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Xuan H, Zhang Z, Jiang W, Li N, Sun L, Xue Y, Guan H, Yuan H. Dual-bioactive molecules loaded aligned core-shell microfibers for tendon tissue engineering. Colloids Surf B Biointerfaces 2023; 228:113416. [PMID: 37348269 DOI: 10.1016/j.colsurfb.2023.113416] [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: 04/13/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
Development of a controlled delivery ultrafine fibrous system with two bioactive molecules is required to stimulate tendon healing in different phase. In this study, we used emulsion stable jet electrospinning to fabricate aligned poly(L-lactic acid) (PLLA) based ultrafine fibers with two small bioactive molecules of L-Arginine (Arg) and low molecular weight hyaluronic acid (HA). The results demonstrated that the aligned Arg/HA/PLLA microfibrous scaffold showed core-shell structure and allowed sequential release of Arg and HA due to their different electric charge. The scaffold also showed enhanced hydrophilicity, cell migration, spread and proliferation. Using an Achilles tendon repair model in rats, we demonstrated that this novel fibrous scaffold can prevent adhesion and promote tendon regeneration. Additionally, two p53 and ER-α-mediated signalling pathways were described as the probable main path of synergistic effects of the novel scaffold on tendon generation. Thus, this study may provide an important strategy for developing biofunctional and biomimetic tendon scaffolds.
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Affiliation(s)
- Hongyun Xuan
- School of Life Sciences, Nantong University, Nantong 226019, PR China
| | - Zhuojun Zhang
- School of Life Sciences, Nantong University, Nantong 226019, PR China
| | - Wei Jiang
- School of Life Sciences, Nantong University, Nantong 226019, PR China
| | - Nianci Li
- School of Life Sciences, Nantong University, Nantong 226019, PR China
| | - Li Sun
- School of Life Sciences, Nantong University, Nantong 226019, PR China
| | - Ye Xue
- School of Life Sciences, Nantong University, Nantong 226019, PR China.
| | - Haitao Guan
- Department of Ultrasonography, Affiliated Suzhou Hospital, Medical School of Nanjing University, Nanjing University, Suzhou 215153, PR China.
| | - Huihua Yuan
- School of Life Sciences, Nantong University, Nantong 226019, PR China.
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2
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The Application of Mechanical Stimulations in Tendon Tissue Engineering. Stem Cells Int 2020; 2020:8824783. [PMID: 33029149 PMCID: PMC7532391 DOI: 10.1155/2020/8824783] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/22/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
Tendon injury is the most common disease in the musculoskeletal system. The current treatment methods have many limitations, such as poor therapeutic effects, functional loss of donor site, and immune rejection. Tendon tissue engineering provides a new treatment strategy for tendon repair and regeneration. In this review, we made a retrospective analysis of applying mechanical stimulation in tendon tissue engineering, and its potential as a direction of development for future clinical treatment strategies. For this purpose, the following topics are discussed; (1) the context of tendon tissue engineering and mechanical stimulation; (2) the applications of various mechanical stimulations in tendon tissue engineering, as well as their inherent mechanisms; (3) the application of magnetic force and the synergy of mechanical and biochemical stimulation. With this, we aim at clarifying some of the main questions that currently exist in the field of tendon tissue engineering and consequently gain new knowledge that may help in the development of future clinical application of tissue engineering in tendon injury.
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Sheng D, Li J, Ai C, Feng S, Ying T, Liu X, Cai J, Ding X, Jin W, Xu H, Chen J, Chen S. Electrospun PCL/Gel-aligned scaffolds enhance the biomechanical strength in tendon repair. J Mater Chem B 2020; 7:4801-4810. [PMID: 31389951 DOI: 10.1039/c9tb00837c] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Tendons can transmit mechanical force from muscles to bones for movement. However, the mechanical strength of tendons is compromised after surgery, thus causing a high rate of tendon retear. Hence, the design and preparation of biodegradable materials with excellent mechanical properties have become an urgent demand for sports medicine. In this study, biomimetic polycaprolactone (PCL)/gelatin (Gel)-aligned scaffolds were fabricated for the mechanical restoration of the injured tendon in a rabbit model. The diameter of nanofibers was about 427.82 ± 56.99 nm, which was approximate to that of the native collagen fibrils; the directional consistency of the nanofibers in PCL/Gel-aligned scaffolds reached 77.33 ± 3.22%, which were ultrastructurally biomimetic. Compared to the observations for the control group, the in vitro mechanical results showed that the PCL/Gel-aligned scaffolds (P/G-A) were anisotropic in terms of failure load, tensile strength, and Young's modulus. After verifying their good cytocompatibility, the scaffolds were implanted into the rabbit patellar tendon in situ. The biomechanical properties of the repaired tendon in P/G-A reached 343.97 ± 65.30 N in failure load, 85.99 ± 16.33 MPa in tensile strength, 590.84 ± 201.87 MPa in Young's modulus, and 171.29 ± 61.50 N mm-1 in stiffness in vivo at 8 weeks post operation. In a word, our results demonstrated that P/G-A could support the regenerated tissue of injured patellar tendons to restore the biomechanical strength in a rabbit model. This suggested that the PCL/Gel-aligned scaffolds can pave a promising way to improve the healing of injured tendons in the clinic in the future.
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Affiliation(s)
- Dandan Sheng
- Department of Sports Medicine, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, People's Republic of China.
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Lin J, Shi Y, Men Y, Wang X, Ye J, Zhang C. Mechanical Roles in Formation of Oriented Collagen Fibers. TISSUE ENGINEERING PART B-REVIEWS 2020; 26:116-128. [PMID: 31801418 DOI: 10.1089/ten.teb.2019.0243] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Collagen is a structural protein that is widely present in vertebrates, being usually distributed in tissues in the form of fibers. In living organisms, fibers are organized in different orientations in various tissues. As the structural base in connective tissue and load-bearing tissue, the orientation of collagen fibers plays an extremely important role in the mechanical properties and physiological and biochemical functions. The study on mechanics role in formation of oriented collagen fibers enables us to understand how discrete cells use limited molecular materials to create tissues with different structures, thereby promoting our understanding of the mechanism of tissue formation from scratch, from invisible to tangible. However, the current understanding of the mechanism of fiber orientation is still insufficient. In addition, existing fabrication methods of oriented fibers are varied and involve interdisciplinary study, and the achievements of each experiment are favorable to the construction and improvement of the fiber orientation theory. To this end, this review focuses on the preparation methods of oriented fibers and proposes a model explaining the formation process of oriented fibers in tendons based on the existing fiber theory. Impact statement As the structural base in connective tissue and load-bearing tissue, the orientation of collagen fibers plays an extremely important role in the mechanical properties and physiological and biochemical functions. However, the current understanding of the mechanism of fiber orientation is still insufficient, which is greatly responsible for the challenge of functional tissue repair and regeneration. Understanding the mechanism of fiber orientation can promote the successful application of fiber orientation scaffolds in tissue repair and regeneration, as well as providing an insight for the mechanism of tissue histomorphology.
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Affiliation(s)
- Jiexiang Lin
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Yanping Shi
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Yutao Men
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Xin Wang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Jinduo Ye
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
| | - Chunqiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, P.R. China
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Zhao T, Qi Y, Xiao S, Ran J, Wang J, Ghamor-Amegavi EP, Zhou X, Li H, He T, Gou Z, Chen Q, Xu K. Integration of mesenchymal stem cell sheet and bFGF-loaded fibrin gel in knitted PLGA scaffolds favorable for tendon repair. J Mater Chem B 2019; 7:2201-2211. [PMID: 32073579 DOI: 10.1039/c8tb02759e] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tendon injuries are common and require a long time to heal, and are particularly associated with some adverse problems such as adhesion and rupture. Herein, we aim to develop new bioactive scaffolds endowed with stem cell sheets and growth factors to enable cell migration and proliferation favorable for tendon regeneration in situ. An exogenous basic fibroblast growth factor (bFGF)-loaded fibrin gel was firstly incorporated into the porous network of knitted poly(lactide-co-glycolide) (PLGA) scaffolds and then sheets of mesenchymal stem cells (MSCs) were also integrated into the scaffolds. It was shown that the pores in the knitted PLGA scaffold were readily filled with a complex network of fibrin fiber gel and the fibrin fibers were beneficial for the controlled release of bFGF over a long time period. After transplantation in a critical-size Achilles tendon defect model (7 mm) in the rat right hindlimb, gross observation revealed no immunologic incompatibility or rejection derived from the scaffold systems. It was observed that the MSC sheets contributed directly to tendon regeneration, and exerted an environment-modifying effect on the injuries in situ, consistent with the beneficial effect of bFGF. It was interesting that the knitted PLGA-fibrin gel scaffolds loaded with MSC sheets and bFGF showed the highest expression of tendon-related gene markers and outstanding repair efficacy, including appreciable biomechanical strength and native-like histological microstructures. Therefore, the integration of MSC sheets and bFGF into PLGA/bFGF-fibrin gel scaffolds may stimulate the proliferation and tenogenic differentiation of MSCs in situ and synergistically enhance the injured tendon reconstruction.
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Affiliation(s)
- Tengfei Zhao
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou, 310009, China.
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More tendon degeneration in patients with shoulder osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:267-275. [PMID: 30284007 DOI: 10.1007/s00167-018-5186-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Tendon disorders are a major problem in the general population. It is known that rotator cuff tendinopathy contributes to osteoarthritis (OA) of the shoulder. The aim of the study was to analyse the presence of tendinopathy in patients with shoulder OA and an intact rotator cuff, using a multimodal approach. METHODS Thirteen consecutive patients median age 67 (52-84) years, with OA of the shoulder, and 13 consecutive control patients, with a fracture of the proximal humerus, median age 70 (51-84) years, underwent an open biopsy procedure from the biceps and subscapularis tendon in conjunction with shoulder arthroplasty. In addition to a macroscopic evaluation, the samples underwent histologic, morphologic and ultrastructural analyses in light and transmission electron microscopy. RESULTS Macroscopic degeneration was found in 15 of 26 specimen in the OA group but in seven of 25 in the control group (p = 0.048). The histologic analysis revealed a non-significant difference for the total degeneration score (TDS) between the study groups. The morphologic evaluation of the samples revealed that the OA group had significantly more samples with non-homogeneous extracellular matrix (ECM), (p = 0.048). Ultrastructurally, the OA group revealed a significantly larger fibril diameter in the biceps tendon (p < 0.0001) but not in the subscapularis tendon compared with the control group. CONCLUSION A significantly worse macroscopic appearance and significantly more morphologically inhomogeneous ECM, indicating more tendon degeneration, were found in the OA group compared with the control group. This indicates that it could be beneficial to treat the tendinosis in an early stage to decrease symptoms from the OA. STUDY DESIGN Level of evidence, III.
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Farfaras S, Ejerhed LE, Hallström EK, Hultenby K, Meknas K, Movin T, Papadogiannakis N, Kartus JT. More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement. Knee Surg Sports Traumatol Arthrosc 2018; 26:79-87. [PMID: 28255657 PMCID: PMC5754398 DOI: 10.1007/s00167-017-4442-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/20/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. METHODS Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. RESULTS Eight patients, median age 53 (45-74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22-48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). CONCLUSION Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. CLINICAL RELEVANCE It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Stefanos Farfaras
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451, Uddevalla, Sweden. .,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden.
| | - Lars Erik Ejerhed
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden
| | - Erling K. Hallström
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
| | - Kjell Hultenby
- Division of Clinical Research Center, Department of Laboratory Medicine, Karolinska Institute Stockholm, Stockholm, Sweden
| | - Khaled Meknas
- Bone and Joint Research Group, Department of Orthopedics, Institute of Clinical Medicine, University Hospital North Norway, The Arctic University of Norway, Tromsø, Norway
| | - Tomas Movin
- Department of Clinical Science, Karolinska Institute, Stockholm, Sweden
| | - Nikos Papadogiannakis
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jüri-Toomas Kartus
- Department of Orthopedics, NU-Hospital Group Trollhättan/Uddevalla, Uddevalla Sjukhus, 451 Uddevalla, Sweden ,Gothenburg University-Sahlgrenska Academy, Gothenburg, Sweden
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Fratani J, Ponssa ML, Abdala V. Tendinous framework of anurans reveals an all-purpose morphology. ZOOLOGY 2017; 126:172-184. [PMID: 29310934 DOI: 10.1016/j.zool.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/14/2023]
Abstract
Tendons are directly associated with movement, amplifying power and reducing muscular work. Taking into account habitat and locomotor challenges faced by anurans, we identify the more conspicuous superficial tendons of a neotropical anuran group and investigate their relation to the former factors. We show that tendons can be visualized as an anatomical framework connected through muscles and/or fascia, and describe the most superficial tendinous layer of the postcranium of Leptodactylus latinasus. To analyze the relation between tendon morphology and ecological characters, we test the relative length ratio of 10 tendon-muscle (t-m) elements in 45 leptodactylid species while taking phylogeny into account. We identify the evolutionary model that best explains our variables. Additionally, we optimize t-m ratio values, and the shape of the longissimus dorsi insertion onto a selected phylogeny of the species. Our data show the existence of an all-purpose morphology that seems to have evolved independently of ecology and functional requirements. This is indicated by no significant relation between morphometric data of the analyzed tendons and habitat use or locomotion, a strong phylogenetic component to most of the analyzed variables, and a generalized pattern of intermediate values for ancestral states. Ornstein-Uhlenbeck is the model that best explains most t-m variables, indicating that stabilizing selection or selective optima might be driving shifts in tendon length within Leptodactylidae. Herein, we show the substantial influence that phylogeny has on tendon morphology, demonstrating that a generalized and stable morphological configuration of tendons is adequate to enable versatile locomotor modes and habitat use. This is an attempt to present the tendinous system as a framework to body support in vertebrates, and can be considered a starting point for further ecomorphological research of this anatomical system in anurans.
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Affiliation(s)
- Jéssica Fratani
- Unidad Ejecutora Lillo (CONICET-Fundación Miguel Lillo), Tucumán, Argentina; Departamento de Vertebrados, Museu Nacional, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - María Laura Ponssa
- Unidad Ejecutora Lillo (CONICET-Fundación Miguel Lillo), Tucumán, Argentina.
| | - Virginia Abdala
- Instituto de Biodiversidad Neotropical UNT-CONICET, Universidad Nacional de Tucumán, Tucumán, Argentina.
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Fang F, Lake SP. Experimental evaluation of multiscale tendon mechanics. J Orthop Res 2017; 35:1353-1365. [PMID: 27878999 DOI: 10.1002/jor.23488] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/16/2016] [Indexed: 02/04/2023]
Abstract
Tendon's primary function is a mechanical link between muscle and bone. The hierarchical structure of tendon and specific compositional constituents are believed to be critical for proper mechanical function. With increased appreciation for tendon importance and the development of various technological advances, this review paper summarizes recent experimental approaches that have been used to study multiscale tendon mechanics, includes an overview of studies that have evaluated the role of specific tissue constituents, and also proposes challenges/opportunities facing tendon study. Tendon has been demonstrated to have specific structural characteristics (e.g., multi-level hierarchy, crimp pattern, helix) and complex mechanical properties (e.g., non-linearity, anisotropy, viscoelasticity). Physical mechanisms including uncrimping, fiber sliding, and collagen reorganization have been shown to govern tendon mechanical responses under both static and dynamic loading. Several tendon constituents with relatively small quantities have been suggested to play a role in its mechanics, although some results are conflicting. Further research should be performed to understand the interplay and communication of tendon mechanical properties across levels of the hierarchical structure, and further show how each of these components contribute to tendon mechanics. The studies summarized and discussed in this review have helped elucidate important aspects of multiscale tendon mechanics, which is a prerequisite for analyzing stress/strain transfer between multiple scales and identifying key principles of mechanotransduction. This information could further facilitate interpreting the functional diversity of tendons from different species, different locations, and even different developmental stages, and then better understand and identify fundamental concepts related to tendon degeneration, disease, and healing. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1353-1365, 2017.
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Affiliation(s)
- Fei Fang
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, Missouri, 63130
| | - Spencer P Lake
- Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, Missouri, 63130.,Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, Missouri, 63130.,Department of Orthopaedic Surgery, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1185, St. Louis, Missouri, 63130
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Chen JL, Zhang W, Liu ZY, Heng BC, Ouyang HW, Dai XS. Physical regulation of stem cells differentiation into teno-lineage: current strategies and future direction. Cell Tissue Res 2014; 360:195-207. [DOI: 10.1007/s00441-014-2077-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 11/17/2014] [Indexed: 12/18/2022]
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Åhlén M, Lidén M, Movin T, Papadogiannakis N, Rostgård-Christensen L, Kartus J. Histological Evaluation of Regenerated Semitendinosus Tendon a Minimum of 6 Years After Harvest for Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2014; 2:2325967114550274. [PMID: 26535362 PMCID: PMC4555632 DOI: 10.1177/2325967114550274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Semitendinosus (ST) and/or gracilis (G) autografts are the most used grafts for anterior cruciate ligament (ACL) surgery. The tendons have been shown to be able to regenerate but with focal areas of scar tissue in the short term. There are no long-term histological studies of the regenerated tendons. Hypothesis: In the long term, the regenerated ST tendon normalizes and has a similar histology as the contralateral nonharvested tendon. Study Design: Case-control study; Level of evidence, 3. Methods: Eighteen patients (8 female, 10 male) who underwent ACL surgery using ipsilateral ST/G tendon autografts were included in this study. Percutaneous specimens were obtained from the regenerated ST tendon and the contralateral nonharvested ST tendon under ultrasonographic guidance at a median of 8.4 years (100.5 months; range, 77-129 months) after the harvest procedure. Specimens from the nonoperated side served as controls. The histology and presence of glycosaminoglycans (GAGs) were assessed using a light microscope and a semiquantitative grading system. Results: Thirty-six biopsies were obtained (2 biopsies from each patient). In 5 biopsies, the amount of tissue was too small to analyze in the light microscope, and 1 patient had been operated on bilaterally and was therefore excluded. In total, 24 biopsies were included in the histological analysis. In overall terms, there were no significant differences between the regenerated and nonharvested ST tendon in terms of fiber structure, cellularity, vascularity, and level of GAGs a minimum 6 years after harvest of the ST tendon. However, 3 of the regenerated tendons displayed a loss of fiber structure. Conclusion: The ST tendon regenerates and may regain a histological appearance similar to that of the nonharvested contralateral tendon, as seen in this study a median of 8.4 years after harvesting. However, in some tendons, loss of fiber structure was found.
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Affiliation(s)
- Martina Åhlén
- Department of Orthopedics, NU-Hospital Organization, Trollhättan/Uddevalla, Sweden. ; University of Gothenburg, Gothenburg, Sweden
| | - Mattias Lidén
- Department of Plastic Surgery, Sahlgrenska University Hospital, Sahlgrenska, Sweden
| | - Tomas Movin
- Department of Clinical Science, Intervention and Technology, Division of Orthopedics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Jüri Kartus
- Department of Research and Development NU-Hospital Organization, Trollhättan/Uddevalla, Sweden
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Tang QM, Chen JL, Shen WL, Yin Z, Liu HH, Fang Z, Heng BC, Ouyang HW, Chen X. Fetal and adult fibroblasts display intrinsic differences in tendon tissue engineering and regeneration. Sci Rep 2014; 4:5515. [PMID: 24992450 PMCID: PMC4080701 DOI: 10.1038/srep05515] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 06/12/2014] [Indexed: 12/14/2022] Open
Abstract
Injured adult tendons do not exhibit optimal healing through a regenerative process, whereas fetal tendons can heal in a regenerative fashion without scar formation. Hence, we compared FFs (mouse fetal fibroblasts) and AFs (mouse adult fibroblasts) as seed cells for the fabrication of scaffold-free engineered tendons. Our results demonstrated that FFs had more potential for tendon tissue engineering, as shown by higher levels of tendon-related gene expression. In the in situ AT injury model, the FFs group also demonstrated much better structural and functional properties after healing, with higher levels of collagen deposition and better microstructure repair. Moreover, fetal fibroblasts could increase the recruitment of fibroblast-like cells and reduce the infiltration of inflammatory cells to the injury site during the regeneration process. Our results suggest that the underlying mechanisms of better regeneration with FFs should be elucidated and be used to enhance adult tendon healing. This may assist in the development of future strategies to treat tendon injuries.
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Affiliation(s)
- Qiao-Mei Tang
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Jia Lin Chen
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Wei Liang Shen
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, Zhejiang University, Hangzhou, China, 310058
| | - Zi Yin
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Huan Huan Liu
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Zhi Fang
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Boon Chin Heng
- Department of Biosystems Science & Engineering (D-BSSE), ETH-Zurich, Mattenstrasse 26, Basel 4058, Switzerland
| | - Hong Wei Ouyang
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
| | - Xiao Chen
- 1] Department of Sports Medicine, School of Medicine, Zhejiang University, Hangzhou, China, 310058 [2] Zhejiang Provincial Key Laboratory of Tissue Engineering and Regenerative Medicine School of Medicine, Zhejiang University, Hangzhou China. 310058
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Murphy RJ, Floyd Dean BJ, Wheway K, Watkins B, Morrey ME, Carr AJ. A Novel Minimally Invasive Ultrasound-Guided Technique to Biopsy Supraspinatus Tendon. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.oto.2013.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Wågsäter D, Paloschi V, Hanemaaijer R, Hultenby K, Bank RA, Franco-Cereceda A, Lindeman JHN, Eriksson P. Impaired collagen biosynthesis and cross-linking in aorta of patients with bicuspid aortic valve. J Am Heart Assoc 2013; 2:e000034. [PMID: 23525417 PMCID: PMC3603268 DOI: 10.1161/jaha.112.000034] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with bicuspid aortic valve (BAV) have an increased risk of developing ascending aortic aneurysm. In the present study, collagen homeostasis in nondilated and dilated aorta segments from patients with BAV was studied, with normal and dilated aortas from tricuspid aortic valve (TAV) patients as reference. Methods and Results Ascending aortas from 56 patients were used for biochemical and morphological analyses of collagen. mRNA expression was analyzed in 109 patients. Collagen turnover rates were similar in nondilated and dilated aortas of BAV patients, showing that aneurysmal formation in BAV is, in contrast to TAV, not associated with an increased collagen turnover. However, BAV in general was associated with an increased aortic collagen turnover compared with nondilated aortas of TAV patients. Importantly, the ratio of hydroxylysyl pyridinoline (HP) to lysyl pyridinoline (LP), 2 distinct forms of collagen cross‐linking, was lower in dilated aortas from patients with BAV, which suggests that BAV is associated with a defect in the posttranslational collagen modification. This suggests a deficiency at the level of lysyl hydroxylase (PLOD1), which was confirmed by mRNA and protein analyses that showed reduced PLOD1 expression but normal lysyl oxidase expression in dilated aortas from patients with BAV. This suggests that impaired collagen cross‐linking in BAV patients may be attributed to changes in the expression and/or activity of PLOD1. Conclusions Our results demonstrate an impaired biosynthesis and posttranslational modification of collagen in aortas of patients with BAV, which may explain the increased aortic aneurysm formation in BAV patients.
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Affiliation(s)
- Dick Wågsäter
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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Skiadas V, Perdikakis E, Plotas A, Lahanis S. MR imaging of anterior knee pain: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2013; 21:294-304. [PMID: 22488011 DOI: 10.1007/s00167-012-1976-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 03/15/2012] [Indexed: 01/11/2023]
Abstract
Anterior knee pathology is a frequent cause of joint pain and limitation of function and mobility among patients presenting to an orthopaedic department. Proper recognition and treatment of pathologic conditions depend on the knowledge of normal anatomy and of the various abnormalities, which affect this area of the knee and may present with anterior knee pain. A broad array of benign and malignant processes may be manifested as anterior knee discomfort, and this common clinical entity is among the most frequent indications for MR imaging of the lower extremities. Clinical history and physical examination are also of paramount importance. The disorders can be categorized and differentiated primarily according to their location. Traumatic or non-traumatic disorders of the patella, patellar retinacula, quadriceps and patellar tendons and supra or infrapatellar fat pad can be the source of symptoms. This article includes a comprehensive pictorial essay of the characteristic MR features of common and uncommon disorders causing anterior knee pain. For accurate assessment of the aforementioned clinical problem, a radiologist should be able to identify typical MR imaging patterns that contribute in establishing the correct diagnosis and thus tailoring the appropriate therapy. Level of evidence IV.
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Stener S, Ejerhed L, Movin T, Sernert N, Papadogiannakis N, Kartus J. The reharvested patellar tendon has the potential for ligamentization when used for anterior cruciate ligament revision surgery. Knee Surg Sports Traumatol Arthrosc 2012; 20:1168-74. [PMID: 22310901 DOI: 10.1007/s00167-012-1908-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 01/12/2012] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of the present study was to make an in-depth clinical, radiographical, and histological evaluation of patients who underwent anterior cruciate ligament (ACL) revision surgery with reharvested central third patellar tendon autograft. METHODS Four patients (two women and two men) underwent ACL revision surgery with reharvested patellar tendon autograft 71 (66-120) months after the primary reconstruction. The patients were followed prospectively and underwent a clinical examination and magnetic resonance imaging (MRI) at two and 10 years. Furthermore, they underwent a second-look arthroscopy involving a biopsy procedure from the reconstructed ACL 3 years after revision surgery. RESULTS The clinical results were poor both at two and 10 years, but the knees were stable and had a firm endpoint in all four patients in the Lachman test. At the second-look arthroscopy, the graft appeared macroscopically normal in all four patients. Histologically two patients had a normal or close to normal appearance of the reconstructed ACL with no or slight increase in cellularity and vascularity. Two patients had a marked increase in cellularity and vascularity, and the findings revealed that ligamentization was present in all four patients. CONCLUSIONS The clinical outcome 10 years after ACL revision surgery was poor in these four patients. In contrast, the reharvested patellar tendon appeared close to normal on MRI, and the second-look arthroscopy with the concomitant histological findings revealed that the grafts were viable 3 years after revision. Therefore, the reharvested patellar tendon seems to have the potential for ligamentization when used for ACL revision surgery. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Sven Stener
- NU-Hospital Organization, Trollhättan/Uddevalla, Sweden.
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de Almeida AM, Demange MK, Sobrado MF, Rodrigues MB, Pedrinelli A, Hernandez AJ. Patellar tendon healing with platelet-rich plasma: a prospective randomized controlled trial. Am J Sports Med 2012; 40:1282-8. [PMID: 22472272 DOI: 10.1177/0363546512441344] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The patellar tendon has limited ability to heal after harvesting its central third. Platelet-rich plasma (PRP) could improve patellar tendon healing. HYPOTHESIS Adding PRP to the patellar tendon harvest site would improve donor site healing and improve clinical outcome at 6 months after anterior cruciate ligament (ACL) reconstruction with a patellar tendon graft. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Twenty-seven patients were randomly divided to receive (n = 12) or not receive (n = 15) PRP in the patellar tendon harvest site during ACL reconstruction. The primary outcome was magnetic resonance imaging (MRI) assessment of patellar tendon healing (gap area) after 6 months. Secondary outcomes were questionnaires and isokinetic testing of ACL reconstruction with a patellar tendon graft comparing both groups. RESULTS Patellar tendon gap area was significantly smaller in the PRP group (4.9 ± 5.3 mm(2); 95% confidence interval [CI], 1.1-8.8) than in the control group (9.4 ± 4.4 mm(2); 95% CI, 6.6-12.2; P = .046). Visual analog scale score for pain was lower in the PRP group immediately postoperatively (3.8 ± 1.0; 95% CI, 3.18-4.49) than in the control group (5.1 ± 1.4; 95% CI, 4.24-5.90; P = .02). There were no differences after 6 months in questionnaire and isokinetic testing results comparing both groups. CONCLUSION We showed that PRP had a positive effect on patellar tendon harvest site healing on MRI after 6 months and also reduced pain in the immediate postoperative period. Questionnaire and isokinetic testing results were not different between the groups at 6 months.
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Affiliation(s)
- Adriano Marques de Almeida
- Department of Orthopedics and Traumatology, São Paulo University Medical School, FIFA Medical Centre of Excellence, R. Dr. Ovidio Pires de Campos, 333, Cerqueira César, 05403-010 São Paulo, Brazil.
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Meknas K, Johansen O, Steigen SE, Olsen R, Jørgensen L, Kartus J. Could tendinosis be involved in osteoarthritis? Scand J Med Sci Sports 2011; 22:627-34. [DOI: 10.1111/j.1600-0838.2010.01287.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scott A, Sampaio A, Abraham T, Duronio C, Underhill TM. Scleraxis expression is coordinately regulated in a murine model of patellar tendon injury. J Orthop Res 2011; 29:289-96. [PMID: 20740671 PMCID: PMC3951487 DOI: 10.1002/jor.21220] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/18/2010] [Indexed: 02/04/2023]
Abstract
This study investigated the expression of Scleraxis in a murine model of patellar tendon injury in which the central third of the patellar tendon was unilaterally injured. The presence of tendon pathology was assessed using dual photon microscopy, conventional histology and microCT. Tendon pathology was also quantified noninvasively over a 12-week period using high-frequency ultrasound and laser Doppler flowmetry. Gene expression (Scx, Tnmd, and Col1a1) was determined at defined end-points (1, 4, 8, and 12 weeks) using qPCR on RNA from individual patellar tendons on injured and uninjured sides. There was significant development of tendon pathology as gauged by ultrasound and laser Doppler over 12 weeks. Injured tendons demonstrated significant histological and microCT evidence of pathological change, and disorganized collagen with reduced density. The expression of Scx and Col1a1 was unchanged at 1 week, significantly upregulated at 4 and 8 weeks, and had returned to baseline by 12 weeks. Tnmd expression was unchanged at 1 week, and significantly increased at 4, 8, and 12 weeks. Patellar tendon injury was associated with marked increases in the expression of Scx, Tnmd, and Col1a1. Our data suggest new roles for Scleraxis in coordinating the response to injury in the pathogenesis of tendon disorders.
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Affiliation(s)
- Alexander Scott
- Biomedical Research Centre, Vancouver, Canada,Department of Cellular and Physiological Sciences, UBC, Vancouver, Canada,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Arthur Sampaio
- Biomedical Research Centre, Vancouver, Canada,Department of Cellular and Physiological Sciences, UBC, Vancouver, Canada
| | - Thomas Abraham
- The James Hogg Research Centre, Heart & Lung Institute at St. Paul’s Hospital, University of British Columbia, Vancouver, Canada
| | | | - Tully M. Underhill
- Biomedical Research Centre, Vancouver, Canada,Department of Cellular and Physiological Sciences, UBC, Vancouver, Canada,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Meknas K, Johansen O, Kartus J. Retro-trochanteric sciatica-like pain: current concept. Knee Surg Sports Traumatol Arthrosc 2011; 19:1971-85. [PMID: 21678093 PMCID: PMC3195768 DOI: 10.1007/s00167-011-1573-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 05/31/2011] [Indexed: 12/05/2022]
Abstract
The aim of this manuscript is to review the current knowledge in terms of retro-trochanteric pain syndrome, make recommendations for diagnosis and differential diagnosis and offer suggestions for treatment options. The terminology in the literature is confusing and these symptoms can be referred to as 'greater trochanteric pain syndrome', 'trochanteric bursitis' and 'trochanteritis', among other denominations. The authors focus on a special type of sciatica, i.e. retro-trochanteric pain radiating down to the lower extremity. The impact of different radiographic assessments is discussed. The authors recommend excluding pathology in the spine and pelvic area before following their suggested treatment algorithm for sciatica-like retro-trochanteric pain.
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Affiliation(s)
- Khaled Meknas
- Department of Orthopaedics, University Hospital of North Norway, 9038 Tromsø, Norway.
| | - Oddmund Johansen
- Department of Orthopaedics, University Hospital of North Norway, 9038 Tromsø, Norway ,Institute of Clinical Medicine, Faculty of Medicine, University of Tromsø, Tromsø, Norway
| | - Jüri Kartus
- Department of Orthopaedics, NU-Hospital Organization, Trollhättan, Uddevalla, Sweden
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Chen X, Song XH, Yin Z, Zou XH, Wang LL, Hu H, Cao T, Zheng M, Ouyang HW. Stepwise Differentiation of Human Embryonic Stem Cells Promotes Tendon Regeneration by Secreting Fetal Tendon Matrix and Differentiation Factors. Stem Cells 2009; 27:1276-87. [DOI: 10.1002/stem.61] [Citation(s) in RCA: 148] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Chen X, Qi YY, Wang LL, Yin Z, Yin GL, Zou XH, Ouyang HW. Ligament regeneration using a knitted silk scaffold combined with collagen matrix. Biomaterials 2008; 29:3683-3692. [PMID: 18541295 DOI: 10.1016/j.biomaterials.2008.05.017] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 05/20/2008] [Indexed: 12/23/2022]
Abstract
This study was aimed to develop a new practical ligament scaffold by synergistic incorporation of silk fibers, a knitted structure, and a collagen matrix. The efficacy for ligament tissue engineering was investigated in vitro and in animal models. Cells cultured on a collagen substrate expressed ligament matrix genes at higher levels than those on a silk substrate. The silk scaffold elicited little inflammatory reaction and degraded slowly after subcutaneous implantation in a mouse model. In the rabbit MCL defect model, MCLs treated with a silk+collagen scaffold deposited more collagen, had better mechanical properties, and showed more native microstructure with larger diameter collagen fibrils and stronger scaffold-ligament interface healing than untreated MCLs and those treated with silk scaffolds. These results demonstrated that the knitted silk+collagen sponge scaffold improves structural and functional ligament repair by regulating ligament matrix gene expression and collagen fibril assembly. The findings are the first to highlight the important roles of biomaterials in ligament regeneration biology. Also, the concept of an "internal-space-preservation" scaffold is proposed for the tissue repair under physical loading.
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Affiliation(s)
- Xiao Chen
- Center for Stem Cell and Tissue Engineering, School of Medicine, Zhejiang University, Hangzhou, China
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