudraiah
- Department of Pharmaceutical Sciences, University of Saint Joseph, Hartford, Connecticut
| | - Cato T. Laurencin
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
| | - Sangamesh G. Kumbar
- Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut
- Department of Orthopaedic Surgery, University of Connecticut Health, Farmington, Connecticut
- Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut
| |
Collapse
|
34
|
Zhang K, de Sa D, Kanakamedala A, Sheean AJ, Vyas D. Management of Concomitant Preoperative Rotator Cuff Pathology and Adhesive Capsulitis: A Systematic Review of Indications, Treatment Approaches, and Outcomes. Arthroscopy 2019; 35:979-993. [PMID: 30733032 DOI: 10.1016/j.arthro.2018.10.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Concomitant preoperative adhesive capsulitis (AC) and rotator cuff (RC) pathology pose therapeutic challenges in light of contrasting interventional and rehabilitative goals. The purposes of this systematic review were to assess the literature regarding the management and rehabilitation of patients with concomitant RC tears and preoperative AC and to compare overall clinical outcomes between strategies for this common scenario. METHODS In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 3 databases (MEDLINE, Embase, and PubMed) were searched and screened in duplicate using predetermined criteria for studies on the aforementioned patient population. Descriptive statistics are presented. RESULTS Of 952 studies, 17 involving 662 shoulders, with a mean age of 59.6 ± 3.5 years, 57.9% female patients, and a mean follow-up period of 18.6 months, were included. Capsular release (CR) (86.1%) and manipulation under anesthesia (MUA) (33.1%) were the most common co-interventions with RC repair. Across studies, mean preoperative American Shoulder and Elbow Surgeons scores ranged from 29.0 to 61.3, visual analog scale scores (pain) ranged from 5.3 to 8.0, and Constant scores ranged from 18.0 to 48.0. Mean postoperative American Shoulder and Elbow Surgeons scores ranged from 76.9 to 92.0, visual analog scale scores (pain) ranged from 0.3 to 2.5, and Constant scores ranged from 72.6 to 93.2. Postoperative rehabilitation comprised abduction braces and passive range of motion immediately postoperatively for mean durations of 5.0 weeks and 5.3 weeks, respectively, followed by active range of motion at a mean of 5.3 weeks and strengthening at 10.9 weeks. Postoperative complications included stiffness, RC retear, instability, glenoid fracture, and superficial infection. CONCLUSIONS The results of this systematic review support treatment of patients with degenerative RC tears and concomitant AC with a combination of RC repair and MUA, CR, or both MUA and CR. Regardless of the treatment modality, accelerated postoperative rehabilitative protocols are beneficial in preventing postoperative persistence of AC and can be safely used in this scenario without a substantial increase in complication rates compared with patients undergoing RC repair alone with conservative rehabilitation. LEVEL OF EVIDENCE Level V, systematic review of Level II, III, IV, and V studies.
Collapse
Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A..
| | | | - Andrew J Sheean
- UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Dharmesh Vyas
- UPMC Lemieux Sports Complex, Cranberry, Pennsylvania, U.S.A
| |
Collapse
|
35
|
Pauly S, Klatte-Schulz F, Stahnke K, Scheibel M, Wildemann B. The effect of autologous platelet rich plasma on tenocytes of the human rotator cuff. BMC Musculoskelet Disord 2018; 19:422. [PMID: 30497435 PMCID: PMC6267832 DOI: 10.1186/s12891-018-2339-5] [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] [Received: 06/14/2018] [Accepted: 11/14/2018] [Indexed: 12/29/2022] Open
Abstract
Background Platelet rich plasma (PRP) is widely used in rotator cuff repairs but its effect on the healing process is unclear. Several cell culture studies on the effect of allogenic PRP have reported promising results but are not transferable to clinical practice. The aim of the present study is to assess the possible effect of autologous PRP on rotator cuff tendon cells. The amount of growth factors involved with tendon-bone healing (PDGF-AB, IGF-1, TGF-β1, BMP-7 and -12) is quantified. Methods Rotator cuff tissue samples were obtained from (n = 24) patients grouped by age (>/< 65 years) and sex into four groups and cells were isolated and characterized. Later, autologous PRP preparations were obtained and the effect was analyzed by means of cell proliferation, collagen I synthesis and expression of collagen I and III. Furthermore, the PRPs were quantified for growth factor content by means of platelet-derived growth factor (PDGF-AB), insulin-like growth factor (IGF-1), transforming growth factor (TGF-β1), as well as bone morphogenetic protein (BMP) -7 and − 12. Results Cell proliferation and absolute synthesis of collagen I were positively affected by PRP exposure compared to controls (p < 0.05), but expression and relative synthesis of collagen I (normalized to cell proliferation) were significantly reduced. PRP contained high amounts of IGF-1 and lower levels of TGF-β1 and PDGF-AB. The amounts of BMP-7 and -12 were below the detection limits. Conclusions PRP is a source of growth factors such involved with tendon-bone healing. PRP had an anabolic effect on the human rotator cuff tenocytes of the same individual in vitro by means of cell proliferation and absolute, but not relative collagen I synthesis. These results encourage further studies on clinical outcomes with more comparable standards in terms of preparation and application methods. Level of evidence Controlled laboratory study.
Collapse
Affiliation(s)
- Stephan Pauly
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Franka Klatte-Schulz
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin, Berlin, Germany
| | - Katharina Stahnke
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Markus Scheibel
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Britt Wildemann
- Julius Wolff Institut, Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin, Augustenburger Platz 1, 13353, Berlin, Germany.,Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin, Berlin, Germany.,Department of Experimental Traumatology, Universitaetsklinikum Jena, Jena, Germany
| |
Collapse
|
36
|
Learn GD, McClellan PE, Knapik DM, Cumsky JL, Webster-Wood V, Anderson JM, Gillespie RJ, Akkus O. Woven collagen biotextiles enable mechanically functional rotator cuff tendon regeneration during repair of segmental tendon defects in vivo. J Biomed Mater Res B Appl Biomater 2018; 107:1864-1876. [PMID: 30485649 DOI: 10.1002/jbm.b.34279] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/04/2018] [Accepted: 10/19/2018] [Indexed: 12/15/2022]
Abstract
Despite advancements in surgical techniques and materials for rotator cuff repair procedures, primary repair failures remain common. This study examines the use of electrochemically aligned collagen (ELAC) threads woven into biotextile scaffolds as grafts to repair critical infraspinatus tendon defects in New Zealand White rabbits. Three surgical treatment groups were evaluated: rabbits undergoing direct repair as operative controls, rabbits receiving ELAC scaffolds alone, and rabbits treated with mesenchymal stem cell (MSC)-seeded ELAC scaffolds. In each animal, the intact, contralateral infraspinatus served as an internal positive control. Tendon-bone constructs were harvested after 3 months in vivo and outcome measures included biomechanical testing, histological staining, and immunohistochemical staining. Biomechanical testing revealed that maximum load-bearing capacity was comparable between all groups, while MSC-seeded scaffold repairs exhibited increased stiffness relative to non-seeded scaffold repairs. Histological staining revealed robust collagen deposition around ELAC fibers and increased cellularity within the continuum of woven scaffolds as compared to native tendon. Immunohistochemical staining revealed presence of collagens I and III in all groups, but procollagen I and the tendon-specific marker tenomodulin were only observed in seeded and non-seeded ELAC scaffold repairs. Findings of this pilot study warrant continued investigation of ELAC biotextile scaffolds for repair of critically-sized rotator cuff tendon defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1864-1876, 2019.
Collapse
Affiliation(s)
- Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Phillip E McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| | - Jameson L Cumsky
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Victoria Webster-Wood
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - James M Anderson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Pathology, Case Western Reserve University, Cleveland, Ohio.,Department of Macromolecular Science, Case Western Reserve University, Cleveland, Ohio
| | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| | - Ozan Akkus
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Orthopaedic Surgery, University Hospitals of Cleveland, Cleveland, Ohio
| |
Collapse
|
37
|
Deprés-Tremblay G, Chevrier A, Snow M, Rodeo S, Buschmann MD. Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit. J Biomater Appl 2018; 33:792-807. [PMID: 30426861 DOI: 10.1177/0885328218811386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.
Collapse
Affiliation(s)
| | | | - Martyn Snow
- 2 The Royal Orthopaedic Hospital, Birmingham, UK
| | - Scott Rodeo
- 3 The Hospital for Special Surgery, New York, NY, USA
| | - Michael D Buschmann
- 4 Ecole Polytechnique de Montreal, 2900 Boul Edouard-Montpetit, Montreal, Canada
| |
Collapse
|
38
|
Malavolta EA, Gracitelli MEC, Assunção JH, Ferreira Neto AA, Bordalo-Rodrigues M, de Camargo OP. Clinical and Structural Evaluations of Rotator Cuff Repair With and Without Added Platelet-Rich Plasma at 5-Year Follow-up: A Prospective Randomized Study. Am J Sports Med 2018; 46:3134-3141. [PMID: 30234999 DOI: 10.1177/0363546518795895] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been studied with the objective of reducing the retear rate and improving functional outcomes after rotator cuff repair. Only one study to date has reported its midterm effect. HYPOTHESIS PRP promotes better functional and structural results in arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS All patients underwent arthroscopic single-row repair of small to medium supraspinatus tears. At the end of the surgical procedure, liquid PRP prepared by apheresis with autologous thrombin was applied in the tendon-to-bone interface in the PRP group. The outcomes were assessed by the University of California, Los Angeles (UCLA) and Constant scales and the visual analog scale (VAS) for pain at 6, 12, 24, and 60 months after surgery and magnetic resonance imaging at 12 and 60 months. RESULTS Of 54 patients initially randomized, we analyzed the clinical outcomes in 51 (25 control, 26 PRP) and the structural outcomes in 44 (22 each group). At 60-month follow-up, the mean UCLA scores were 32.5 ± 3.8 and 32.1 ± 4.6 in the control and PRP groups, respectively ( P = .992). The mean Constant scores were 82.0 ± 9.5 in the control group and 82.1 ± 11.0 in the PRP group ( P = .699). The mean VAS scores were 1.4 ± 1.8 and 1.5 ± 2.1 in the control and PRP groups, respectively ( P = .910). None of the clinical assessments at 6, 12, and 24 months in either group produced statistically significant differences, and both groups showed significant improvements throughout the follow-up time in the 3 evaluations ( P < .001). The control group exhibited 1 full-thickness retear (Sugaya type IV) and 11 partial-thickness retears (Sugaya type III), while the PRP group had 7 partial-thickness retears (Sugaya type III). The overall number of retears did not differ between groups ( P = .203). CONCLUSION PRP obtained by apheresis and applied in liquid form with the addition of thrombin at the end of single-row repair of supraspinatus tears did not promote better clinical or structural results at 60-month follow-up. REGISTRATION NCT01029574 ( ClinicalTrials.gov identifier).
Collapse
|
39
|
Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair. JOURNAL OF BIOMIMETICS BIOMATERIALS AND BIOMEDICAL ENGINEERING 2018. [DOI: 10.4028/www.scientific.net/jbbbe.39.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present.
Collapse
|
40
|
Abstract
In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing.
Collapse
|
41
|
Ruder JA, Dickinson EY, Peindl RD, Habet NA, Fleischli JE. Greater Tuberosity Decortication Decreases Load to Failure of All-Suture Anchor Constructs in Rotator Cuff Repair. Arthroscopy 2018; 34:2777-2781. [PMID: 30195950 DOI: 10.1016/j.arthro.2018.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of greater tuberosity decortication on ultimate load to failure and displacement after cyclic loading with an all-suture anchor. METHODS A 2.9-mm all-suture anchor was evaluated in decorticated and nondecorticated greater tuberosities of 10 matched pairs of human cadaveric shoulders. Greater tuberosity decortication was performed to a mean depth of 1.7 mm. Anchors were placed in the anterior, middle, and posterior tuberosity. Anchors were tested under cyclic loads followed by load-to-failure testing. Displacement after 20, 100, and 200 cycles and ultimate failure strength were determined. Clinical failure was defined as displacement greater than 5 mm during cyclic loading. RESULTS After 20 and 100 cycles, there was no difference in mean displacement between the decorticated and nondecorticated cohorts (P = .139 and P = .127, respectively). The mean displacement after 200 cycles was greater in the decorticated cohort, although not significantly (3.4 vs 2.7 mm; P = .05). The mean ultimate load to failure was significantly lower in the decorticated cohort (314 vs 386 N, P = .049). There were 2 clinical failures in the decorticated specimens and 1 in the nondecorticated specimens. CONCLUSIONS A minimal greater tuberosity decortication significantly decreases the ultimate load to failure of an all-suture anchor. However, decreased biomechanical strength may not necessitate actual clinical failure. CLINICAL RELEVANCE A decrease in ultimate load to failure could increase the risk of catastrophic postoperative anchor failure. However, while this decrease in strength is statistically significant, the overall decrease in strength may not be sufficient in magnitude to translate to clinical failure.
Collapse
Affiliation(s)
- John A Ruder
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, U.S.A
| | | | - Richard D Peindl
- Orthopaedic Engineering Research Laboratory, Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, U.S.A
| | - Nahir A Habet
- Orthopaedic Engineering Research Department, Carolinas Healthcare System (now Atrium), Charlotte, North Carolina, U.S.A
| | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A..
| |
Collapse
|
42
|
Childers EP, Dreger NZ, Ellenberger AB, Wandel MB, Domino K, Xu Y, Luong D, Yu J, Orsini D, Bell RH, Premanandan C, Fening SD, Becker ML. Enhanced Rotator-Cuff Repair Using Platelet-Rich Plasma Adsorbed on Branched Poly(ester urea)s. Biomacromolecules 2018; 19:3129-3139. [DOI: 10.1021/acs.biomac.8b00725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Erin P. Childers
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Nathan Z. Dreger
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Alex B. Ellenberger
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Mary Beth Wandel
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Karen Domino
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Yanyi Xu
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Derek Luong
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - Jiayi Yu
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
| | - David Orsini
- Summa Health System, Akron, Ohio 44304, United States
| | - Robert H. Bell
- Department of Orthopaedics, Crystal Clinic, Inc., Akron, Ohio 44333, United States
| | - Christopher Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio 43210, United States
| | - Stephen D. Fening
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio 44106, United States
| | - Matthew L. Becker
- Department of Polymer Science, The University of Akron, Akron, Ohio 44325, United States
- Department of Biomedical Engineering, The University of Akron, Akron, Ohio 44325, United States
| |
Collapse
|
43
|
Li X, Shen P, Su W, Zhao S, Zhao J. Into-Tunnel Repair Versus Onto-Surface Repair for Rotator Cuff Tears in a Rabbit Model. Am J Sports Med 2018; 46:1711-1719. [PMID: 29620913 DOI: 10.1177/0363546518764685] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Clinically, onto-surface repair is commonly used for rotator cuff tears. The retear rate after rotator cuff repair (RCR) is relatively high, with failure occurring mostly at the tendon-bone connection site. For anterior cruciate ligament (ACL) reconstruction, into-tunnel reconstruction is commonly employed. The retear rate after ACL reconstruction is relatively low, with retears seldom occurring at the tendon-bone interface. No study on into-tunnel RCR has been conducted. HYPOTHESIS Into-tunnel RCR could promote fibrocartilage regeneration at the tendon-bone interface and has biomechanical advantage over onto-surface repair in a rabbit rotator cuff tear model. STUDY DESIGN Controlled laboratory study. METHODS Thirty-six New Zealand White rabbits were used in this study. The supraspinatus tendons were cut from the footprint to create a rotator cuff tear on both shoulders. On one side, the supraspinatus was cut longitudinally into 2 halves, sutured, and pulled into 2 tunnels through the greater tuberosity (into-tunnel repair). On the other side, the tendon was reattached to the surface of the footprint with transosseous sutures (onto-surface repair). Twelve animals were sacrificed, of which 6 were used for a histological examination and the other 6 for biomechanical testing, at 4, 8, and 12 weeks, respectively. RESULTS The tendon-bone interface in the into-tunnel group showed a different healing pattern from that in the onto-surface group. In the former, most of the tendon tissue in the tunnel was replaced with newly generated fibrocartilage; the rest of the tendon fibers appeared in large bundles with direct connection to the bone. In the latter, fibrocartilage regeneration was seldom found at the tendon-bone interface; the tendon near the bone surface appeared as small fibrils. The biomechanical evaluation revealed a higher ultimate load ( P < .001) and stiffness ( P < .001) at the tendon-bone junction in the into-tunnel group than those in the onto-surface group at 12 weeks. CONCLUSION In a rabbit rotator cuff tear model, into-tunnel RCR could result in a different tendon-bone healing pattern, with obvious fibrocartilage regeneration at the interface and higher tendon-bone healing strength than that in onto-surface repair. CLINICAL RELEVANCE New RCR patterns may be developed to improve the tendon-bone healing pattern and obtain better tendon-bone healing strength.
Collapse
Affiliation(s)
- Xiaoxi Li
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Shen
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
44
|
Abstract
PURPOSE OF REVIEW With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. RECENT FINDINGS Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue. Recent electromyography studies have identified exercises which elicit highest level of muscle activation for individual dynamic stabilizers. The physical therapist should also be aware of potential complications and be prepared to manage appropriately if they should arise. During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendon-to-bone healing. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. Advanced strengthening is initiated when all preceding criteria have been met. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames.
Collapse
Affiliation(s)
- Terrance A Sgroi
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA.
| | - Michelle Cilenti
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA
| |
Collapse
|
45
|
Sussman WI, Mautner K, Malanga G. The role of rehabilitation after regenerative and orthobiologic procedures for the treatment of tendinopathy: a systematic review. Regen Med 2018. [DOI: 10.2217/rme-2017-0110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: Significant variability exists in the literature, with no clear consensus to the optimal protocol after a regenerative procedure. Given this uncertainty, the authors systematically reviewed the literature cataloging the different variables that may influence outcomes. Methods: Search was limited to randomized clinical trials and prospective cohort studies of regenerative procedures for the treatment of tendinopathy. Variables were predetermined, and included: cyrotherapy, pre- and post-procedure nonsteroidal anti-inflammatory drugs use, recommendations for alternative pain medications, immobilization and duration of rest. Variables were categorized based on the influence of the intervention on the three phases of healing. Results: 749 studies were assessed for eligibility, and 60 studies were included. Significant variability existed in the literature. Conclusion: Despite the importance of rehabilitation after regenerative procedures, there is a paucity of evidence available to guide clinicians and highlights the need for additional validation.
Collapse
Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University, Boston, MA 02111, USA
- Orthopedic Care Physician Network, N Easton, MA 02356, USA
| | - Ken Mautner
- Department of Physical Medicine & Rehabilitation & Department of Orthopedics, Emory University, Atlanta, GA 30329, USA
| | - Gerard Malanga
- Department of Physical Medicine & Rehabilitation, Rutgers School of Medicine University of Medicine & Density, Newark, NJ 07101, USA
| |
Collapse
|
46
|
Narayanan G, Nair LS, Laurencin CT. Regenerative Engineering of the Rotator Cuff of the Shoulder. ACS Biomater Sci Eng 2018; 4:751-786. [PMID: 33418763 DOI: 10.1021/acsbiomaterials.7b00631] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Rotator cuff tears often heal poorly, leading to re-tears after repair. This is in part attributed to the low proliferative ability of the resident cells (tendon fibroblasts and tendon-stem cells) upon injury to the rotator cuff tissue and the low vascularity of the tendon insertion. In addition, surgical outcomes of current techniques used in clinical settings are often suboptimal, leading to the formation of neo-tissue with poor biomechanics and structural characteristics, which results in re-tears. This has prompted interest in a new approach, which we term as "Regenerative Engineering", for regenerating rotator cuff tendons. In the Regenerative Engineering paradigm, roles played by stem cells, scaffolds, growth factors/small molecules, the use of local physical forces, and morphogenesis interplayed with clinical surgery techniques may synchronously act, leading to synergistic effects and resulting in successful tissue regeneration. In this regard, various cell sources such as tendon fibroblasts and adult tissue-derived stem cells have been isolated, characterized, and investigated for regenerating rotator cuff tendons. Likewise, numerous scaffolds with varying architecture, geometry, and mechanical characteristics of biologic and synthetic origin have been developed. Furthermore, these scaffolds have been also fabricated with biochemical cues (growth factors and small molecules), facilitating tissue regeneration. In this Review, various strategies to regenerate rotator cuff tendons using stem cells, advanced materials, and factors in the setting of physical forces under the Regenerative Engineering paradigm are described.
Collapse
Affiliation(s)
- Ganesh Narayanan
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| | - Lakshmi S Nair
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States
| | - Cato T Laurencin
- Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, Connecticut 06030, United States.,Department of Chemical and Biomolecular Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Department of Materials Science and Engineering, University of Connecticut, Storrs, Connecticut 06269, United States.,Connecticut Institute for Clinical and Translational Science, University of Connecticut Health Center, Farmington, Connecticut 06030, United States
| |
Collapse
|
47
|
You X, Shen Y, Yu W, He Y. Enhancement of tendon‑bone healing following rotator cuff repair using hydroxyapatite with TGFβ1. Mol Med Rep 2018; 17:4981-4988. [PMID: 29393349 PMCID: PMC5865958 DOI: 10.3892/mmr.2018.8499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/15/2017] [Indexed: 12/22/2022] Open
Abstract
The formation of fibrocartilage at the healing site following a rotator cuff tear repair is a major problem in the field of tendon-bone healing. The present study aimed to enhance the healing of the tendon-bone interface following rotator-cuff tear repair by the interposition of hydroxyapatite (HA) encapsulated with transforming growth factor β1 (TGFβ1). Using an acute rotator cuff repair model, rats were divided into three groups: i) Repair only (control); ii) HA group; and iii) HA-TGFβ1 group. Animals were sacrificed at 2, 4 and 8 weeks following surgery. Micro-computed tomography (CT), histomorphometric analyses and biomechanical tests were used to evaluate the supraspinatus tendon-bone complex. The micro-CT images revealed notable novel bone formation in the groups treated with HA-TGFβ1. The histomorphometric analyses demonstrated improved fibrocartilage formation and collagen organization at the tendon-bone interface. The HA-TGFβ1 combination significantly improved the area of fibrocartilage, particularly at early time points (2 and 4 weeks). There was a significantly greater load-to-failure force achieved in the HA and HA-TGFβ1 groups compared with the control group at 4 and 8 weeks. Augmentation of the ceramic powder with HA-TGFβ1 at the tendon-bone interface was demonstrated to strengthen the healing entheses, increase bone and fibrocartilage formation and improve collagen organization compared with surgical repair alone. Local application of HA-TGFβ1 demonstrates potential in improving tendon-bone healing following rotator cuff repair.
Collapse
Affiliation(s)
- Xiebo You
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yueqin Shen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure, Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai 200050, P.R. China
| | - Weihan Yu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Yaohua He
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| |
Collapse
|
48
|
Ebert JR, Wang A, Smith A, Nairn R, Breidahl W, Zheng MH, Ackland T. A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Controlled Trial. Am J Sports Med 2017; 45:2965-2974. [PMID: 28806095 DOI: 10.1177/0363546517719048] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) has been applied as an adjunct to rotator cuff repair to improve tendon-bone healing and potentially reduce the incidence of subsequent tendon retears. PURPOSE To investigate whether the midterm clinical and radiographic outcomes of arthroscopic supraspinatus repair are enhanced after repeated postoperative applications of PRP. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 60 patients (30 control; 30 PRP) were initially randomized to receive 2 ultrasound-guided injections of PRP to the tendon repair site at 7 and 14 days after double-row arthroscopic supraspinatus repair or not. A total of 55 patients (91.7%) underwent a clinical review and magnetic resonance imaging (MRI) at a mean of 3.5 years after surgery (range, 36-51 months). Patient-reported outcome measures (PROMs) included the Constant score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain. Global rating of change (GRC) scale and patient satisfaction scores were evaluated. Structural integrity of the surgical repair was assessed via MRI using the Sugaya classification system. RESULTS At the midterm review, there was no difference between the groups for any of the PROMs. No differences between the groups were demonstrated for the subjective and range of motion subscales of the Constant score, although a significantly higher Constant strength subscale score was observed in the PRP group (3.3 points; 95% CI, 1.0-5.7; P = .006). There was no evidence for any group differences in MRI scores or retear rates, with 66.7% of PRP patients and 64.3% of control patients rated as Sugaya grade 1. Two control patients had symptomatic retears (both full thickness) within the first 16 weeks after surgery compared with 2 PRP patients, who suffered symptomatic retears (both partial thickness) between 16 weeks and a mean 3.5-year follow-up. CONCLUSION Significant postoperative clinical improvements and high levels of patient satisfaction were observed in patients at the midterm review after supraspinatus repair. While pain-free, maximal abduction strength was greater in the midterm after PRP treatment, repeated applications of PRP delivered at 7 and 14 days after surgery provided no additional benefit to tendon integrity.
Collapse
Affiliation(s)
- Jay R Ebert
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Allan Wang
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, St John of God Subiaco Hospital, Perth, Western Australia, Australia.,Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Anne Smith
- School of Physiotherapy and Exercise Science and Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Robert Nairn
- Perth Radiological Clinic, Perth, Western Australia, Australia
| | | | - Ming Hao Zheng
- Department of Orthopaedic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Timothy Ackland
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
49
|
Deprés-Tremblay G, Chevrier A, Hurtig MB, Snow M, Rodeo S, Buschmann MD. Freeze-Dried Chitosan-Platelet-Rich Plasma Implants for Rotator Cuff Tear Repair: Pilot Ovine Studies. ACS Biomater Sci Eng 2017; 4:3737-3746. [DOI: 10.1021/acsbiomaterials.7b00354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Mark B Hurtig
- Department of Clinical Studies, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham B31 2Ap, United Kingdom
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, New York 10021, United States
| | | |
Collapse
|
50
|
Bilsel K, Yildiz F, Kapicioglu M, Uzer G, Elmadag M, Pulatkan A, Esrefoglu M, Bozdag E, Milano G. Efficacy of bone marrow-stimulating technique in rotator cuff repair. J Shoulder Elbow Surg 2017; 26:1360-1366. [PMID: 28395947 DOI: 10.1016/j.jse.2017.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/20/2017] [Accepted: 02/07/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study used a chronic rotator cuff (RC) tear model to investigate the effect of microfracture as a bone marrow-stimulating (BMS) technique for RC healing. METHODS A chronic retracted RC tendon tear model was created bilaterally in the subscapularis tendons of 20 New Zealand rabbits. The tendons were repaired after 8 weeks using a single-row configuration. Tendons in the right shoulder were repaired in standard fashion (control group). Microfractures were performed in the left shoulders before repair (microfracture group). The animals were euthanized 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness, and elongation at failure. Gross and histologic evaluations of the tendon-to-bone healing were evaluated. RESULTS Macroscopically, subscapularis tendons were attached on the lesser tuberosity. In the microfracture group, collagen fibers were organized in relatively thicker bundles. The mean ultimate failure load of the microfracture group was significantly greater at 8 weeks (148.4 ± 31 N vs. 101.4 ± 26 N, respectively; P = .011) and 16 weeks (155 ± 30 N vs. 114.9 ± 25 N, respectively; P = .017) after repair. There were no significant differences between the groups for linear stiffness at 8 weeks (15.9 ± 2.7 N/mm vs. 15.8 ± 1.3 N/mm, respectively; P = .798) and 16 weeks (16.9 ± 4.3 N/mm vs. 17.1 ± 3.6 N/mm, respectively, P = .848) and elongation at failure at 8 weeks (4.7 ± 1.1 mm vs. 4.7 ± 1.3 mm, respectively; P = .848) and 16 weels (4.8 ± 1.5 mm vs. 4.9 ± 0.9 mm, respectively; P = .749). CONCLUSION The microfracture on the tuberosity of the repaired chronic rotator cuff tear promoted dynamic tendon healing with significantly increased ultimate force to failure and with thicker collagen bundles and more fibrocartilage histologically at 8 weeks.
Collapse
Affiliation(s)
- Kerem Bilsel
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
| | - Fatih Yildiz
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Kapicioglu
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Gokcer Uzer
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mehmet Elmadag
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mukaddes Esrefoglu
- Department of Histology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ergun Bozdag
- Biomechanics Laboratory, Department of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Giuseppe Milano
- Department of Orthopedics and Traumatology, Catholic University, Rome, Italy
| |
Collapse
|