Weft-knitted silk-poly(lactide-co-glycolide) mesh scaffold combined with collagen matrix and seeded with mesenchymal stem cells for rabbit Achilles tendon repair

Reconstruction of Rabbit Anterior Cruciate Ligament by Bone Marrow-Derived Mesenchymal Stem Cell Implantation Through a Weft-Knitted Silk Mesh Scaffold Covering a Whip-Shaped Core

To investigate the feasibility of using whip core wrapped by silk weft knitted mesh sheath as a scaffold and bone marrow-derived mesenchymal stem cells (BMSCs) to reconstruct the rabbit anterior cruciate ligament (ACL), BMSC implantation using the mesh-whip scaffold was performed to construct a BMSC-scaffold complex. Then, the BMSC-scaffold complex was implanted into an animal model of an ACL deficient rabbit. Regenerated ACLs were then taken from the animal model three and six months after implantation, followed by hematoxylin-eosin and Masson staining, quantitative RT-PCR detection, as well as mechanical performance evaluation. The results showed that many Sharpey’s fibers had arranged regularly between the neo-ACL and the bone three months after surgery, and an interface structure formed six months after surgery. Regenerated ligaments contained silk fibers and suficient collagen. Type I collagen, type III collagen, and tenascin-C were all highly expressed in the experimental group compared to the control group (no BMSC implantation) in the regenerated ligaments. In addition, the maximum pullout force values of neo-ACL in the three- and six-month experimental groups were 70.6±17.8 N and 122.8±25.7 N, respectively. The findings suggest that BMSC implantation using the mesh-whip scaffold is a promising method to reconstruct rabbit ACL.

Advanced Nanofiber-Based Scaffolds for Achilles Tendon Regenerative Engineering

The Achilles tendon (AT) is responsible for running, jumping, and standing. The AT injuries are very common in the population. In the adult population (21–60 years), the incidence of AT injuries is approximately 2.35 per 1,000 people. It negatively impacts people’s quality of life and increases the medical burden. Due to its low cellularity and vascular deficiency, AT has a poor healing ability. Therefore, AT injury healing has attracted a lot of attention from researchers. Current AT injury treatment options cannot effectively restore the mechanical structure and function of AT, which promotes the development of AT regenerative tissue engineering. Various nanofiber-based scaffolds are currently being explored due to their structural similarity to natural tendon and their ability to promote tissue regeneration. This review discusses current methods of AT regeneration, recent advances in the fabrication and enhancement of nanofiber-based scaffolds, and the development and use of multiscale nanofiber-based scaffolds for AT regeneration.

Application of textile technology in tissue engineering: A review

One of the key elements in tissue engineering is to design and fabricate scaffolds with tissue-like properties. Among various scaffold fabrication methods, textile technology has shown its unique advantages in mimicking human tissues' properties such as hierarchical, anisotropic, and strain-stiffening properties. As essential components in textile technology, textile patterns affect the porosity, architecture, and mechanical properties of textile-based scaffolds. However, the potential of various textile patterns has not been fully explored when fabricating textile-based scaffolds, and the effect of different textile patterns on scaffold properties has not been thoroughly investigated. This review summarizes textile technology development and highlights its application in tissue engineering to facilitate the broader application of textile technology, especially various textile patterns in tissue engineering. The potential of using different textile methods such as weaving, knitting, and braiding to mimic properties of human tissues is discussed, and the effect of process parameters in these methods on fabric properties is summarized. Finally, perspectives on future directions for explorations are presented. STATEMENT OF SIGNIFICANCE: Recently, biomedical engineers have applied textile technology to fabricate scaffolds for tissue engineering applications. Various textile methods, especially weaving, knitting, and braiding, enables engineers to customize the physical, mechanical, and biological properties of scaffolds. However, most textile-based scaffolds only use simple textile patterns, and the effect of different textile patterns on scaffold properties has not been thoroughly investigated. In this review, we cover for the first time the effect of process parameters in different textile methods on fabric properties, exploring the potential of using different textile methods to mimic properties of human tissues. Previous advances in textile technology are presented, and future directions for explorations are presented, hoping to facilitate new breakthroughs of textile-based tissue engineering.

Bone Mesenchymal Stem Cells Contribute to Ligament Regeneration and Graft-Bone Healing after Anterior Cruciate Ligament Reconstruction with Silk-Collagen Scaffold

Anterior cruciate ligament (ACL) reconstruction was realized using a combination of bone mesenchymal stem cells (BMSCs) and silk–collagen scaffold, and an in vivo evaluation of this combination was performed. By combining type I collagen and degummed silk fibroin mesh, silk–collagen scaffolds were prepared to simulate ligament components. BMSCs isolated from bone marrow of rabbits were cultured for a homogenous population and seeded on the silk–collagen scaffold. In the scaffold and BMSC (S/C) group, scaffolds were seeded with BMSCs for 72 h and then rolled and used to replace the ACL in 20 rabbits. In the scaffold (S) group, scaffolds immersed only in culture medium for 72 h were used for ACL reconstruction. Specimens were collected at 4 and 16 weeks postoperatively to assess ligament regeneration and bone integration. HE and immunohistochemical staining (IHC) were performed to assess ligament regeneration in the knee cavity. To assess bone integration at the graft–bone interface, HE, Russell–Movat staining, micro-CT, and biomechanical tests were performed. After 4 weeks, vigorous cell proliferation was observed in the core part of the scaffold in the S/C group, and a quantity of fibroblast-like cells and extracellular matrix (ECM) was observed in the center part of the graft at 16 weeks after surgery. At 4 and 16 weeks postoperatively, the tenascin-C expression in the S/C group was considerably higher than that in the S group (4 w, p < 0.01; 16 w, p < 0.01). Furthermore, bone integration was better in the S/C group than in the S group, with histological observation of trabecular bone growth into the graft and more mineralized tissue formation detected by micro-CT (4 w, bone volume fraction (BV/TV), p = 0.0169, bone mineral density (BMD), p = 0.0001; 16 w, BV/TV, p = 0.1233, BMD, p = 0.0494). These results indicate that BMSCs promote ligament regeneration in the knee cavity and bone integration at the graft–bone interface. Silk–collagen scaffolds and BMSCs will likely be combined for clinical practice in the future.

Tendon tissue engineering: Cells, growth factors, scaffolds and production techniques

Tendon injuries are a global health problem that affects millions of people annually. The properties of tendons make their natural rehabilitation a very complex and long-lasting process. Thanks to the development of the fields of biomaterials, bioengineering and cell biology, a new discipline has emerged, tissue engineering. Within this discipline, diverse approaches have been proposed. The obtained results turn out to be promising, as increasingly more complex and natural tendon-like structures are obtained. In this review, the nature of the tendon and the conventional treatments that have been applied so far are underlined. Then, a comparison between the different tendon tissue engineering approaches that have been proposed to date is made, focusing on each of the elements necessary to obtain the structures that allow adequate regeneration of the tendon: growth factors, cells, scaffolds and techniques for scaffold development. The analysis of all these aspects allows understanding, in a global way, the effect that each element used in the regeneration of the tendon has and, thus, clarify the possible future approaches by making new combinations of materials, designs, cells and bioactive molecules to achieve a personalized regeneration of a functional tendon.

The determinant role of fabrication technique in final characteristics of scaffolds for tissue engineering applications: A focus on silk fibroin-based scaffolds

3D scaffolds are in the center of attention for tissue engineering applications. Whilst many studies have focused on the biological properties of scaffolds, less attention has been paid to meeting the biomechanics of the target tissues. In this work, we show how using the same original biomaterial, but different fabrication techniques can lead to a broad range of structural, mechanical, and biological characteristics. Starting with silk fibroin filament as our base biomaterial, we employed electrospinning, film casting, and weft knitting as different scaffold fabrication techniques. Among these three, the weft knit scaffold showed outstanding cell-scaffold interaction including full 3D cell attachment, complete cell coverage around individual filaments, and in-depth cell infiltration. Post-fabrication degumming of silk filament yarns resulted in more bulky and less open pores for the silk fibroin knit scaffold. The decreased pore size after degumming of knit scaffold alleviated the need to in-advance pore filling (a requisite for increasing cell adhesion in a typical knit scaffold having big pores). From a mechanical viewpoint, the weft knit scaffold shows the highest mechanical strength alongside with far better extensibility. Interestingly, the silk filament weft knit scaffold (in the course direction) was 100 and 1000 times more compliant than silk fibroin film and electrospun web, respectively. The observed effect of material type and fabrication technique highlights the suitability of silk fibroin weft-knit scaffolds for the regeneration of load-bearing soft tissues such as urine bladder.

Systematic Review of Silk Scaffolds in Musculoskeletal Tissue Engineering Applications in the Recent Decade

During the past decade, various novel tissue engineering (TE) strategies have been developed to maintain, repair, and restore the biomechanical functions of the musculoskeletal system. Silk fibroins are natural polymers with numerous advantageous properties such as good biocompatibility, high mechanical strength, and low degradation rate and are increasingly being recognized as a scaffolding material of choice in musculoskeletal TE applications. This current systematic review examines and summarizes the latest research on silk scaffolds in musculoskeletal TE applications within the past decade. Scientific databases searched include PubMed, Web of Science, Medline, Cochrane library, and Embase. The following keywords and search terms were used: musculoskeletal, tendon, ligament, intervertebral disc, muscle, cartilage, bone, silk, and tissue engineering. Our Review was limited to articles on musculoskeletal TE, which were published in English from 2010 to September 2019. The eligibility of the articles was assessed by two reviewers according to prespecified inclusion and exclusion criteria, after which an independent reviewer performed data extraction and a second independent reviewer validated the data obtained. A total of 1120 articles were reviewed from the databases. According to inclusion and exclusion criteria, 480 articles were considered as relevant for the purpose of this systematic review. Tissue engineering is an effective modality for repairing or replacing injured or damaged tissues and organs with artificial materials. This Review is intended to reveal the research status of silk-based scaffolds in the musculoskeletal system within the recent decade. In addition, a comprehensive translational research route for silk biomaterial from bench to bedside is described in this Review.

Evaluation of a new collagen-based medical device (ElastiCo®) for the treatment of acute Achilles tendon injury and prevention of peritendinous adhesions: An in vitro biocompatibility and in vivo investigation

Tendon healing still represents a challenge for clinicians because it is slow and incomplete. The most injured is the Achilles tendon, and surgery is the therapeutic strategy often adopted because it provides a quicker functional recovery. Peritendinous adhesions are the main complication of surgery with hyperplasia and chemotaxis of fibroblasts. A biomaterial that blocks fibroblast migration, without interfering with the passage of cytokines and growth factors, might be useful. The present study evaluated the biocompatibility of a new Type I collagen-based scaffold (ElastiCo®) and its ability to promote Achilles tendon healing, inhibiting adhesion formation. After verifying in vitro biocompatibility, physical, and mechanical properties of the scaffold, an in vivo study was performed in 28 rats, operated to induce an acute lesion in both Achilles tendons. One tendon was treated with the suture only and the contralateral one with suture wrapped with ElastiCo® film. After 8 and 16 weeks, it was observed that ElastiCo® reduced internal and external peritendinous adhesions and Collagen III content and increased Collagen I. Elastic modulus increased with both treatments over time. Current results highlighted the clinical translationality of ElastiCo® that could improve the quality of life in patients affected by Achilles tendon lesions surgically treated.

Construction and application of textile-based tissue engineering scaffolds: a review

Tissue engineering (TE) provides a practicable method for tissue and organ repair or substitution. As the most important component of TE, a scaffold plays a critical role in providing a growing environment for cell proliferation and functional differentiation as well as good mechanical support. And the restorative effects are greatly dependent upon the nature of the scaffold including the composition, morphology, structure, and mechanical performance. Medical textiles have been widely employed in the clinic for a long time and are being extensively investigated as TE scaffolds. However, unfortunately, the advantages of textile technology cannot be fully exploited in tissue regeneration due to the ignoring of the diversity of fabric structures. Therefore, this review focuses on textile-based scaffolds, emphasizing the significance of the fabric design and the resultant characteristics of cell behavior and extracellular matrix reconstruction. The structure and mechanical behavior of the fabrics constructed by various textile techniques for different tissue repairs are summarized. Furthermore, the prospect of structural design in the TE scaffold preparation was anticipated, including profiled fibers and some unique and complex textile structures. Hopefully, the readers of this review would appreciate the importance of structural design of the scaffold and the usefulness of textile-based TE scaffolds in tissue regeneration.

Tendon and Ligament Healing and Current Approaches to Tendon and Ligament Regeneration

Ligament and tendon injuries are common problems in orthopedics. There is a need for treatments that can expedite nonoperative healing or improve the efficacy of surgical repair or reconstruction of ligaments and tendons. Successful biologically-based attempts at repair and reconstruction would require a thorough understanding of normal tendon and ligament healing. The inflammatory, proliferative, and remodeling phases, and the cells involved in tendon and ligament healing will be reviewed. Then, current research efforts focusing on biologically-based treatments of ligament and tendon injuries will be summarized, with a focus on stem cells endogenous to tendons and ligaments. Statement of clinical significance: This paper details mechanisms of ligament and tendon healing, as well as attempts to apply stem cells to ligament and tendon healing. Understanding of these topics could lead to more efficacious therapies to treat ligament and tendon injuries. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:7-12, 2020.

Electrospun thymosin Beta-4 loaded PLGA/PLA nanofiber/ microfiber hybrid yarns for tendon tissue engineering application

Microfiber yarns (MY) have been widely employed to construct tendon tissue grafts. However, suboptimal ultrastructure and inappropriate environments for cell interactions limit their clinical application. Herein, we designed a modified electrospinning device to coat poly(lactic-co-glycolic acid) PLGA nanofibers onto polylactic acid (PLA) MY to generate PLGA/PLA hybrid yarns (HY), which had a well-aligned nanofibrous structure, resembling the ultrastructure of native tendon tissues and showed enhanced failure load compared to PLA MY. PLGA/PLA HY significantly improved the growth, proliferation, and tendon-specific gene expressions of human adipose derived mesenchymal stem cells (HADMSC) compared to PLA MY. Moreover, thymosin beta-4 (Tβ4) loaded PLGA/PLA HY presented a sustained drug release manner for 28 days and showed an additive effect on promoting HADMSC migration, proliferation, and tenogenic differentiation. Collectively, the combination of Tβ4 with the nano-topography of PLGA/PLA HY might be an efficient strategy to promote tenogenesis of adult stem cells for tendon tissue engineering.

Complications in the Management of Acute Achilles Tendon Rupture: A Systematic Review and Network Meta-analysis of 2060 Patients

BACKGROUND

Acute Achilles tendon rupture (ATR) has increased in the past decade, and many new treatments and rehabilitation regimens have been introduced. But major complications in ATR management remain an unsolved problem.

PURPOSE

To compare the risk of major complications of acute ATR after different combinations of treatments and rehabilitation regimens.

STUDY DESIGN

Systematic review and network meta-analysis.

METHOD

The authors searched 4 databases (PubMed, Medline, Embase, and the Cochrane Library) from the date of inception until February 2018 for articles in English. The authors considered randomized controlled trials comparing interventions and rehabilitation protocols for acute ATR and restricted (1) interventions to nonoperative treatment, minimally invasive surgery, and open surgery and (2) rehabilitation protocols to accelerated rehabilitation and early immobilization. Major complications were assessed-namely, rerupture, deep infection, and deep vein thrombosis (DVT). Only patients with primary acute ATR were considered. Quality assessment was performed with the Cochrane "risk of bias" tool. A series of additional tests were conducted to ensure the validity of the results.

RESULTS

Twenty-nine randomized controlled trials with 2060 patients were included in this Bayesian network meta-analysis. The mean incidence of overall major complications from all managements was 9.13% (median, 6.67%). The mean incidence rates of rerupture, deep infection, and DVT from all managements were 5%, 1.50%, and 2.67%, respectively. According to relative risk, nonoperative treatment combined with early immobilization was significantly associated with a higher risk of major complications. According to the surface under the cumulative ranking curve, minimally invasive surgery with accelerated rehabilitation had the highest possibility (79.7%) of being the best management with regard to minimizing major complications.

CONCLUSION

For treating acute ATR, management combining minimally invasive surgery with accelerated rehabilitation had the highest possibility of being superior in terms of major complication risks, according to the surface under the cumulative ranking curve. Management combining nonoperative treatment with early immobilization was statistically associated with a higher risk of complications as compared with the other methods of management.

Integration of mesenchymal stem cell sheet and bFGF-loaded fibrin gel in knitted PLGA scaffolds favorable for tendon repair

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.

Evaluation of Decellularized Bovine Tendon Sheets for Achilles Tendon Defect Reconstruction in a Rabbit Model

BACKGROUND

Achilles tendon (AT) defects frequently occur in trauma and chronic injuries. Currently, no method can satisfactorily reconstruct the AT with completely restored function.

PURPOSE

To evaluate the postoperative outcomes of AT defect reconstruction with decellularized bovine tendon sheets (DBTSs) in a rabbit model.

STUDY DESIGN

Controlled laboratory study.

METHODS

DBTSs were prepared from bovine tendons after compression, decellularization, antigen extraction, freeze drying, and sterilization. Platelet-rich plasma (PRP) was obtained by differential centrifugation. Sixty-three rabbits were used in this study, and the AT defect model was created bilaterally. All rabbits were divided into 3 groups (n = 21). In the DBTS group and the DBTS + PRP group, 2-cm-long AT was excised and reconstructed by DBTSs or PRP-treated DBTSs. In the control group, the rabbits underwent AT transection, and stumps were sutured. After surgery, all rabbits were assessed by ultrasonography and magnetic resonance imaging and then sacrificed for histological examination and biomechanical testing at 4, 8, or 12 weeks.

RESULTS

Gross observations demonstrated the absence of immunologic incompatibility and rejection. Histological examination showed that DBTSs promoted host cell infiltration and new fibrous tissue integration as compared with the control group. In each group, there was an AT-like structure formation and aligned collagen fiber deposition at 12 weeks. Mechanical properties of the reconstructed AT were not significantly different among the 3 groups at 4, 8, and 12 weeks after surgery ( P > .05). Ultrasonography and magnetic resonance imaging results illustrated that the reconstructed AT from each group maintained remodeling, and there was no significant difference in the echogenicity scoring ( P > .05) and percentages of good and excellent ( P > .05) among the 3 groups.

CONCLUSION

DBTSs, which retain the native tendon structure and bioactive factors, had the ability to remodel and integrate into the rabbit AT and improve the healing process.

CLINICAL RELEVANCE

DBTSs could serve as an effective bioscaffold to reconstruct AT defects.

Infrared Laser Improves Collagen Organization in Muscle and Tendon Tissue During the Process of Compensatory Overload

BACKGROUND

The photobiomodulation using the low-level laser therapy (LLLT) exerts a positive modulating effect on the synthesis of collagen in skeletal muscles and tendons. However, few studies have addressed this effect during the compensatory overload.

OBJECTIVE

Evaluate the effect of infrared laser on the deposition and organization of collagen fibers in muscle and tendon tissue during compensatory overload of the plantar muscle in rats.

MATERIALS AND METHODS

Wistar rats were submitted to bilateral ablation of the synergist muscles of the hind paws and divided in groups: Control, Hypertrophy, and Hypertrophy (H)+LLLT (780 nm, 40 mW, 9.6 J/cm² and 10 s/point, 8 points, total energy 3.2 J, daily), evaluated at 7 and 14 days. Muscle cuts were stained with Picrosirius-Red and hematoxylin-eosin and tendon cuts were submitted to birefringence for determination of collagen distribution and organization.

RESULTS

After 7 days an increase was observed in the area between beam muscles in H+LLLT (25.45% ± 2.56) in comparison to H (20.3% ± 3.31), in mature fibers and fibrilis in H+LLLT (29346.88 μm² ± 2182.56; 47602.8 μm² ± 2201.86 respectively) in comparison to H (26656.5 μm² ± 1880.46; 45630.34 μm² ± 2805.82 respectively) and in the collagen area in H+LLLT (2.25% ± 0.19) in comparison to H (2.0% ± 0.15). However, after 14 days a reduction was observed in the area between beam muscles in H+LLLT (13.88% ± 2.54) in comparison to H (19.1% ± 2.61), in fibrils and mature fibers in H+LLLT (17174.1 μm² ± 2563.82; 32634.04 μm² ± 1689.38 respectively) in comparison to H (55249.86 μm² ± 1992.65; 44318.36 μm² ± 1759.57) and in the collagen area in H+LLLT (1.76% ± 0.16) in comparison to H (2.09 ± 0.27). A greater organization of collagen fibers in the tendon was observed after 7 and 14 days in H+LLLT groups.

CONCLUSIONS

Infrared laser irradiation induces an improvement in collagen organization in tendons and a reduction in the total area of collagen in muscles during compensatory atrophy following the ablation of synergist muscles.

Effect of scaffold morphology and cell co-culture on tenogenic differentiation of HADMSC on centrifugal melt electrospun poly (L‑lactic acid) fibrous meshes

Engineered tendon grafts offer a promising alternative for grafting during the reconstruction of complex tendon tears. The tissue-engineered tendon substitutes have the advantage of increased biosafety and the option to customize their biochemical and biophysical properties to promote tendon regeneration. In this study, we developed a novel centrifugal melt electrospinning (CME) technique, with the goal of optimizing the fabrication parameters to generate fibrous scaffolds for tendon tissue engineering. The effects of CME processing parameters, including rotational speed, voltage, and temperature, on fiber properties (i.e. orientation, mean diameter, and productivity) were systematically investigated. By using this solvent-free and environmentally friendly method, we fabricated both random and aligned poly (L-lactic acid) (PLLA) fibrous scaffolds with controllable mesh thickness. We also investigated and compared their morphology, surface hydrophilicity, and mechanical properties. We seeded human adipose derived mesenchymal stem cells (HADMSC) on various PLLA fibrous scaffolds and conditioned the constructs in tenogenic differentiation medium for up to 21 days, to investigate the effects of fiber alignment and scaffold thickness on cell behavior. Aligned fibrous scaffolds induced cell elongation and orientation through a contact guidance phenomenon and promoted HADMSC proliferation and differentiation towards tenocytes. At the early stage, thinner scaffolds were beneficial for HADMSC proliferation, but the scaffold thickness had no significant effects on cell proliferation for longer-term cell culture. We further co-seeded HADMSC and human umbilical vein endothelial cells (HUVEC) on aligned PLLA fibrous mats and determined how the vascularization affected HADMSC tenogenesis. We found that co-cultured HADMSC-HUVEC expressed more tendon-related markers on the aligned fibrous scaffold. The co-culture systems promoted in vitro HADMSC differentiation towards tenocytes. These aligned fibrous scaffolds fabricated by CME technique could potentially be utilized to repair and regenerate tendon defects and injuries with cell co-culture and controlled vascularization.

Rabbit Achilles tendon full transection model - wound healing, adhesion formation and biomechanics at 3, 6 and 12 weeks post-surgery

After tendon rupture repair, two main problems may occur: re-rupture and adhesion formation. Suitable non-murine animal models are needed to study the healing tendon in terms of biomechanical properties and extent of adhesion formation. In this study 24 New Zealand White rabbits received a full transection of the Achilles tendon 2 cm above the calcaneus, sutured with a 4-strand Becker suture. Post-surgical analysis was performed at 3, 6 and 12 weeks. In the 6-week group, animals received a cast either in a 180 deg stretched position during 6 weeks (adhesion provoking immobilization), or were re-casted with a 150 deg position after 3 weeks (adhesion inhibiting immobilization), while in the other groups (3 and 12 weeks) a 180 deg position cast was applied for 3 weeks. Adhesion extent was analyzed by histology and ultrasound. Histopathological scoring was performed according to a method by Stoll et al. (2011), and the main biomechanical properties were assessed. Histopathological scores increased as a function of time, but did not reach values of healthy tendons after 12 weeks (only around 15 out of 20 points). Adhesion provoking immobilization led to an adhesion extent of 82.7±9.7%, while adhesion inhibiting immobilization led to 31.9±9.8% after 6 weeks. Biomechanical properties increased over time, however, they did not reach full strength nor elastic modulus at 12 weeks post-operation. Furthermore, the rabbit Achilles tendon model can be modulated in terms of adhesion formation to the surrounding tissue. It clearly shows the different healing stages in terms of histopathology and offers a suitable model regarding biomechanics because it exhibits similar biomechanics as the human flexor tendons of the hand.

Summary: The rabbit Achilles tendon full transection model can be used to study adhesion extent in a controlled way. It also mimics the biomechanics of human hand flexor tendons.

Silk Fibroin Scaffolds for Urologic Tissue Engineering

Urologic tissue engineering efforts have been largely focused on bladder and urethral defect repair. The current surgical gold standard for treatment of poorly compliant pathological bladders and severe urethral stricture disease is enterocystoplasty and onlay urethroplasty with autologous tissue, respectively. The complications associated with autologous tissue use and harvesting have led to efforts to develop tissue-engineered alternatives. Natural and synthetic materials have been used with varying degrees of success, but none has proved consistently reliable for urologic tissue defect repair in humans. Silk fibroin (SF) scaffolds have been tested in bladder and urethral repair because of their favorable biomechanical properties including structural strength, elasticity, biodegradability, and biocompatibility. SF scaffolds have been used in multiple animal models and have demonstrated robust regeneration of smooth muscle and urothelium. The pre-clinical data involving SF scaffolds in urologic defect repair are encouraging and suggest that they hold potential for future clinical use.

IN VITRO AND IN VIVO DEGRADATION OF A TWISTED SILK FIBROIN–POLY(LACTIC-CO-GLYCOLIC ACID) FIBER COMPOSITE ROPE-LIKE SCAFFOLD AND CHANGES IN ITS MECHANICAL PROPERTIES

Natural silk fibroin fiber is slowly degraded, which makes it difficult to be replaced quickly by regenerating tissues of tissue engineering. We used poly(lactic-co-glycolic acid) (PLGA, lactic acid:glycolic acid [Formula: see text] 10:90) fibers to adjust the overall degradation rate of the scaffolds. This study fabricated a three-strand helical composite rope-like scaffold from silk fibroin and PLGA fibers (silk fibroin:PLGA [Formula: see text] 36:64) using a twisting method. In vitro and in vivo degradation experiments were performed over 16 weeks. Results suggest that the in vitro and in vivo degradation tendencies of the scaffold were similar, with mass loss lagging behind mechanical property loss. The speed of degradation in vivo was faster than that in vitro. Mechanical property loss of the scaffold was fast during the first three weeks, when mass loss was slow. Mass loss rate accelerated from weeks 3 to 8. The mass and mechanical properties were relatively stable from 8 to 16 weeks. After 16 weeks of degradation, the scaffold still had considerably strong mechanical properties. The scaffold showed a reasonable and suitable degradation speed with good histocompatibility for ligament tissue engineering.

Novel fiber-based pure chitosan scaffold for tendon augmentation: biomechanical and cell biological evaluation

One possibility to improve the mechanical properties after tendon ruptures is augmentation with a scaffold. Based on wet spinning technology, chitosan fibres were processed to a novel pure high-grade multifilament yarn with reproducible quality. The fibres were braided to obtain a 3D tendon scaffold. The CS fibres and scaffolds were evaluated biomechanically and compared to human supraspinatus (SSP) tendons. For the cytobiological characterization, in vitro cell culture experiments with human mesenchymal stem cells (hMSC) were performed. Three types of 3D circular braided scaffolds were fabricated. Significantly, higher ultimate stress values were measured for scaffold with larger filament yarn, compared to scaffold with smaller filament yarn. During cultivation over 28 days, the cells showed in dependence of isolation method and/or donor a doubling or tripling of the cell number or even a six-fold increase on the CS scaffold, which was comparable to the control (polystyrene) or in the case of cells obtained from human biceps tendon even higher proliferation rates. After 14 days, the scaffold surface was covered homogeneously with a cell layer. In summary, the present work demonstrates that braided chitosan scaffolds constitute a straightforward approach for designing tendon analogues, maintaining important flexibility in scaffold design and providing favourable mechanical properties of the resulting construct.

A synthetic bridging patch of modified co-electrospun dual nano-scaffolds for massive rotator cuff tear

An electrospun nano-scaffold with two different segments is fabricated to bridge a massive rotator cuff tear successfully.

In vivo bioresponses to silk proteins

Silks are appealing materials for numerous biomedical applications involving drug delivery, tissue engineering, or implantable devices, because of their tunable mechanical properties and wide range of physical structures. In addition to the functionalities needed for specific clinical applications, a key factor necessary for clinical success for any implanted material is appropriate interactions with the body in vivo. This review summarizes our current understanding of the in vivo biological responses to silks, including degradation, the immune and inflammatory response, and tissue remodeling with particular attention to vascularization. While we focus in this review on silkworm silk fibroin protein due to the large quantity of in vivo data thanks to its widespread use in medical materials and consumer products, spider silk information is also included if available. Silk proteins are degraded in the body on a time course that is dependent on the method of silk fabrication and can range from hours to years. Silk protein typically induces a mild inflammatory response that decreases within a few weeks of implantation. The response involves recruitment and activation of macrophages and may include activation of a mild foreign body response with the formation of multinuclear giant cells, depending on the material format and location of implantation. The number of immune cells present decreases with time and granulation tissue, if formed, is replaced by endogenous, not fibrous, tissue. Importantly, silk materials have not been demonstrated to induce mineralization, except when used in calcified tissues. Due to its ability to be degraded, silk can be remodeled in the body allowing for vascularization and tissue ingrowth with eventual complete replacement by native tissue. The degree of remodeling, tissue ingrowth, or other specific cell behaviors can be modulated with addition of growth or other signaling factors. Silk can also be combined with numerous other materials including proteins, synthetic polymers, and ceramics to enhance its characteristics for a particular function. Overall, the diverse array of silk materials shows excellent bioresponses in vivo with low immunogenicity and the ability to be remodeled and replaced by native tissue making it suitable for numerous clinical applications.