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Iida N, Thoreson AR, Reisdorf RL, Tsukamoto I, El Hor H, Zhao C. Relationship Between the Changes of Tendon Elastic Moduli With Ultrasound Shear Wave Elastography and Mechanical Compression Test. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:586-591. [PMID: 38272742 DOI: 10.1016/j.ultrasmedbio.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/07/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the consistency of the changes in the elastic modulus measured with ultrasound shear wave elastography (SWE) with changes measured through mechanical testing using tendons that were artificially altered by chemical modifications. METHODS Thirty-six canine flexor digitorum profundus tendons were used for this experiment. To mimic tendon mechanical property changes induced by tendinopathy conditions, tendons were treated with collagenase to soften the tissue by collagen digestion or with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC) to stiffen the tissues through chemical crosslinking. Tendons were randomly assigned to one of three groups: immersion in phosphate-buffered saline (PBS) as a control group (n = 12), collagenase treatment (n = 12) or EDC treatment (n = 12). Immediately following SWE measurement of each tendon, mechanical compression testing was performed as a gold standard to validate the SWE measurement. Both tests were conducted before and after treatment. RESULTS The compressive modulus and SWE shear modulus significantly decreased after collagenase treatment. Conversely, both moduli significantly increased after EDC treatment. There was no significant difference in either modulus before or after PBS treatment. As a result of a regression analysis with the percentage change of the compressive modulus as the dependent variable and SWE shear modulus as the independent variable, the best-fit regression was found to be an exponential function and the coefficient of determination was 0.687. CONCLUSION The changes in the compressive moduli and SWE shear moduli in tendons induced by chemical treatments were correlated by approximately 70%.
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Affiliation(s)
- Naoya Iida
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrew R Thoreson
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Ichiro Tsukamoto
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hicham El Hor
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Fofiu A, Tripon RG, Băţagă T, Chirilă TV. Exogenous Crosslinking of Tendons as a Strategy for Mechanical Augmentation and Repair: A Narrative Review. Orthop Res Rev 2023; 15:165-173. [PMID: 37637359 PMCID: PMC10455955 DOI: 10.2147/orr.s421106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Collagens constitute a family of triple-helical proteins with a high level of structural polymorphism and a broad diversity of structural and chemical characteristics. Collagens are designed to form supporting aggregates in the extracellular spaces of our body, but they can be isolated from animal sources and processed to become available as biomaterials with wide applications in biomedicine and bioengineering. Collagens can be conveniently modified chemically, and their propensity for participating in crosslinking reactions is an important feature. While the crosslinking promoted by a variety of agents provides a range of collagen-based products, there has been minor interest for therapies based on the crosslinking of collagen while located within living connective tissues, known as exogenous crosslinking. Currently, there is only one such treatment in ocular therapeutics (for keratoconus), and another two in development, all based on mechanical augmentation of tissues due to ultraviolet (UV)-induced crosslinking. As seen in this review, there was some interest to employ exogenous crosslinking in order to reinforce mechanically the lax tendons with an aim to arrest tear propagation, stabilize the tissue, and facilitate the healing. Here we reviewed in details both the early stages and the actual status of the experimental research dedicated to the topic. Many results have not been encouraging, however there is sufficient evidence that tendons can be mechanically reinforced by chemical or photochemical exogenous crosslinking. We also compare the exogenous crosslinking using chemical agents, which was predominant in the literature reviewed, to that promoted by UV radiation, which was rather neglected but might have some advantages.
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Affiliation(s)
- Alexandru Fofiu
- Department of Orthopedics-Traumatology, Emergency County Hospital Bistriţa, Bistriţa Năsăud, Romania
- School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Robert G Tripon
- Department of Ophthalmology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Tiberiu Băţagă
- Department of Orthopedics-Traumatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
| | - Traian V Chirilă
- School of Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology, Târgu Mureş, Romania
- Department of Research, Queensland Eye Institute, South Brisbane, QLD, Australia
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Institute of Bioengineering and Nanotechnology, University of Queensland, St Lucia, QLD, Australia
- School of Molecular Science, University of Western Australia, Crawley, WA, Australia
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Bala MM, Şahin AA, Boz M, Durukan Y, Fırat T, Pakdil M, Özturan KE. Effects of Cyanoacrylate in Rabbits with Induced Achilles Tendon Rupture. Med Sci Monit 2021; 27:e929709. [PMID: 34483334 PMCID: PMC8434771 DOI: 10.12659/msm.929709] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study, we aimed to investigate the effects of N-butyl-2-cyanoacrylate (cyanoacrylate) on the biomechanical and histopathological aspects of tendon healing in a rabbit model of Achilles tendon injury. MATERIAL AND METHODS In total, 36 rabbits were randomized to experimental (cyanoacrylate) and control groups (n=36 tendons in each group). A simple suture was used in the control group and a simple suture plus cyanoacrylate was used in the experimental group. Nine rabbits from each group were euthanized at week 4 and week 6 after surgery for histopathological and biomechanical testing. RESULTS Granulation tissue formation was significantly greater in the experimental group in week 4 and week 6 than in the control group. Foreign body giant cell formation was significantly higher in the experimental group in week 4 and week 6. The maximum rupture force was significantly higher in the experimental group in week 4 and week 6 than in the control group. Elasticity and stiffness were comparable between groups in week 4; however, stiffness, but not elasticity, was significantly higher in the experimental group in week 6. CONCLUSIONS In the short term, cyanoacrylate enhanced tendon endurance in both a histopathological and biomechanical manner. We conclude that the early initiation of rehabilitation in patients may be safe in cases of cyanoacrylate use for surgical repair of tendon injury.
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Affiliation(s)
- Mehmet Murat Bala
- Department of Orthopaedics and Traumatology, Trabzon Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Abdullah Alper Şahin
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Ordu, Ordu, Turkey
| | - Mehmet Boz
- Department of Orthopaedics and Traumatology, Malatya Training and Research Hospital, Malatya, Turkey
| | - Yasin Durukan
- Department of Orthopaedics and Traumatology, Sakarya Training and Research Hospital, University of Sakarya, Sakarya, Turkey
| | - Tülin Fırat
- Department of Histology and Embryology, Faculty of Medicine, University of Bolu Abant Izzet Baysal, Bolu, Turkey
| | - Murat Pakdil
- Department of Mechanical Engineering, Faculty of Engineering, University of Bolu Abant Izzet Baysal, Bolu, Turkey
| | - Kutay Engin Özturan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, University of Bolu Abant Izzet Baysal, Bolu, Turkey
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Zhou Y, Xie S, Tang Y, Li X, Cao Y, Hu J, Lu H. Effect of book-shaped acellular tendon scaffold with bone marrow mesenchymal stem cells sheets on bone-tendon interface healing. J Orthop Translat 2020; 26:162-170. [PMID: 33437635 PMCID: PMC7773951 DOI: 10.1016/j.jot.2020.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Tissue engineering has exhibited great effect on treatment for bone-tendon interface (BTI) injury. The aim of this study was to evaluate the effect of a book-shaped acellular tendon scaffold (ATS) with bone marrow mesenchymal stem cells sheets (MSCS) for BTI injury repair. Methods ATS was designed based on the shape of "book", decellularization effect was evaluated by Hematoxylin and eosin (H&E), 4', 6-diamidino-2-phenylindole (DAPI) and scanning electron microscopy (SEM), then bone marrow mesenchymal stem cells (MSCs) were cultured on ATS to assess the differentiation inductivity of ATS. A rabbit right partial patellotomy model was established, and MSCS seeded on ATS were implanted into the lesion site. The patella-patellar tendon (PPT) at 2, 4, 8 or 16 weeks post-operation were obtained for histological, biomechanical and immunofluorescence analysis. Results H&E, DAPI and SEM results confirmed the efficiency of decellularization of ATS, and their in vitro tenogenic and chondrogenic ability were successfully identified. In vivo results showed increased macrophage polarization toward the M2 phenotype, IL-10 expression, regenerated bone and fibrocartilage at the patella-patellar tendon interface of animals received MSCS modified ATS implantation. In addition, the level of tensile strength was also the highest in MSCS modified ATS implantation group. Conclusion This study suggests that ATS combined with MSCS performed therapeutic effects on promoting the regeneration of cartilage layer and enhancing the healing quality of patella-patellar tendon interface. The translational potential of this article This study showed the good biocompatibility of the ATS, as well as the great efficacy of ATS with MSCS on tendon to bone healing. The results meant that the novel book-shaped ATS with MSCS may have a great potential for clinical application.
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Affiliation(s)
- Yongchun Zhou
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710000, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Shanshan Xie
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Yifu Tang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Xiaoning Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.,Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, People's Republic of China.,Xiangya Hospital-International Chinese Musculoskeletal Research Society Sports Medicine Research Centre, People's Republic of China
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5
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Zhang T, Hatta T, Thoreson AR, Lu C, Steinmann SP, Moran SL, Zhao C. Rotator cuff repair with a novel mesh suture: An ex vivo assessment of mechanical properties. J Orthop Res 2018; 36:987-992. [PMID: 28762567 DOI: 10.1002/jor.23668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/29/2017] [Indexed: 02/04/2023]
Abstract
Surgical repair is a common treatment for rotator cuff tear; however, the retear rate is high. A high degree of suture repair strength is important to ensure rotator cuff integrity for healing. The purpose of this study was to compare the mechanical performance of rotator cuffs repaired with a mesh suture versus traditional polydioxanone suture II and FiberWire sutures in a canine in vitro model. Seventy-two canine shoulders were harvested. An infraspinatus tendon tear was created in each shoulder. Two suture techniques-simple interrupted sutures and two-row suture bridge-were used to reconnect the infraspinatus tendon to the greater tuberosity, using three different suture types: Mesh suture, polydioxanone suture II, or FiberWire. Shoulders were loaded to failure under displacement control at a rate of 20 mm/min. Failure load was compared between suture types and techniques. Ultimate failure load was significantly higher in the specimens repaired with mesh suture than with polydioxanone suture II or FiberWire, regardless of suture technique. There was no significant difference in stiffness among the six groups, with the exception that FiberWire repairs were stiffer than polydioxanone suture II repairs with the simple interrupted technique. All specimens failed by suture pull-out from the tendon. Based on our biomechanical findings, rotator cuff repair with the mesh suture might provide superior initial strength against failure compared with the traditional polydioxanone suture II or FiberWire sutures. Use of the mesh suture may provide increased initial fixation strength and decrease gap formation, which could result in improved healing and lower re-tear rates following rotator cuff repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:987-992, 2018.
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Affiliation(s)
- Tao Zhang
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905.,Joint Surgery and Sports Medicine, Jinan Central Hospital, Shandong, 250013, China
| | - Taku Hatta
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
| | - Andrew R Thoreson
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
| | - ChengChang Lu
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
| | - Scott P Steinmann
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
| | - Steven L Moran
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
| | - Chunfeng Zhao
- Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, Minnesota, 55905
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Linderman SW, Gelberman RH, Thomopoulos S, Shen H. Cell and Biologic-Based Treatment of Flexor Tendon Injuries. ACTA ACUST UNITED AC 2016; 26:206-215. [PMID: 28042226 DOI: 10.1053/j.oto.2016.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The two primary factors leading to poor clinical results after intrasynovial tendon repair are adhesion formation within the digital sheath and repair-site elongation and rupture. As the outcomes following modern tendon multi-strand repair and controlled rehabilitation techniques are often unsatisfactory, alternative approaches, such as the application of growth factors and mesenchymal stem cells (MSCs), have become increasingly attractive treatment options. Successful biological therapies require carefully controlled spatiotemporal delivery of cells, growth factors, and biocompatible scaffold matrices in order to simultaneously (1) promote matrix synthesis at the tendon repair site leading to increased biomechanical strength and stiffness and (2) suppress matrix synthesis along the tendon surface and synovial sheath preventing adhesion formation. This review summarizes recent cell and biologic-based experimental treatments for flexor tendon injury, with an emphasis on large animal translational studies.
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Affiliation(s)
- Stephen W Linderman
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States; Department of Biomedical Engineering, Washington University, St. Louis, MO, United States
| | - Richard H Gelberman
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Columbia University, New York, NY, United States; Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Hua Shen
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, United States
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Zhao C, Ozasa Y, Shimura H, Reisdorf RL, Thoreson AR, Jay G, Moran SL, An KN, Amadio PC. Effects of lubricant and autologous bone marrow stromal cell augmentation on immobilized flexor tendon repairs. J Orthop Res 2016; 34:154-60. [PMID: 26177854 PMCID: PMC5166703 DOI: 10.1002/jor.22980] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/08/2015] [Indexed: 02/04/2023]
Abstract
The purpose of the study was to test a novel treatment that carbodiimide-derivatized-hyaluronic acid-lubricin (cd-HA-lubricin) combined cell-based therapy in an immobilized flexor tendon repair in a canine model. Seventy-eight flexor tendons from 39 dogs were transected. One tendon was treated with cd-HA-lubricin plus an interpositional graft of 8 × 10(5) BMSCs and GDF-5. The other tendon was repaired without treatment. After 21 day of immobilization, 19 dogs were sacrificed; the remaining 20 dogs underwent a 21-day rehabilitation protocol before euthanasia. The work of flexion, tendon gliding resistance, and adhesion score in treated tendons were significantly less than the untreated tendons (p < 0.05). The failure strength of the untreated tendons was higher than the treated tendons at 21 and 42 days (p < 0.05). However, there is no significant difference in stiffness between two groups at day 42. Histologic analysis of treated tendons showed a smooth surface and viable transplanted cells 42 days after the repair, whereas untreated tendons showed severe adhesion formation around the repair site. The combination of lubricant and cell treatment resulted in significantly improved digit function, reduced adhesion formation. This novel treatment can address the unmet needs of patients who are unable to commence an early mobilization protocol after flexor tendon repair.
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Affiliation(s)
- Chunfeng Zhao
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Yasuhiro Ozasa
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Haruhiko Shimura
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Ramona L. Reisdorf
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Andrew R. Thoreson
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Gregory Jay
- Department of Emergency Medicine, Brown University, Providence, Rhode Island
| | - Steven L. Moran
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Kai-Nan An
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
| | - Peter C. Amadio
- Division of Orthopedic Research Mayo Clinic, Biomechanics Laboratory and the Tendon & Soft Tissue Biology Laboratory, Rochester, Minnesota
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Thoreson AR, Hiwatari R, An KN, Amadio PC, Zhao C. The Effect of 1-Ethyl-3-(3-Dimethylaminopropyl) Carbodiimide Suture Coating on Tendon Repair Strength and Cell Viability in a Canine Model. J Hand Surg Am 2015; 40:1986-91. [PMID: 26304735 PMCID: PMC4584204 DOI: 10.1016/j.jhsa.2015.06.117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if impregnating a suture with a cross-linking agent, 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride (EDC), improved suture pull-out strength and cell viability. METHODS Canine flexor digitorum profundus tendons were cut in canine zone D, and a single suture loop was placed in each end, with sutures soaked in either saline or an EDC solution with a concentration of 1%, 10%, or 50%. Suture pull-out strength, stiffness, and elongation to failure was determined by pulling the loop until failure. Cytotoxicity of the EDC treatment was evaluated by suspending treated sutures over cultured tenocytes. RESULTS Mechanical properties for the EDC-treated side were improved over controls when treated with the 10% and 50% EDC solutions. The ratio of dead to live cells was significantly increased at all distances from the suture for the 50% EDC-treated group. CONCLUSIONS Suture treated with a 10% EDC solution provided the best combination of mechanical reinforcement and limited toxicity. CLINICAL RELEVANCE Sutures so treated may improve the ability of a tendon repair to sustain early mobilization.
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Affiliation(s)
- Andrew R. Thoreson
- Division of Orthopedic Research, Mayo Clinic Biomechanics Laboratory 200 First Street SW Rochester, MN, USA 55905
| | - Ryo Hiwatari
- Division of Orthopedic Research, Mayo Clinic Biomechanics Laboratory 200 First Street SW Rochester, MN, USA 55905
| | - Kai-Nan An
- Division of Orthopedic Research, Mayo Clinic Biomechanics Laboratory 200 First Street SW Rochester, MN, USA 55905
| | - Peter C. Amadio
- Division of Orthopedic Research, Mayo Clinic Biomechanics Laboratory 200 First Street SW Rochester, MN, USA 55905
| | - Chunfeng Zhao
- Division of Orthopedic Research, Mayo Clinic Biomechanics Laboratory 200 First Street SW Rochester, MN, USA 55905,Corresponding Author: Chunfeng Zhao, M.D., Department of Orthopedic Surgery, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905, USA, Phone: 507-538-1717 Fax: 507-284-5392,
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9
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Ji X, Reisdorf RL, Thoreson AR, Berglund LR, Moran SL, Jay GD, An KN, Amadio PC, Zhao C. Surface Modification with Chemically Modified Synovial Fluid for Flexor Tendon Reconstruction in a Canine Model in Vivo. J Bone Joint Surg Am 2015; 97:972-8. [PMID: 26085530 PMCID: PMC4469787 DOI: 10.2106/jbjs.n.01100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Functional restoration is the major concern after flexor tendon reconstruction in the hand. The purpose of the present study was to investigate the effects of modifying the surface of extrasynovial tendon autografts with carbodiimide-derivatized synovial fluid with gelatin (cd-SF-G) on functional outcomes of flexor tendon reconstruction using a canine model. METHODS The second and fifth flexor digitorum profundus tendons from eleven dogs were transected and repaired in zone II. The dogs then had six weeks of free activity leading to tendon rupture and scar formation (the repair-failure phase). In the reconstruction phase, two autologous peroneus longus tendons from each dog were harvested; one tendon was coated with cd-SF-G and the other, with saline solution, as a control. A non-weight-bearing rehabilitation protocol was followed for six weeks after reconstruction. The digits were then harvested and evaluations of function, adhesion status, gliding resistance, attachment strength, cell viability, and histology were performed. RESULTS The tendons coated with cd-SF-G demonstrated significantly lower values (mean and standard deviation) compared with the saline-solution group for work of flexion (0.63 ± 0.24 versus 1.34 ± 0.42 N-mm/deg), adhesion score (3.5 ± 1.6 versus 6.1 ± 1.3), proximal adhesion breaking force (8.6 ± 3.2 versus 20.2 ± 10.2 N), and gliding resistance (0.26 ± 0.08 versus 0.46 ± 0.22 N) (p < 0.05). There was no significant difference between the cd-SF-G and saline-solution groups (p > 0.05) in distal attachment-site strength (56.9 ± 28.4 versus 77.2 ± 36.2 N), stiffness (19 ± 7.5 versus 24.5 ± 14.5 N/mm), and compressive modulus from indentation testing (4.37 ± 1.26 versus 3.98 ± 1.24 N/mm). Histological analysis showed that tendons coated with cd-SF-G had smoother surfaces and demonstrated tendon-to-bone and tendon-to-tendon incorporation. No significant difference in viable cell count between the two groups was observed on tendon culture. CONCLUSIONS Modification of the flexor tendon surface with cd-SF-G significantly improved digital function and reduced adhesion formation without affecting graft healing and stiffness. CLINICAL RELEVANCE This study used native synovial fluid as a basic lubricating reagent to treat a tendon graft in vivo, a novel avenue for improving clinical outcomes of flexor tendon reconstruction. This methodology may also apply to other surgical procedures where postoperative adhesions impair function.
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Affiliation(s)
- Xiaoxi Ji
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Ramona L. Reisdorf
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Andrew R. Thoreson
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Lawrence R. Berglund
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Steven L. Moran
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Gregory D. Jay
- Department of Emergency Medicine, Brown University, 593 Eddy Street, Claverick 100, Providence, RI 02903
| | - Kai-Nan An
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Peter C. Amadio
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
| | - Chunfeng Zhao
- Departments of Orthopedic Surgery (X.J., R.L.R., A.R.T., L.R.B., K-N.A., P.C.A., and C.Z.) and Plastic Surgery (S.L.M.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for C. Zhao:
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Qu J, Thoreson AR, Chen Q, An KN, Amadio PC, Zhao C. Tendon gradient mineralization for tendon to bone interface integration. J Orthop Res 2013; 31:1713-9. [PMID: 23939935 PMCID: PMC4121959 DOI: 10.1002/jor.22412] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/28/2013] [Indexed: 02/04/2023]
Abstract
Tendon-to-bone integration is a great challenge for tendon or ligament reconstruction regardless of use of autograft or allograft tendons. We mineralized the tendon, thus transforming the tendon-to-bone into a "bone-to-bone" interface for healing. Sixty dog flexor digitorum profundus (FDP) tendons were divided randomly into five groups: (1) normal FDP tendon, (2) CaP (non-extraction and mineralization without fetuin), (3) CaPEXT (Extraction by Na2 HPO4 and mineralization without fetuin), (4) CaPFetuin (non-extraction and mineralization with fetuin), and (5) CaPEXTFetuin (extraction and mineralization with fetuin). The calcium and phosphate content significantly increased in tendons treated with combination of extraction and fetuin compared to the other treatments. Histology also revealed a dense mineral deposition throughout the tendon outer layers and penetrated into the tendon to a depth of 200 µm in a graded manner. Compressive moduli were significantly lower in the four mineralized groups compared with normal control group. No significant differences in maximum failure strength or stiffness were found in the suture pull-out test among all groups. Mineralization of tendon alters the interface from tendon to bone into mineralized tendon to bone, which may facilitate tendon-to-bone junction healing following tendon or ligament reconstruction.
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Affiliation(s)
| | | | | | | | | | - Chunfeng Zhao
- Corresponding Author: Chunfeng Zhao, M.D., Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 USA, Phone: (507) 538-1717, Fax: (507) 284-5392,
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Al-Qattan MM, Al-Rakan MA, Al-Hassan TS. A biomechanical study of flexor tendon repair in zone II: comparing a combined grasping and locking core suture technique to its grasping and locking components. Injury 2011; 42:1300-2. [PMID: 21382621 DOI: 10.1016/j.injury.2011.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/27/2011] [Accepted: 02/08/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION All previous experimental and clinical repairs of flexor tendons in zone II have used either a grasping or a locking technique. In this article, a combined (grasping and locking) repair was compared biomechanically to its grasping and locking components. METHODS Using fresh flexor profundus adult sheep tendons, three techniques of tendon repair were tested biomechanically: the 'three figure-of-eight sutures' (a six-strand grasping technique), the 'locked cruciate repair' (a four-strand locked technique) and the 'combined technique' (a 10-strand repair using both the figure-of-eight and cruciate sutures). All repairs were tested to single-cycle tensile failure using a computerised tensometer. For each repair, the 2-mm gap force and the ultimate breaking (failure) force were recorded. RESULTS Biomechanically, the combined repair was found to be the strongest regarding both gap and failure (P<0.025; two-tailed by the Mann-Whitney test). CONCLUSION The combined 10-strand repair is stronger biomechanically than its grasping and locking components.
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Affiliation(s)
- M M Al-Qattan
- Division of Plastic Surgery, King Saud University, Riyadh, Saudi Arabia.
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Giambini H, Ikeda J, Amadio PC, An KN, Zhao C. The quadriga effect revisited: designing a "safety incision" to prevent tendon repair rupture and gap formation in a canine model in vitro. J Orthop Res 2010; 28:1482-9. [PMID: 20872585 PMCID: PMC3591491 DOI: 10.1002/jor.21168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Loss of experimental animals due to tendon repair failure results in the need for additional animals to complete the study. We designed a relief proximal to the flexor digitorum profundus (FDP) tendon repair site to serve as a "safety incision" to prevent repair site ruptures and maximize safety incision-to-suture strength. The FDP tendons were dissected in 24 canine forepaws. The 2nd and 5th tendons were lacerated at the proximal interphalangeal joint level and sutured using a modified Kessler technique and peripheral running suture. Tendon width was measured where the FDP tendon separates into each individual digit and a safety incision, equal to the 2nd and 5th tendon widths, was performed 3, 4, or 5 mm (Groups 1, 2, and 3) proximal to the separation. The tendons were pulled at a rate of 1 mm/s until either the "safety incision" ruptured or the repair failed. There was no gap formation at the repair site in Groups 1 and 2. However, all Group 3 tendons failed by repair site rupture with the safety incision intact. An adequate safety incision to protect repair gap and rupture and maintain tendon tension for the FDP animal model should be about 4 mm from where the FDP tendon separates.
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Affiliation(s)
- Hugo Giambini
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA
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