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Li H, Liu X, Zhang L, Zhang L. Plunge-Freezing Cryopreservation of Tendons. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2024; 40:14007-14015. [PMID: 38916446 DOI: 10.1021/acs.langmuir.4c01215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Allograft transplantation is an important method for tendon reconstruction after injury, and its clinical success highly relies on the storage and transportation of the grafts. Cryopreservation is a promising strategy for tendon storage. In this study, we report a novel cryopreservation agent (CPA) formulation with a high biocompatibility for tendon cryopreservation. Mainly composed of natural zwitterionic betaine and the biocompatible polymer poly(vinylpyrrolidone) (PVP), it exhibited ideal abilities to depress the freezing point and inhibit ice growth and recrystallization. Notably, after cryopreservation via plunge-freezing for 1 month, Young's modulus (144 MPa, 98% of fresh tendons) and ultimate stress (46.7 MPa, 99% of fresh tendons) remained stable, and the cross-linking of collagen microfibers, protein structures, and glycosaminoglycan (GAG) contents changed slightly. These results indicate that the formulation (5 wt % betaine and 5 wt % PVP in phosphate-buffered saline, PBS solution) effectively maintains the biomechanical properties and tissue structure. This work offers a novel cryopreservation method for tendons and may also provide insights into the long-term preservation of various other tissues.
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Affiliation(s)
- Haoyue Li
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Xinmeng Liu
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Liming Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
| | - Lei Zhang
- Department of Biochemical Engineering, Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, China
- Haihe Laboratory of Sustainable Chemical Transformations, Tianjin 300192, China
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Schmidt J, Goode D, Flannigan R, Mohammadi H. A review of the experimental methods and results of testing the mechanical properties of Tunica Albuginea. J Med Eng Technol 2023; 47:234-241. [PMID: 38236639 DOI: 10.1080/03091902.2023.2300829] [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] [Received: 06/29/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
The present work provides a comprehensive review of the literature on the mechanical properties and existing human tunica albuginea tissue testing methods. Assessments were completed on papers reporting experimental values of Young's modulus, tensile strength, puncture strength, stiffness, toughness, and strain at the ultimate tensile strength (UTS). A high degree of variability in the reported experimental values was found; Young's modulus ranged from 5 MPa to 118 MPa, and tensile strength went from 1.1 MPa to 6.1 MPa. A comparison of the variability of the reported experimental values for puncture strength, stiffness, toughness, and strain at the UTS could not be completed due to a lack of experimental results. This review discusses the pathophysiology and surgical treatment of erectile dysfunction and Peyronie's disease, variability in the existing reported mechanical properties, the impact of the variability of mechanical properties on in silico models and explores the absence of a standardised testing method as a possible reason for the variable in results. Finally, this work attempts to provide suggestions for standardising future mechanical testing of the tunica albuginea through minimising and reporting freeze/thaw cycling, noting the proximal/distal region of the cadaver tunica sample, reporting the orientation (o'clock position) of the cadaver tunica sample, and testing the cadaver tunica samples in bi-axial tension. Ultimately, standardising the testing methodologies of the tunica albuginea will provide higher confidence in reported mechanical property values.
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Affiliation(s)
- Jaymes Schmidt
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, Canada
| | - Dylan Goode
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Faculty of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Hadi Mohammadi
- The Heart Valve Performance Laboratory, School of Engineering, Faculty of Applied Science, University of British Columbia, Kelowna, BC, Canada
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Farago D, Kozma B, Kiss RM. Categorize the existing clamps used for tensile test of human graft- a systematic review. BMC Musculoskelet Disord 2022; 23:707. [PMID: 35879684 PMCID: PMC9316330 DOI: 10.1186/s12891-022-05650-w] [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: 07/28/2021] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background The use of tendon allografts for orthopedic repair has gained wide acceptance in recent years, most notably in anterior cruciate tendon reconstruction. Multiple studies support the use of tendon allografts and the benefits of its use are well accepted and understood. One of the important criteria of the use of tendon allografts is statistically similar histological and biomechanical properties to autographs. The aim of this systematic literature review is to investigate and categorize existing clamps used in the determination of the biomechanical properties of tendons such as maximum load, maximum strength, modulus of elasticity, ultimate strain, and stiffness. A variety of clamps for use during the endurance test of tendons were categorized according to the temperature used during the measurement. The clamps are divided into three groups: room temperature, cooled and heated clamps. The second goal of our review is to overview of clamps on the following aspects: name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters, and summarize in Table 3, as a comprehensive catalogue. Methods This systematic review was carried out in keeping with the PRISMA 2020 E&E and the PRISMA-S guidelines and checklists. A search was conducted for publications dating between 1991 and February 28th 2022 through three electronic databases (Web of Science, Scopus, and PubMed). We used Critical Appraisal Skills Program checklist to check the quality of included articles. Results The database search and additional sources resulted in 1725 records. 1635 records eliminated during the screening for various reasons (case report, other languages, book chapter, unavailable text/conference abstract, unrelated topic). The number of articles used in the final synthesis was 90. A variety of clamps for use during the endurance test of tendons were identified and categorized according to the temperature used during the measurement. Based on this, the clamps are divided into three groups: room temperature, cooled or heated clamps. Conclusions On the basis of the systematic literature review, mechanical parameters determined by usage with cooled clamps proved to be more reliable than with those at room temperature and with heated clamps. The collected information from the articles included name of clamp, author and date, type of clamps, type of endurance test (static or dynamic), type preloading (dynamic or static), type of tendon and measured and calculated parameters given in Table 3. summarized. The main advantage of the cooled clamps is that there is no limit to the type and length of the tendon. This study provides an overview of clamps and does not represent the modernity of any method. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05650-w.
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Affiliation(s)
- Denes Farago
- Cooperation Research Center for Biomechanics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary. .,Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Blanka Kozma
- Department of Biomedical Engineering, SUNY University at Buffalo, Buffalo, USA
| | - Rita Maria Kiss
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, Budapest, Hungary
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Different sterilization and disinfection methods used for human tendons - a systematic review using mechanical properties to evaluate tendon allografts. BMC Musculoskelet Disord 2021; 22:404. [PMID: 33941147 PMCID: PMC8091719 DOI: 10.1186/s12891-021-04296-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background It is important to know the biomechanical properties of an allograft. This is because when looking to do a transplant of a tendon, the tendon must have very similar biomechanical properties to the original tendon. To use tendon allografts, it is critical to properly sterilize the tendon before implantation. In past decades, several sterilization procedures have been used. This study aimed to systematically evaluate the existing literature to compare the values of failure load/ultimate strength and Young’s modulus of elasticity of different sterilization methods on commonly used tendon allografts. Five major scientific literature databases (Web of Science, Science Direct, Scopus, PLOS ONE, Hindawi) and additional sources were used. Results Studies used had to show a particular sterilization method. Studies were identified to meet the following inclusion criteria: is a controlled laboratory study, gamma irradiation (dose reported), and other sterilization methods. Search for publications dated between 1991 and March 31st, 2020. The database search and additional sources resulted in 284 records. Two hundred thirty records eliminated during the screening for various reasons. The number of articles used in the final synthesis was 54. Conclusions Identified sterilization methods (gamma irradiation, ethylene oxid, supercritical carbon dioxide (SCCO2), BioCleanse, Electron Beam) are offered as a catalog of potential methods. As a result of the broadness of the present research, it provides an overview of sterilization methods and their effect on the mechanical properties (failure load and Young’s modulus of elasticity) of tendons. It does not stand for the state-of-the-art of any single process. Based on a systematic literature review, we recommend freezing and gamma irradiation or electron beam at 14.8–28.5 kGy. These methods are effective at keeping or improving the mechanical properties, while fully sterilizing the inside and the outside of the tendon. Other sterilization method (ethylene oxide, supercritical carbon dioxide (SCCO2), BioCleanse) deteriorated the mechanical properties. These methods are not recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04296-4.
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Sun Y, Lovric V, Wang T, Oliver RA, Walsh WR. Effects of SCCO 2, Gamma Irradiation, and Sodium Dodecyl Sulfate Treatments on the Initial Properties of Tendon Allografts. Int J Mol Sci 2020; 21:ijms21051565. [PMID: 32106592 PMCID: PMC7084268 DOI: 10.3390/ijms21051565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/07/2020] [Accepted: 02/15/2020] [Indexed: 01/05/2023] Open
Abstract
Sterile and decellularized allograft tendons are viable biomaterials used in reconstructive surgeries for dense connective tissue injuries. Established allograft processing techniques including gamma irradiation and sodium dodecyl sulfate (SDS) can affect tissue integrity. Supercritical carbon dioxide (SCCO2) represents a novel alternative that has the potential to decellularize and sterilize tendons with minimized exposure to denaturants, shortened treatment time, lack of toxic residues, and superior tissue penetration, and thus efficacy. This study attempted to develop a single-step hybrid decellularization and sterilization protocol for tendons that involved SCCO2 treatment with various chemical additives. The processed tendons were evaluated with mechanical testing, histology, scanning electron microscopy (SEM), and Fourier-transform infrared (FTIR) spectroscopy. Uniaxial mechanical testing showed that tendons treated with SCCO2 and additive NovaKillTM Gen2 and 0.1% SDS had significantly higher (p < 0.05) ultimate tensile stress (UTS) and Young's modulus compared to gamma-irradiated and standard-SDS-treated tendons. This was corroborated by the ultrastructural intactness of SCCO2-treated tendons as examined by SEM and FTIR spectroscopy, which was not preserved in gamma-irradiated and standard SDS-treated tendons. However, complete decellularization was not achieved by the experimented SCCO2-SDS protocols used in this study. The present study therefore serves as a concrete starting point for development of an SCCO2-based combined sterilization and decellularization protocol for allograft tendons, where additive choice is to be optimized.
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Effects of freeze-thaw on the biomechanical and structural properties of the rat Achilles tendon. J Biomech 2018; 81:52-57. [DOI: 10.1016/j.jbiomech.2018.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022]
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Bi C, Thoreson AR, Zhao C. The effects of lyophilization on flexural stiffness of extrasynovial and intrasynovial tendon. J Biomech 2018; 76:229-234. [PMID: 29935733 DOI: 10.1016/j.jbiomech.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/30/2018] [Accepted: 06/09/2018] [Indexed: 11/28/2022]
Abstract
Tendon or ligament reconstructions often use autologous or allogenic tendons from either extrasynovial or intrasynovial sources. Allograft tendons must be lyophilized for preservation before transplantation, a process which can impact mechanical properties of the graft. Reconstituted graft properties that are similar to native tendon are desirable. Although tensile and compressive properties of tendons have been investigated, there is a paucity of information describing flexural properties of tendon, which can impact the gliding resistance. This study aims to design a testing method to quantify tendon flexural modulus, and investigate the effects of lyophilization/rehydration procedures on tendon flexibility. A total of 20 peroneus longus tendons (extrasynovial) and 20 flexor digitorum profundus tendons (intrasynovial) were collected. Ten of each tendon were processed with 5 freeze-thaw cycles followed by lyophilization and rehydration with saline solution (0.9%). Bend testing was conducted on tendons to quantify the flexural modulus with and without processing. As canine FDP tendons contain fibrous and fibrocartilaginous tissue regions, the flexural moduli were measured in both regions. Flexural modulus of rehydrated, lyophilized extrasynovial PL tendon was significantly lower than that of similarly processed intrasynovial FDP tendon (p < 0.001). Flexural moduli of both the fibrocartilaginous and non-fibrocartilaginous regions of intrasynovial tendon significantly increased after lyophilization (p < 0.001). The flexural modulus of the fibrocartilaginous region was significantly higher than that of the non-fibrocartilaginous region in intrasynovial tendon (p < 0.001). Lyophilization significantly increases the flexural modulus of extrasynovial and intrasynovial tendons, and flexural modulus differs significantly between these two tendon types. Increases in stiffness caused by lyophilization may impact the mechanical performance of the allograft in vivo.
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Affiliation(s)
- Chun Bi
- Soft Tissue Biology and Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Orthopaedic Traumatology, Trauma Center, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 650 Xin Songjiang Road, Shanghai 201620, China
| | - Andrew R Thoreson
- Materials and Structural Testing Core Laboratory, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA
| | - Chunfeng Zhao
- Soft Tissue Biology and Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Zheng X, Xu W, Gu J, Hu Y, Cui M, Feng YE, Gao S. Effects of graft preconditioning on γ-irradiated deep frozen tendon allografts used in anterior cruciate ligament reconstruction. Exp Ther Med 2018; 16:1338-1342. [PMID: 30116383 PMCID: PMC6090265 DOI: 10.3892/etm.2018.6338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/25/2018] [Indexed: 11/14/2022] Open
Abstract
Preconditioning of the grafts prior to implantation into the knee is considered to reduce the loss of tension caused by graft viscoelasticity after anterior cruciate ligament reconstruction. The present study analyzed the impacts of different preconditioning forces on the biomechanical properties of the γ-irradiated deep frozen tendon allografts. A total of 36 tendon grafts were randomly divided into three groups and were preconditioned at 80 N (group 1), 160 N (group 2) and 320 N (group 3) for 10 min. Subsequently, the grafts were gradually completely relaxed for 1 min and subsequently received 25 cyclic loads of 0–80 N. Afterwards, the grafts were loaded to 80 N, which was maintained for 30 min. Finally, load was gradually increased until ultimate failure at maximum load (UFML) was obtained. There were significant differences in the stiffness and UFML values between the 3 groups (all P<0.05). The graft stiffness in group 3 significantly increased compared with the other 2 groups, and the stiffness of group 2 grafts increased compared with group 1. The UFML in group 3 was significantly lower compared with groups 1 and 2, while there was no significant difference between groups 1 and 2. In the present study, the results suggested that increasing the initial tension could effectively reduce the loss of stiffness due to viscoelasticity for the γ-irradiated deep frozen allogeneic tendon grafts. However, overloaded initial tension decreased the tensile strength.
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Affiliation(s)
- Xiaozuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Wei Xu
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Emergency Department, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, P.R. China
| | - Juyuan Gu
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yang Hu
- The Second Department of Intensive Care Unit, Children's Hospital of Hebei Province, Shijiazhuang, Hebei 050000, P.R. China
| | - Meijuan Cui
- Department of Medical Records, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Yu-E Feng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
| | - Shijun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China.,Orthopaedic Biomechanics Laboratory of Hebei Province, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, P.R. China
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Herbert A, Edwards JH, Jones GL, Ingham E, Fisher J. The effects of irradiation dose and storage time following treatment on the viscoelastic properties of decellularised porcine super flexor tendon. J Biomech 2017; 57:157-160. [PMID: 28449861 PMCID: PMC5754329 DOI: 10.1016/j.jbiomech.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/31/2017] [Accepted: 04/09/2017] [Indexed: 12/28/2022]
Abstract
Decellularised porcine super flexor tendon (pSFT) offers a promising solution to the replacement of damaged anterior cruciate ligament. It is desirable to package and terminally sterilise the acellular grafts to eliminate any possible harmful pathogens. However, irradiation techniques can damage the collagen structure and consequently reduce the mechanical properties. The aims of this study were to investigate the effects of irradiation sterilisation of varying dosages on the viscoelastic properties of the decellularised pSFT. Decellularised pSFT tendons were subjected to irradiation sterilisation using either 30 kGy gamma, 55 kGy gamma, 34 kGy E-beam, 15 kGy gamma, 15 kGy E-beam and (15 + 15) kGy E-beam (fractionated dose). Specimens then underwent stress relaxation testing at 0 and 12 months post sterilisation to determine whether any effect on the viscoelastic properties was progressive. Significant differences were found which demonstrated that all irradiation treatments had an effect on the time-independent and time-dependent viscoelastic properties of irradiated tendons compared to peracetic acid only treated controls. No significant differences were found between the irradiated groups and no significant differences were found between groups at 0 and 12 months. These results indicate the decellularised pSFT graft has a stable shelf-life.
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Affiliation(s)
- Anthony Herbert
- (IMBE) Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK.
| | | | - Gemma L Jones
- IMBE, Faculty of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Eileen Ingham
- IMBE, Faculty of Biomedical Sciences, University of Leeds, Leeds, UK
| | - John Fisher
- (IMBE) Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, UK
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Evaluation of porcine xenograft in collateral ligament reconstruction in beagle dogs. Res Vet Sci 2014; 97:605-10. [PMID: 25465130 DOI: 10.1016/j.rvsc.2014.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/13/2014] [Accepted: 10/19/2014] [Indexed: 11/19/2022]
Abstract
This study evaluated the effectiveness of irradiated porcine tendon xenografts for lateral collateral ligament (LCL) reconstruction. Twenty healthy adult beagle dogs underwent LCL reconstruction using irradiated porcine tendons treated with poly-gamma-glutamic acid. Serological and histological assessments were performed to evaluate host immunological response at 3 and 12 months after surgery. The healing and functional integrity of the LCL reconstructions were assessed by mechanical testing and gait analysis. Histological assessment of the porcine xenografts showed gradual host cellular infiltration and graft collagen remodeling during the healing process. Porcine xenografts showed angiogenesis and no signs of inflammatory reaction. Additionally, biomechanical and gait evaluations supported graft functional integration with no differences between normal and porcine xenograft reconstruction at 12 months after surgery. Irradiated porcine xenografts showed greater cellular responses and healing properties in short- and long-term evaluations. Irradiated porcine tendons appear to be useful as xenografts for the reconstruction of damaged ligaments.
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Operative technique for human composite flexor tendon allograft procurement and engraftment. Ann Plast Surg 2014; 72:S191-7. [PMID: 24691346 DOI: 10.1097/sap.0000000000000091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Devastating volar hand injuries with significant damage to the pulley structures and fibro-osseous sheath, flexor tendons, and volar plates pose a major problem to the reconstructive hand surgeon. Despite advances in tendon handling, operative technique, and postoperative hand rehabilitation, patients who have undergone flexor tendon reconstruction are often plagued by chronic pain, stiffness, and decreased range of motion with resultant decreased ability to work and poor quality of life. Postoperative adhesion formation and lack of suitable donor material for tendon autograft are 2 fundamental problems that continue to challenge the hand surgeon. In 1967, Erle E. Peacock, Jr, described a technique of flexor tendon reconstruction using cadaveric composite flexor tendon allograft, which consisted of both the flexor digitorum profundus and superficialis tendons in their respective fibro-osseous sheaths consisting of the digital pulley structures and the underlying periosteum and volar plates. This technique never gained widespread acceptance due to concerns regarding tissue antigenicity, infectious disease transmission, and the rising popularity of the method of Hunter for silastic rod-based flexor tendon reconstruction initially described during the same period. With modern-day advances in tissue processing with acellularization and extensive donor screening for transmissible diseases, this technique should be revisited to address the reconstructive needs of patients with extensive volar soft tissue and tendon injury. Herein, we describe the operative technique of composite flexor tendon procurement and reconstruction with key modifications from the initial technique described by Peacock for improved composite construct elevation, soft tissue inset, and bony attachment.
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Effects of repetitive freeze–thawing cycles on T2 and T2* of the Achilles tendon. Eur J Radiol 2014; 83:349-53. [DOI: 10.1016/j.ejrad.2013.10.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/24/2013] [Accepted: 10/12/2013] [Indexed: 11/21/2022]
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13
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Wei W, Liu Y, Yang X, Tian S, Liu C, Zhang Y, Xu Z, Hu B, Tian Z, Sun K. Fractionation of 50kGy electron beam irradiation: effects on biomechanics of human flexor digitorum superficialis tendons treated with ascorbate. J Biomech 2012; 46:658-61. [PMID: 23261247 DOI: 10.1016/j.jbiomech.2012.11.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 11/23/2012] [Accepted: 11/25/2012] [Indexed: 11/28/2022]
Abstract
The electron beam (Ebeam) irradiation has begun to be considered as an efficient alternative to gamma irradiation in the sterilization of allografts in the reconstruction of anterior cruciate ligament. The purpose of this study was to evaluate the biomechanical properties of human tendons after exposure to electron beam and free radical scavenger ascorbate. Forty human flexor digitorum superficialis tendons were prepared from five fresh cadavers and divided randomly into four groups: A, fresh (0kGy); B, 50kGy Ebeam irradiation; C, fractionated 50kGy Ebeam irradiation; D, fractionated 50kGy Ebeam on ascorbate-treated tendons. The fractionation of 50kGy was achieved by repeated irradiation of 2.5kGy for 20 repetitions. Biomechanical properties were analyzed during load-to-failure testing. The fresh tendons were found to be significant different in ultimate load, ultimate elongation relative to tendons in group B. Statistical differences were found between group B and C in ultimate load. No differences were detected between group A and C in all the parameters. Compare tendons in group C and D, significant differences were found in ultimate load and ultimate stress. It is recommended that fractionated 50kGy electron beam irradiation and free radical scavenger ascorbate should be applied in the sterilization of allografts tendons.
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Affiliation(s)
- Wei Wei
- Department of Orthopedics, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China.
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