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Umemori K, Pourdeyhimi B, Little D. Three-Dimensional Meltblowing as a High-Speed Fabrication Process for Tendon Tissue Engineered Scaffolds. BIOPRINTING (AMSTERDAM, NETHERLANDS) 2025; 48:e00409. [PMID: 40322756 PMCID: PMC12048014 DOI: 10.1016/j.bprint.2025.e00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
Rotator cuff tears continue to be a critical challenge for successful repair due to the formation of fibrotic scar tissue during healing. Tendon tissue engineering seeks to improve these outcomes using nonwoven fabrication methods to produce biomimetic scaffolds. Meltblowing has several advantages over other nonwoven approaches including non-toxic fabrication processes and being high-throughput and economical, while accurately producing fiber diameters comparable to native tendon microstructure. Recently 3D meltblowing (3DMB) introduced high degrees of tunability to the core process, allowing for production of highly aligned fiber mats at anatomically relevant dimensions. Here, we evaluated 3DMB scaffolds fabricated using poly-L-lactic acid (PLA) and poly-ε-caprolactone (PCL) by characterizing scaffold properties before and after culture with human adipose stem cells (hASCs). Mechanical and fiber characterization of 3DMB scaffolds closely resembled tendon microarchitecture by exhibiting high fiber alignment and mechanical anisotropy. hASC-seeded 3DMB scaffolds after 28 days of culture proliferated and deposited aligned tendon-like extracellular matrix. Furthermore, cell culture enhanced the Young's modulus of PLA 3DMB scaffolds and improved yield stress, yield stretch, and stiffness of both 3DMB scaffolds. The proteome of cultured 3DMB scaffolds increased expression of tendon-related proteins after 28 days of culture, but polymer-dependent differences in glycoprotein composition was observed. Together, 3DMB is a promising method for tendon tissue engineering, by showing improved fiber and mechanical properties compared to meltblown scaffolds. However, while an improvement on prior iterations, continued development of this 3DMB technology is needed to better mimic the mechanical properties and biologic composition of native tendon.
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Affiliation(s)
- Kentaro Umemori
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Benham Pourdeyhimi
- The Nonwovens Institute, North Carolina State University, Raleigh, North Carolina
| | - Dianne Little
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
- Department of Basic Medical Science, Purdue University College of Veterinary Medicine, West Lafayette, Indiana
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Cutbush K, Hollman F, Jomaa M, Singh N, Ziegenfuss B, Vijaysegaran P, Italia K, Whitehouse SL, Namazie RM, Gupta A. Combined cuff repair and superior capsular reconstruction reinforcement in patients with massive rotator cuff (re)tears: a minimum 2-year clinical and radiological follow-up. J Shoulder Elbow Surg 2025; 34:1387-1397. [PMID: 39510341 DOI: 10.1016/j.jse.2024.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/08/2024] [Accepted: 08/24/2024] [Indexed: 11/15/2024]
Abstract
BACKGROUND Due to the ageing population, the number of symptomatic degenerative rotator cuff tears has increased substantially, and some are challenging to repair due to poor tendon quality with significant retraction. In order to optimize repair integrity and function, rotator cuff repair reinforcement with a superior capsule reconstruction has been proposed. This study presents the results of a technique combining cuff repair and capsular reconstruction (CRACR) using acellular dermal allograft in patients with massive rotator cuff tears and retears. METHODS From December 2017 to July 2019, 50 consecutive patients with previous failed rotator cuff repairs or primary surgery on poor tendon quality defined as massive rotator cuff tear (full thickness rotator cuff tears with 2 or more tendons involved), were treated with the CRACR technique and enrolled prospectively. Contraindications for the CRACR procedure were Hamada stage ≥3 cuff tear arthropathy and patient's preference for reverse total shoulder arthroplasty. Patients were reviewed at 3, 6, 12, and 24 months (American Shoulder and Elbow Surgeons scores, Constant Murley Scores, Visual Analogue Scores, Oxford Shoulder Score, QuickDASH). Postoperative magnetic resonance imaging scans were requested at 6 weeks, 3 months, 6 months, 12 months, and 24 months postoperatively, to assess repair integrity. RESULTS Mean age at surgery was 58.0 years (SD 8.1, range 41-79). Of the 50 patients, 14 patients (28.0%) had previous failed rotator cuff repair. From the 36 primary cases, 28 (77.8%) had massive rotator cuff tears and one (2.8%) a perioperative irreparable tear, while 28 (77.8%) patients had a subscapularis tear. At 2 years of follow-up all scores improved significantly (Visual Analogue Scores 6.3 to 1.5; American Shoulder and Elbow Surgeons 34.0 to 79.0; Constant Murley Scores 30.9 to 68.0; OSS 23.3 to 40.1; QuickDASH 56.2 to 20.3; all P < .001). Magnetic resonance imaging scans were conducted at a mean of 14.4 months (SD 7.0, range 3-26) after surgery showing 6 isolated superior capsular reconstruction failures and 5 isolated rotator cuff retears. CONCLUSION In the short term, the CRACR technique is a valid option for patients with massive rotator cuff tears and retears with a high chance of a postoperative retear due to poor tendon quality. Clinical results and repair integrity are promising. Longer term follow-up is ongoing to establish the efficacy of this procedure.
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Affiliation(s)
- Kenneth Cutbush
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Freek Hollman
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Mohammad Jomaa
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; St Andrew's War Memorial Hospital, Brisbane, QLD, Australia; Surgical, Treatment and Rehabilitation Services (STARS), Metro North Health, Brisbane, QLD, Australia
| | - Nagmani Singh
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Brandon Ziegenfuss
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Praveen Vijaysegaran
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Kristine Italia
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia
| | - Sarah L Whitehouse
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ridzwan Mohamed Namazie
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; School of Medicine, The University of Queensland, Brisbane, QLD, Australia; Surgical, Treatment and Rehabilitation Services (STARS), Metro North Health, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia
| | - Ashish Gupta
- Queensland Unit for Advanced Shoulder Research (QUASR), Queensland University of Technology, Brisbane, QLD, Australia; Greenslopes Private Hospital, Brisbane, QLD, Australia
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Oh LS, Silverman AA, Rossi N, Randolph MA, Paten JA, Siadat SM, Ruberti JW. Soluble allogeneic telocollagen as a direct protein therapeutic: results of serial injections in a rodent rotator cuff tear model. J Shoulder Elbow Surg 2025; 34:1291-1304. [PMID: 39384013 DOI: 10.1016/j.jse.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 10/11/2024]
Abstract
HYPOTHESIS Delivery of soluble allogeneic type I telocollagen (allo-telocollagen) will accelerate and improve the healing of damaged tendons. Our hypothesis draws from known mechanochemical properties of type I collagen that direct its incorporation into damaged connective tissue. We further suggest that allo-telocollagen will raise a minimal immunogenic reaction as a result of homology within species. METHODS Seventy-eight shoulders (39 Sprague-Dawley rats) had their supraspinatus tendon surgically detached from its footprint on the humerus and repaired (72 shoulders) or left uninjured (6 shoulders). The repaired tissue was treated with an injection of 100 μL of saline, 10 mg/mL allogeneic atelocollagen (allo-atelocollagen), or 10 mg/mL allo-telocollagen at 0, 1, and 2 weeks postsurgery. At 30 and 60 days postsurgery, the tendons were assessed by mechanical testing (failure load, failure stress, stiffness, and relaxation) and by semiquantitative histologic scoring. RESULTS At 30 days postsurgery, the mechanical and histologic outcomes were not statistically different. However, at day 60, allo-telocollagen improved the failure strength of the supraspinatus (29.9 ± 4.7 N) relative to saline (20.0 ± 3.5 N, P < .001) or allo-atelocollagen (23.2 ± 1.5 N, P = .025) treated tendons, and it approached that of uninjured controls (36.9 ± 5.0 N, P = .021). Allo-telocollagen improved the failure stress of the supraspinatus (34.1 ± 9.3 MPa) relative to the saline-treated tendons (21.4 ± 6.0 MPa, P = .031, 160% improvement) and was no different than uninjured controls (33.4 ± 9.9 MPa, P = .999) or allo-atelocollagen (32.3 ± 7.4 MPa, P = .977). The stiffness of uninjured controls was far greater than any of injured or treated tendons (>200% stiffer). Histologic scoring showed that the allo-telocollagen-treated tendons produced better collagen fiber arrangement (1.55 ± 0.17) than saline (2.50 ± 0.29, P = .001) or allo-atelocollagen (2.23 ± 0.28, P = .042) treated tendons and that it did not increase markers of immunogenesis (1.10 ± 0.42) relative to either saline (1.44 ± 0.20, P = .369) or allo-atelocollagen (0.68 ± 0.41, P = .1058). CONCLUSIONS Although all 3 treatments produced similar results at 30 days, by 60 days, soluble allo-telocollagen clearly separated from the other interventions, yielding better mechanical and histologic outcomes in a torn or repaired rotator cuff rat model. Allo-telocollagen-treated tendons also approached the failure strength and matched the failure stresses of uninjured control tendons. The data suggest a new use for allo-telocollagen as a deliverable direct protein mechanotherapeutic that can improve both healing quality and speed.
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Affiliation(s)
- Luke S Oh
- Orthopaedic Sports Medicine, Rothman Orthopaedics, AdventHealth, Orlando, FL, USA
| | | | - Nicolò Rossi
- Plastic Surgery Research, Harvard Medical School, Boston, MA, USA
| | - Mark A Randolph
- Plastic Surgery Research, Harvard Medical School, Boston, MA, USA
| | - Jeffrey A Paten
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
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Hoffmeister TM, Denard PJ, Tashjian RZ, Sethi PM. Augmentation Techniques for Rotator Cuff Repairs. JBJS Rev 2025; 13:01874474-202504000-00002. [PMID: 40238930 PMCID: PMC11999096 DOI: 10.2106/jbjs.rvw.25.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2025]
Abstract
» Despite enhanced understanding of risk factors for failure and enhanced surgical repair techniques, the risk for failure of the rotator cuff to heal after surgery is still substantial.» A patient-specific approach to augmentation is essential, with decisions based on tear and patient characteristics.» Augmentation can improve repair strength and promote cellular infiltration, which collectively contribute to better healing outcomes.» Augmentation strategies may improve outcomes in rotator cuff repairs, particularly in high-risk cases; however, there is a lack of consensus among surgeons on the most effective strategies for each scenario.
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Affiliation(s)
| | | | - Robert Z. Tashjian
- Department of Orthopedics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Paul M. Sethi
- ONS Foundation for Clinical Research and Education, ONS, Greenwich, Connecticut
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Teixidor-Rodríguez P, Brugada-Bellsolà F, Pérez ML, Menéndez-Girón S, Busquets-Bonet J, Domínguez-Alonso CJ. Pilot study to assess the safety and efficacy of human acellular dermal matrix for Chiari surgery. NEUROCIRUGIA (ENGLISH EDITION) 2025:500653. [PMID: 40023443 DOI: 10.1016/j.neucie.2025.500653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 11/25/2024] [Indexed: 03/04/2025]
Abstract
PURPOSE Although there may be benefits to adult patients who have had Chiari surgery when duroplasty is indicated, there are also more risks involved. The complications derived from a non-hermetic dural closure in the posterior fossa can be significant, mainly cerebrospinal fluid (CSF) leakage, meningitis and pseudomeningocele. We explored the option of utilizing a different duroplasty that we typically utilized in order to reduce these risks. The aim of this study is to assess the safety and efficacy of two duraplasties used for Chiari malformation (ChM) surgery: Tutopatch®, and a human acellular dermal matrix (hADM). Tutopatch®, a well-known collagen membrane commonly used by our senior surgeon, and hADM, prepared by the tissue establishment and with potential properties for use as duraplasty. METHODS A unicentric prospective study was designed with one group of patients treated with hADM and another group that retrospectively acquired surgical treatment with Tutopatch®. There were nineteen patients in each group. The patients in both groups were diagnosed with same pathology and were operated on by the same senior surgeon. This study was approved by the same hospital's Medical Ethics Committee. Demographics, clinical risk factors, clinical syndrome and pre/postoperative and postoperative events after surgery were analysed. All serious adverse events (SAEs) and adverse events (AEs) after surgery were recorded. RESULTS No differences were found between the two groups related to sex, clinical risk factors, clinical syndrome and clinical outcomes. Seven patients presented with complications, seven the Tutopatch® group (two of them requiring a new reoperation) and none in the hADM group. CONCLUSION This pilot study shows that hADM is a safe and effective alternative to Tutopatch® duraplasty, as although the two materials performed equally well in the surgical repair of Chiari malformation, the former showed better clinical outcomes. Future studies are needed to confirm these outcomes in larger cohorts.
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Affiliation(s)
- Pilar Teixidor-Rodríguez
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet sn, CP 08916 Badalona, Barcelona, Spain.
| | - Ferran Brugada-Bellsolà
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet sn, CP 08916 Badalona, Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Passeig Taulat, 116 08005 Barcelona, Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Pg. de la Vall d'Hebron, 125, 08035 Barcelona, Spain
| | - Sebastián Menéndez-Girón
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet sn, CP 08916 Badalona, Barcelona, Spain
| | - Jordi Busquets-Bonet
- Department of Anaesthesiology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Carlos Javier Domínguez-Alonso
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Ctra del Canyet sn, CP 08916 Badalona, Barcelona, Spain
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Blakeney WG, Sharifa AA, Graham D, Kop A. Dermal Graft Thickness Over 2 mm and Grafts Oriented Parallel to Skin Tension Lines Increased Graft Strength and Suture Retention: A Biomechanical Study. Arthroscopy 2024:S0749-8063(24)01028-4. [PMID: 39672246 DOI: 10.1016/j.arthro.2024.11.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 11/21/2024] [Accepted: 11/21/2024] [Indexed: 12/15/2024]
Abstract
PURPOSE To assess the variability in graft biomechanical properties of an acellular human dermal matrix patch. METHODS A total of 22 strips obtained from 6 separate graft specimens (AlloPatch HD) were tested. Load elongation properties after cyclic loading, including ultimate load at break, energy at break, and extension at break, were tested and compared by graft thickness. Suture pull-out testing using a simple vertical stitch suture retention test was performed. RESULTS There was a significant, strong positive correlation between graft thickness and ultimate load to failure, energy at break, and extension at break (P < .01). The association between direction of graft in relation to skin tension lines and ultimate load to failure was also significant (P < .034). The difference in ultimate load to failure from the extremes of graft thickness in this study (1.1 mm vs 3.2 mm) was almost 4-fold (104 N/mm2 vs 402 N/mm2). The suture pull-out testing of 10 dermal graft test strips showed that once the graft thickness reached a threshold thickness of 2 mm, the mode of failure changed from cutting through the graft vertically to tearing the graft diagonally. CONCLUSIONS The tested dermal allograft patch shows great variability in thickness within and between individual patches. This study has revealed that grafts thicker than 2 mm and those used in parallel to skin tension lines exhibit a higher ultimate load to failure. Furthermore, graft thickness over 2 mm influenced the method of suture failure. CLINICAL RELEVANCE Caution should be exercised when using grafts less than 2 mm due to lower ultimate load to failure and suture pull-out. Marking the patches in accordance with skin tension lines would help determine the ideal orientation of insertion.
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Affiliation(s)
- William G Blakeney
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Australia; Department of Surgery, University of Western Australia, Perth, Australia.
| | - Aysha Abu Sharifa
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Australia
| | - David Graham
- Department of Orthopaedic Surgery, Royal Perth Hospital, Perth, Australia
| | - Alan Kop
- Department of Medical Engineering and Physics, Centre for Implant Technology and Retrieval Analysis, Royal Perth Hospital, Perth, Australia
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Russo M, Dirkx GK, Rosso C. Patch Augmentation in Arthroscopic Rotator Cuff Surgery-Review of Current Evidence and Newest Trends. J Clin Med 2024; 13:5066. [PMID: 39274280 PMCID: PMC11395888 DOI: 10.3390/jcm13175066] [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: 07/15/2024] [Revised: 08/14/2024] [Accepted: 08/22/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Rotator cuff tears are a common and debilitating condition requiring surgical intervention. Arthroscopic rotator cuff repair is essential for restoring shoulder function and alleviating pain. Tear classification by size and tendon retraction, along with the grade for fatty infiltration, influence postoperative outcomes, with large tears and higher fatty infiltration grades linked to higher retear rates. Managing complex tears is challenging, with failure rates ranging from 20 to 94%. Patch augmentation has emerged as a promising strategy, using biological or synthetic materials to reinforce tendon repairs, enhancing structural integrity and reducing retear risk. Methods: A review of the recent literature from January 2018 to March 2024 was conducted using PubMed/MEDLINE, Embase, and Web of Science. Keywords included "rotator cuff tear", "rotator cuff augmentation", "rotator cuff patch", "tendon augmentation", "massive rotator cuff tear", "patch augmentation", and "grafts". Relevant articles were selected based on their abstracts for a comprehensive review. Results: Initial methods used autograft tissues, but advances in biomaterials have led to standardized, biocompatible synthetic patches. Studies show reduced retear rates with patch augmentation, ranging from 17 to 45%. Conclusions: Patch augmentation reduces the retear rates and improves tendon repair, but complications like immune responses and infections persist. Cost-effectiveness analyses indicate that while initial costs are higher, long-term savings from reduced rehabilitation, revision surgeries, and increased productivity can make patch augmentation economically beneficial.
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Affiliation(s)
- Maximilian Russo
- Departement of Orthopedics and Traumatology, Spitäler fmi AG, 3800 Interlaken, Switzerland
| | - Gert Karl Dirkx
- ARTHRO Medics, 4054 Basel, Switzerland
- Regionaal Ziekenhuis Tienen, 3300 Tienen, Belgium
| | - Claudio Rosso
- ARTHRO Medics, 4054 Basel, Switzerland
- Orthopedics and Trauma Surgery Clinic, University of Basel, 4001 Basel, Switzerland
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Capella-Monsonís H, Crum RJ, Hussey GS, Badylak SF. Advances, challenges, and future directions in the clinical translation of ECM biomaterials for regenerative medicine applications. Adv Drug Deliv Rev 2024; 211:115347. [PMID: 38844005 DOI: 10.1016/j.addr.2024.115347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Extracellular Matrix (ECM) scaffolds and biomaterials have been widely used for decades across a variety of diverse clinical applications and have been implanted in millions of patients worldwide. ECM-based biomaterials have been especially successful in soft tissue repair applications but their utility in other clinical applications such as for regeneration of bone or neural tissue is less well understood. The beneficial healing outcome with the use of ECM biomaterials is the result of their biocompatibility, their biophysical properties and their ability to modify cell behavior after injury. As a consequence of successful clinical outcomes, there has been motivation for the development of next-generation formulations of ECM materials ranging from hydrogels, bioinks, powders, to whole organ or tissue scaffolds. The continued development of novel ECM formulations as well as active research interest in these materials ensures a wealth of possibilities for future clinical translation and innovation in regenerative medicine. The clinical translation of next generation formulations ECM scaffolds faces predictable challenges such as manufacturing, manageable regulatory pathways, surgical implantation, and the cost required to address these challenges. The current status of ECM-based biomaterials, including clinical translation, novel formulations and therapies currently under development, and the challenges that limit clinical translation of ECM biomaterials are reviewed herein.
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Affiliation(s)
- Héctor Capella-Monsonís
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Viscus Biologics LLC, 2603 Miles Road, Cleveland, OH 44128, USA
| | - Raphael J Crum
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - George S Hussey
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Pathology, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stephen F Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 450 Technology Drive, Pittsburgh, PA 15219, USA; Department of Surgery, School of Medicine, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Bioengineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261, USA.
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Shah D, Rathod M, Tiwari A, Kini A, Bhagunde P, Bagaria V. A Histological and Biomechanical Analysis of Human Acellular Dermis (HAD) Created Using a Novel Processing and Preservation Technique. Indian J Orthop 2024; 58:922-931. [PMID: 38948369 PMCID: PMC11208345 DOI: 10.1007/s43465-024-01181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/04/2024] [Indexed: 07/02/2024]
Abstract
Background Large and complex defects requiring reconstruction are challenging for orthopaedic surgeons. The use of human acellular dermal (HAD) matrices to augment large soft tissue defects such as those seen in massive rotator cuff tears, knee extensor mechanism failures and neglected Tendo-Achilles tears has proven to be a valuable tool in surgeons reconstructive armamentarium. Different methods for allograft decellularization and preservation alter the native properties of the scaffold. Traditional processing and preservation methods have shown to have drawbacks that preclude its widespread use. Some of the common issues include inferior biomechanical properties, the risk of rejection, limited customization, difficulty in storing and transporting, the requirement of pre-operative preparation, and last but not the least increased cost. Methods We describe a novel processing and preservation method utilizing a two-step non-denaturing decellularization method coupled with preservation using a water-sequestering agent (glycerol) to remove immunogenic components while retaining biomechanical properties. The efficiency of this novel process was compared with the traditional freeze-drying method and verified by histological evaluation and biomechanical strength analysis. Results The absence of cellular components and matrix integrity in hematoxylin and eosin-stained glycerol-preserved HAD (gly-HAD) samples compared to freeze-dried HAD (FD-HAD) demonstrated effective yet gentle decellularization. Biomechanical strength analysis revealed that gly-HADs are stronger with an ultimate tensile load to the failure strength of 210 N compared to FD-HAD (124N). The gly-HADs were found to have an optimal suture-retention strength of 126 N. Finally, sterility testing of the resultant grafts was checked to ensure a sterility assurance level of 10-6 to establish implantability. Conclusion The novel processing and preservation technique is described in this paper to create a Human Acellular Dermis with higher biomechanical strength and superior histological characteristics. The processing and preservation technique ensured high sterility assurance levels to establish implantability.
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Affiliation(s)
- Damini Shah
- Novo Tissue Bank and Research Centre, Mumbai, India
| | - Madhu Rathod
- Novo Tissue Bank and Research Centre, Mumbai, India
| | | | - Abhishek Kini
- Sir H N Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra 400004 India
| | - Prasad Bhagunde
- Sona Medical Centre & Consultant Orthopaedic Surgeon Saifee Hospital, Jaslok Hospital and Research Centre, Breach Candy Hospital Trust, Mumbai, India
| | - Vaibhav Bagaria
- Department of Orthopaedic Surgery, Sir H N Reliance Foundation Hospital, Girgaum, Mumbai, Maharashtra 400004 India
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Rotundo R, Pancrazi GL, Grassi A, Ceresoli L, Di Domenico GL, Bonafede V. Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:1221. [PMID: 38473691 DOI: 10.3390/ma17051221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. METHODS Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. RESULTS Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. CONCLUSIONS Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.
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Affiliation(s)
- Roberto Rotundo
- Periodontology Unit, University Vita-Salute and IRCCS San Raffaele, 20132 Milan, Italy
| | - Gian Luca Pancrazi
- Oral Surgery, University Vita-Salute and IRCCS San Raffaele, 20132 Milan, Italy
| | - Alessia Grassi
- Oral Surgery, University Vita-Salute and IRCCS San Raffaele, 20132 Milan, Italy
| | - Lara Ceresoli
- Oral Surgery, University Vita-Salute and IRCCS San Raffaele, 20132 Milan, Italy
| | | | - Vanessa Bonafede
- Periodontology Unit, University Vita-Salute and IRCCS San Raffaele, 20132 Milan, Italy
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López-Chicón P, Pérez ML, Castells-Sala C, Piteira AR, Fariñas O, Tabera J, Vilarrodona A. Quality by Design: Development of Safe and Efficacious Full-Thickness Acellular Dermal Matrix Based on EuroGTPII Methodologies. Ther Clin Risk Manag 2023; 19:567-578. [PMID: 37425344 PMCID: PMC10325720 DOI: 10.2147/tcrm.s410574] [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: 03/01/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background The activities of tissue establishments are constantly and rapidly evolving. The development of a new type of allograft, full-thickness acellular dermal matrix, with high mechanical properties to be used in tendon repair surgeries and abdominal wall reconstruction, has determined the need for quality by design process in order to assess evidence of quality, safety and efficacy. The EuroGTPII methodologies were specifically tailored to perform the risk assessment, identify and suggest tests in order to mitigate the potential risk consequences of a novel tissue preparation implementation. Methods The new allograft and associated preparation processes were assessed using the EuroGTP methodologies and characterized to properly evaluate the novelty (Step 1), identify and quantify the potential risks and risk consequences (Step 2), and define the extent of pre-clinical and clinical assessments required to mitigate the risks identified in the assessment (Step 3). Results Four risk consequences associated with the preparation process were identified: (i) implant failure related with tissue procurement and the reagents used during the decellularization protocol; (ii) unwanted immunogenicity related with the processing; (iii) disease transmission linked with the processing, reagents used, reduction in the reliability of microbiology testing and the storage conditions; and (iv) toxicity related to the reagents used and handling of the tissue during clinical application. The outcome of the risk assessment was a low level of risk. Nevertheless, it determined the need for a series of risk mitigation strategies proposed to reduce each individual risk and to provide additional evidence of the safety and efficacy of full-thickness acellular dermal matrix grafts. Conclusion EuroGTPII methodologies allow us to identify the risks and ensure the correct definition of pre-clinical assessments required to address and mitigate the potential risk consequences, before proceeding with clinical use of the new allografts in patients.
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Affiliation(s)
- Patricia López-Chicón
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Vall Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Cristina Castells-Sala
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Ana Rita Piteira
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Jaime Tabera
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Vall Hebron Institute of Research (VHIR), Barcelona, Spain
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12
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Lim WSR, Yew AKS, Lie H, Chou SM, Lie DTT. Rotator cuff repair with an interposition polypropylene mesh: A biomechanical ovine study. World J Orthop 2023; 14:319-327. [PMID: 37304195 PMCID: PMC10251272 DOI: 10.5312/wjo.v14.i5.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Chronic large to massive rotator cuff tears are difficult to treat and re-tears are common even after surgical repair. We propose using a synthetic polypropylene mesh to increase the tensile strength of rotator cuff repairs. We hypothesize that using a polypropylene mesh to bridge the repair of large rotator cuff tears will increase the ultimate failure load of the repair.
AIM To investigate the mechanical properties of rotator cuff tears repaired with a polypropylene interposition graft in an ovine ex-vivo model.
METHODS A 20 mm length of infraspinatus tendon was resected from fifteen fresh sheep shoulders to simulate a large tear. We used a polypropylene mesh as an interposition graft between the ends of the tendon for repair. In seven specimens, the mesh was secured to remnant tendon by continuous stitching while mattress stitches were used for eight specimens. Five specimens with an intact tendon were tested. The specimens underwent cyclic loading to determine the ultimate failure load and gap formation.
RESULTS The mean gap formation after 3000 cycles was 1.67 mm in the continuous group, and 4.16 mm in the mattress group (P = 0.001). The mean ultimate failure load was significantly higher at 549.2 N in the continuous group, 426.4 N in the mattress group and 370 N in the intact group (P = 0.003).
CONCLUSION The use of a polypropylene mesh is biomechanically suitable as an interposition graft for large irreparable rotator cuff tears.
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Affiliation(s)
- Winston Shang Rong Lim
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Hannah Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
| | - Siaw Meng Chou
- College of Engineering, Nanyang Technical University, Singapore 797101, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore 169856, Singapore
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13
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Castells-Sala C, Pérez ML, López-Chicón P, Lopez-Puerto L, Martinez JIR, Ruiz-Ponsell L, Sastre S, Madariaga SE, Aiti A, Fariñas O, Vilarrodona A. Development of a full-thickness acellular dermal graft from human skin: Case report of first patient rotator cuff patch augmentation repair. Transpl Immunol 2023; 78:101825. [PMID: 36934900 DOI: 10.1016/j.trim.2023.101825] [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: 11/25/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
The processing and initial testing of a new human tissue preparation is described. Full-thickness Acellular Dermal Matrix (ftADM) is the extracellular matrix (ECM) obtained by decellularization of full-thickness human skin from cadaveric donors. The safety, stability and usability of the graft are discussed with respect to the results of the residual cellular content, maintenance of ECM components, and biomechanical properties. Quantitative and qualitative analysis of the ECM demonstrated the absence of cell debris, while the native structure of human dermis was maintained. Biomechanical testing showed stiffness values comparable to other commercial products used for tendon reinforcement, suggesting that our ftADM could be successfully used not only in soft tissue regeneration surgeries, but also in tendon reinforcement. First case of ftADM in rotator cuff augmentation is described. Technical management of the patch during surgery and clinical outcomes are discussed.
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Affiliation(s)
- C Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain.
| | - M L Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - P López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Lopez-Puerto
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - J I Rodríguez Martinez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Ruiz-Ponsell
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - S Sastre
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S E Madariaga
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Aiti
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain
| | - O Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - A Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
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14
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Gatot C, Lie HM, Tijauw Tjoen DL. Human Dermal Allograft Patch Augmentation of Degenerate Rotator Cuff Tendon Using a Single Lateral-Row Technique. Arthrosc Tech 2022; 11:e2143-e2151. [PMID: 36632385 PMCID: PMC9826975 DOI: 10.1016/j.eats.2022.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
The role of biological augmentation in arthroscopic rotator cuff repair surgery has increased over the years. It has shown favorable healing rates and functional outcomes. Patch augmentation is commonly applied in repairs of massively retracted cuff tears, full-thickness tears, revision repair, or open cuff surgery. There is a paucity of literature on the use of patch augmentation when dealing with a chronic degenerate tendon associated with small-sized cuff tears. In recent years, the resorbable bioinductive bovine collagen implant has gained popularity for its application in partial-thickness tears via an isolated bioinductive repair fashion, without traditional rotator cuff repair. These bioinductive implants, albeit promising in their biological properties for tendon repair, lack structural strength and do not confer similar biomechanical advantages as human dermal allograft. We share our surgical technique for an arthroscopic patch augmentation involving human dermal allograft, using a single-lateral row surgical fixation, to address a degenerate cuff tendon with small-sized rotator cuff tear. We believe that our use of a human dermal patch augmentation conferred increased biomechanical advantage and reduced costs while delivering favorable outcomes for patients in our value-driven care.
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Affiliation(s)
- Cheryl Gatot
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore,Address correspondence to Cheryl Gatot, Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd., Academia, Level 4, Singapore 169856.
| | - Hannah Marian Lie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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15
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Fatigue Testing of Human Flexor Tendons Using a Customized 3D-Printed Clamping System. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12157836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Improved surgical procedures and implant developments for ligament or tendon repair require an in-depth understanding of tissue load-deformation and fatigue properties. Cyclic testing will provide crucial information on the behavior of these materials under reoccurring loads and on fatigue strength. Sparse data are available describing soft tissue behavior under cyclic loading. To examine fatigue strength, a new technology was trialed deploying 3D-printing to facilitate and standardize cyclic tests aiming to determine tendon fatigue behavior. Cadaveric flexor digitorum tendons were harvested and mounted for tensile testing with no tapering being made, using 3D-printed clamps and holder arms, while ensuring a consistent testing length. Loads ranging between 200 to 510 N were applied at a frequency of 4 Hz, and cycles to failure ranged between 8 and >260,000. S–N curves (Woehler curves) were generated based on the peak stresses and cycles to failure. Power regression yielded a combined coefficient of determination of stress and cycles to failure of R2 = 0.65, while the individual coefficients for tissues of single donors ranged between R2 = 0.54 and R2 = 0.88. The here-presented results demonstrate that S–N curves of human tendons can be obtained using a standardized setting deploying 3D-printing technology.
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16
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Chatterjee M, Muljadi PM, Andarawis-Puri N. The role of the tendon ECM in mechanotransduction: disruption and repair following overuse. Connect Tissue Res 2022; 63:28-42. [PMID: 34030531 DOI: 10.1080/03008207.2021.1925663] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose: Tendon overuse injuries are prevalent conditions with limited therapeutic options to halt disease progression. The specialized extracellular matrix (ECM) both enables joint function and mediates mechanical signals to tendon cells, driving biological responses to exercise or injury. With overuse, tendon ECM composition and structure changes at multiple scales, disrupting mechanotransduction and resulting in inadequate repair and disease progression. This review highlights the multiscale ECM changes that occur with tendon overuse and corresponding effects on cell-matrix interactions and cellular response to load.Results: Different functional joint requirements and tendon types experience a wide range of loading profiles, creating varied downstream mechanical stimuli. Distinct ECM structure and mechanical properties within the fascicle matrix, interfascicle matrix, and enthesis and their varied disruption with overuse are considered. The pericellular matrix (PCM) comprising the microscale tendon cell environment has a unique composition that changes with overuse injury and exercise, suggesting an important role in mechanotransduction and promoting repair. Cell-matrix interactions are mediated by structures including cilia, integrins, connexins and cytoskeleton that signal downstream homeostasis, adaptation, or repair. ECM disruption with tendon overuse may cause altered mechanical loading and cell-matrix interactions, resulting in mechanobiological understimulation, apoptosis, and ineffective repair. Current interventions to promote repair of tendon overuse injuries including exercise, targeting cell signaling, and modulating inflammation are considered.Conclusion: Future therapeutics should be assessed with regard of their effects on multiscale mechanotransduction in addition to joint function, with consideration of the central role of ECM.
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Affiliation(s)
- Monideepa Chatterjee
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Patrick M Muljadi
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Nelly Andarawis-Puri
- Nancy E. And Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York, USA.,Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA.,Hospital for Special Surgery, New York, New York, USA
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17
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Mosher CZ, Brudnicki PAP, Gong Z, Childs HR, Lee SW, Antrobus RM, Fang EC, Schiros TN, Lu HH. Green electrospinning for biomaterials and biofabrication. Biofabrication 2021; 13. [PMID: 34102612 DOI: 10.1088/1758-5090/ac0964] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/08/2021] [Indexed: 11/12/2022]
Abstract
Green manufacturing has emerged across industries, propelled by a growing awareness of the negative environmental and health impacts associated with traditional practices. In the biomaterials industry, electrospinning is a ubiquitous fabrication method for producing nano- to micro-scale fibrous meshes that resemble native tissues, but this process traditionally utilizes solvents that are environmentally hazardous and pose a significant barrier to industrial scale-up and clinical translation. Applying sustainability principles to biomaterial production, we have developed a 'green electrospinning' process by systematically testing biologically benign solvents (U.S. Food and Drug Administration Q3C Class 3), and have identified acetic acid as a green solvent that exhibits low ecological impact (global warming potential (GWP) = 1.40 CO2eq. kg/L) and supports a stable electrospinning jet under routine fabrication conditions. By tuning electrospinning parameters, such as needle-plate distance and flow rate, we updated the fabrication of widely utilized biomedical polymers (e.g. poly-α-hydroxyesters, collagen), polymer blends, polymer-ceramic composites, and growth factor delivery systems. Resulting 'green' fibers and composites are comparable to traditional meshes in terms of composition, chemistry, architecture, mechanical properties, and biocompatibility. Interestingly, material properties of green synthetic fibers are more biomimetic than those of traditionally electrospun fibers, doubling in ductility (91.86 ± 35.65 vs. 45 ± 15.07%,n= 10,p< 0.05) without compromising yield strength (1.32 ± 0.26 vs. 1.38 ± 0.32 MPa) or ultimate tensile strength (2.49 ± 0.55 vs. 2.36 ± 0.45 MPa). Most importantly, green electrospinning proves advantageous for biofabrication, rendering a greater protection of growth factors during fiber formation (72.30 ± 1.94 vs. 62.87 ± 2.49% alpha helical content,n= 3,p< 0.05) and recapitulating native ECM mechanics in the fabrication of biopolymer-based meshes (16.57 ± 3.92% ductility, 33.38 ± 30.26 MPa elastic modulus, 1.30 ± 0.19 MPa yield strength, and 2.13 ± 0.36 MPa ultimate tensile strength,n= 10). The eco-conscious approach demonstrated here represents a paradigm shift in biofabrication, and will accelerate the translation of scalable biomaterials and biomimetic scaffolds for tissue engineering and regenerative medicine.
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Affiliation(s)
- Christopher Z Mosher
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Philip A P Brudnicki
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Zhengxiang Gong
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Hannah R Childs
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Sang Won Lee
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Romare M Antrobus
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Elisa C Fang
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America
| | - Theanne N Schiros
- Materials Research Science and Engineering Center, Columbia University, New York, NY 10027, United States of America.,Science and Mathematics Department, Fashion Institute of Technology, New York, NY 10001, United States of America
| | - Helen H Lu
- Biomaterials and Interface Tissue Engineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States of America.,Materials Research Science and Engineering Center, Columbia University, New York, NY 10027, United States of America
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18
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Ezagüi Bentolila L. Surgical Technique for Arthroscopic Rotator Cuff Augmentation With Human Acellular Dermal Matrix. Arthrosc Tech 2021; 10:e1025-e1032. [PMID: 33981546 PMCID: PMC8085310 DOI: 10.1016/j.eats.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic repair is probably the gold standard for treating large rotator cuff tears. Although positive, the results of this type of intervention depend on many factors such as the size of the tear, the age of the patient, and the number of previous surgeries. To decrease the rate of recurrence, we propose a surgical technique for augmenting the repair using an acellular dermal matrix (ArthroFlex, LifeNet Health). Our technique allows the surgeon to initially suture the tear in a regular fashion without visual interference. Once the tear is repaired, the augmentation is performed in a simple, all-arthroscopic, reproducible, and safe way. Also, we do not use extra implants for the fixation of the graft, so it does not increase the cost of the procedure (leaving aside the cost of the matrix itself).
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Affiliation(s)
- León Ezagüi Bentolila
- Address correspondence to León Ezagüi Bentolila, M.D., Hospital El Pilar, Barcelona, Spain.
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19
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Pashuck TD, Hirahara AM, Cook JL, Cook CR, Andersen WJ, Smith MJ. Superior Capsular Reconstruction Using Dermal Allograft Is a Safe and Effective Treatment for Massive Irreparable Rotator Cuff Tears: 2-Year Clinical Outcomes. Arthroscopy 2021; 37:489-496.e1. [PMID: 33080333 DOI: 10.1016/j.arthro.2020.10.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 10/02/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate functional, symptomatic, and diagnostic imaging outcomes after arthroscopic superior capsular reconstruction (SCR) using dermal allograft in patients with massive irreparable rotator cuff tears. METHODS From 2015 to 2017, this multicenter study retrospectively evaluated patients undergoing arthroscopic SCR for treatment of symptomatic massive rotator cuff tears. Study criteria included the presence of a massive irreparable rotator cuff tear with retraction to the glenoid without diffuse bipolar cartilage loss, Grade 4 or 5 Hamada classification, and subscapularis pathology that could not be addressed. All SCR procedures were performed with neutral abduction of the arm at the time of implantation. Outcome measures included visual analog pain scale (VAS) score, the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and active forward elevation (FE) through 2 years postoperatively. Imaging analyses included radiographs, ultrasound, and magnetic resonance imaging at 6 months and 1 year. RESULTS Fourteen patients met all study criteria including required follow-up. There were statistically significant improvements in VAS pain (3.3-0.6, P = .001), ASES (55.0-86.5, P < .0001), SANE (33.1-71.5, P < .0001), and active FE (128-172, P = .0005) with mean follow-up of 2.1 years. Twelve patients (86%) met the minimum clinically important difference in VAS pain, ASES, and SANE. Thirteen grafts (93%) had ultrasonographic evidence for vascularity by 1 year postoperatively. There were 2 graft complications (14%) with one (7%) requiring revision to reverse total shoulder arthroplasty. CONCLUSIONS Arthroscopic SCR using dermal allograft can be a safe and effective treatment option for patients with massive irreparable rotator cuff tears with statistically significant improvements in VAS pain, ASES, SANE, and active FE at 2-years postoperatively, with 93% of grafts demonstrating vascularity at 1-year postoperatively. Neutral abduction of the arm at the time of implantation resulted in positive clinical outcomes and may decrease graft failure rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Troy D Pashuck
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A
| | | | - James L Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A.; Mizzou BioJoint Center, University of Missouri, Columbia, Missouri, U.S.A
| | - Cristi R Cook
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A.; Mizzou BioJoint Center, University of Missouri, Columbia, Missouri, U.S.A
| | | | - Matthew J Smith
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, U.S.A.; Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri, U.S.A.; Mizzou BioJoint Center, University of Missouri, Columbia, Missouri, U.S.A..
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20
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Yeung DA, Kelly NH. The Role of Collagen-Based Biomaterials in Chronic Wound Healing and Sports Medicine Applications. Bioengineering (Basel) 2021; 8:bioengineering8010008. [PMID: 33429996 PMCID: PMC7827215 DOI: 10.3390/bioengineering8010008] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
Advancements in tissue engineering have taken aim at treating tissue types that have difficulty healing naturally. In order to achieve improved healing conditions, the balance of exogenous matrix, cells, and different factors must be carefully controlled. This review seeks to explore the aspects of tissue engineering in specific tissue types treated in sports medicine and advanced wound management from the perspective of the matrix component. While the predominant material to be discussed is collagen I, it would be remiss not to mention its relation to the other contributing factors to tissue engineered healing. The main categories of materials summarized here are (1) reconstituted collagen scaffolds, (2) decellularized matrix tissue, and (3) non-decellularized tissue. These three groups are ordered by their increase in additional components beyond simply collagen.
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21
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Vredenburgh ZD, Prodromo JP, Tibone JE, Dunphy TR, Weber J, McGarry MH, Chae S, Adamson GJ, Lee TQ. Biomechanics of tensor fascia lata allograft for superior capsular reconstruction. J Shoulder Elbow Surg 2021; 30:178-187. [PMID: 32778385 DOI: 10.1016/j.jse.2020.04.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We hypothesized that in a cadaveric massive rotator cuff tear (MCT) model, a fascia lata (FL) allograft superior capsular reconstruction (SCR) would restore subacromial contact pressure and humeral head superior translation without limiting range of motion (ROM). Therefore, the objective of this study was to compare these parameters between an intact rotator cuff, MCT, and allograft FL SCR. METHODS Eight fresh cadavers were studied using a custom shoulder testing system. ROM, superior translation, and subacromial contact pressure were measured in each of 3 states: (1) intact rotator cuff, (2) MCT, and (3) MCT with SCR. RESULTS Total ROM was increased in the MCT state at 60° of abduction (P = .037). FL SCR did not restrict internal or external rotational ROM. Increased superior translation was observed in the MCT state at 0° and 30° of humeral abduction, with no significant difference between the intact cuff and FL SCR states. The MCT state significantly increased mean subacromial contact pressure at 0° of abduction with 30° and 60° of external rotation, and FL SCR restored this to intact levels. Peak subacromial contact pressure was increased for the MCT state at 0° of abduction with 30° and 60° of external rotation, as well as 30° of abduction with 30° of external rotation. CONCLUSION This study demonstrates a tensor FL allograft preparation technique for use in SCR. After MCT, FL SCR restores ROM, superior translation, and subacromial contact pressure to the intact state.
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Affiliation(s)
- Zachary D Vredenburgh
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | - Joel Weber
- Evergreen Health Orthopedics & Sports Care, Kirkland, WA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Seungbum Chae
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, Daegu Catholic University Hospital School of Medicine, Daegu, Republic of Korea
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
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22
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Lee SJ, Kang SW, Chung I, Jang H. Which Factors Influence Clinical Outcomes After Superior Capsular Reconstruction Surgery? Orthop J Sports Med 2020; 8:2325967120966410. [PMID: 33403209 PMCID: PMC7747125 DOI: 10.1177/2325967120966410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (ASCR) has recently been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about retear after ASCR or subsequent treatment has been reported. PURPOSE To investigate the retear rate of patients who underwent ASCR and to analyze the clinical outcomes of treatments performed for a retear. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into 2 groups: those with no retear (30 shoulders) and those with retear (16 shoulders). Pre- and postoperative clinical and radiological results were compared between the 2 groups. The retear pattern and treatment outcomes of the retear group were analyzed. RESULTS The overall incidence of retear was 35% (16/46). No difference was found in preoperative demographic or clinical data between the 2 groups. Preoperative magnetic resonance imaging data showed a significant between-group difference in the preoperative Goutallier grade of the subscapularis (1.5 ± 1.1 in the no-retear group vs 2.5 ± 1.3 in the retear group; P = .016). In the retear group, there were 10 cases of lateral side tears, 3 cases of midsubstance tears, 2 cases of medial side tears, and 1 case of medial and lateral tears. Reoperation was performed in 8 patients who had lateral insertion tear. CONCLUSION Overall, clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 35% (16/46) of the patients showed retear, and lateral side retear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side retears was worse, and reoperation was often required. Therefore, it is important that the lateral side be firmly fixed during the ASCR procedure.
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Affiliation(s)
- Seung-Jun Lee
- Shoulder, Elbow and Sports Medicine Center, Busan Central Hospital, Busan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ilkwon Chung
- Shoulder, Elbow and Sports Medicine Center, Busan Central Hospital, Busan, Republic of Korea
| | - Hyungseo Jang
- Shoulder, Elbow and Sports Medicine Center, Busan Central Hospital, Busan, Republic of Korea
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23
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Wang Z, Long Z, Amadio PC, Gingery A, Moran SL, Steinmann SP, Zhao C. Biomechanical Comparison of Augmentation of Engineered Tendon-Fibrocartilage-Bone Composite With Acellular Dermal Graft Using Double Rip-Stop Technique for Canine Rotator Cuff Repair. Orthop J Sports Med 2020; 8:2325967120939001. [PMID: 32953920 PMCID: PMC7476351 DOI: 10.1177/2325967120939001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 01/08/2023] Open
Abstract
Background The retear rate after rotator cuff repair remains unacceptably high. Various biological engineered scaffolds have been proposed to reduce the retear rate. We have developed a double rip-stop repair with medial row knot (DRSK) technique to enhance suture-tendon strength and a novel engineered tendon-fibrocartilage-bone composite (TFBC) for rotator cuff repair. Hypothesis DRSK rotator cuff repair augmented with TFBC will have better biomechanical properties than that of DRSK repair with an acellular dermal graft (DG). Study Design Controlled laboratory study. Methods Fresh-frozen canine shoulders (n = 30) and knees (n = 10) were used. TFBCs were harvested from the patellar tendon-tibia complex and prepared for rotator cuff repair. The infraspinatus tendon was sharply detached from its bony attachment and randomly assigned to the (1) control group: DRSK repair alone, (2) TFBC group: DRSK repair with TFBC, and (3) DG group: DRSK repair with DG. All specimens were tested to failure, and videos were recorded. The footprint area, tendon thickness, load to create 3-mm gap formation, failure load, failure modes, and stiffness were recorded and compared. Data were recorded as mean ± SD. Results The mean load to create a 3-mm gap in both the control group (206.8 ± 55.7 N) and TFBC group (208.9 ± 39.1 N) was significantly higher than that in the DG group (157.7 ± 52.3 N) (P < .05 for all). The failure load of the control group (275.7 ± 75.0 N) and TFBC group (275.2 ± 52.5 N) was significantly higher compared with the DG group (201.5 ± 49.7 N) (P < .05 for both comparisons). The stiffness of the control group (26.4 ± 4.7 N/mm) was significantly higher than of the TFBC group (20.4 ± 4.4 N/mm) and the DG group (21.1 ± 4.8 N/mm) (P < .05 for both comparisons). Conclusion TFBC augmentation showed superior biomechanical performance to DG augmentation in rotator cuff tears repaired using the DRSK technique, while there was no difference between the TFBC and control groups. Clinical Relevance TFBC may help to reduce retear or gap formation after rotator cuff repair using the DRSK technique.
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Affiliation(s)
- Zhanwen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, PR China
| | - Zeling Long
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott P Steinmann
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Rey-Vinolas S, Castaño O, Ruiz-Macarrilla L, Llorens X, Mora JM, Engel E, Mateos-Timoneda MA. Development of a novel automatable fabrication method based on electrospinning co electrospraying for rotator cuff augmentation patches. PLoS One 2019; 14:e0224661. [PMID: 31725745 PMCID: PMC6855444 DOI: 10.1371/journal.pone.0224661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 10/18/2019] [Indexed: 01/02/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder diseases. Rotator cuff augmentation (RCA) is trying to solve the high retear failure percentage after the surgery procedures (20-90%). The ideal augmentation patch must provide a temporal mechanical support during the healing process. In this work, we proposed a simple method for the fabrication of synthetic RCA patches. This method combines the use of electrospraying to produce poly-L-lactic-co-ε-caprolactone (PLC) films in an organogel form and electrospinning to produce poly(lactic) acid (PLA) nanofibers. The device consists in a combination of layers, creating a multilayered construct, enabling the possibility of tuning its mechanical properties and thickness. Besides, both techniques are simple to escalate for industrial production. A complete characterization has been performed to optimize the involved number of layers and production time of PLC films and PLA nanofibers fabrication, obtaining a final optimal configuration for RCA devices. Structural, mechanical and suture properties were evaluated. Also, the possibility of surface functionalization to improve the bioactivity of the scaffold was studied, adding aligned electrospun PLA nanofibers on the surface of the device to mimic the natural tendon topography. Surface modification was characterized by culturing adult normal human dermal fibroblasts. Lack of toxicity was detected for material presented, and cell alignment shape orientation guided by aligned fibers, mimicking tendon structure, was obtained. Cell proliferation and protein production were also evaluated.
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Affiliation(s)
- Sergi Rey-Vinolas
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
| | - Oscar Castaño
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Serra Hunter Fellow, Electronics and Biomedical Engineering Department, University of Barcelona (UB), Barcelona, Spain
- Bioelectronics Unit and Nanobioengineering Lab., Institute for Nanoscience and Nanotechnology of the University of Barcelona (IN2UB), Barcelona, Spain
| | | | - Xavier Llorens
- Fundació Joan Costa Roma, Consorci Sanitari de Terrassa, Terrassa, Spain
- Servei de C.O.T., Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - José M. Mora
- Fundació Joan Costa Roma, Consorci Sanitari de Terrassa, Terrassa, Spain
- Servei de C.O.T., Hospital de Terrassa, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Elisabeth Engel
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Department of Materials Science and Metallurgical Engineering, EEBE campus, Technical University of Catalonia (UPC), Barcelona, Spain
| | - Miguel A. Mateos-Timoneda
- Biomaterials for Regenerative Therapies, Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), Barcelona, Spain
- CIBER en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
- Department of Materials Science and Metallurgical Engineering, EEBE campus, Technical University of Catalonia (UPC), Barcelona, Spain
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25
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Tavelli L, McGuire MK, Zucchelli G, Rasperini G, Feinberg SE, Wang HL, Giannobile WV. Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration. J Periodontol 2019; 91:17-25. [PMID: 31475361 DOI: 10.1002/jper.19-0351] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/03/2019] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
The present article focuses on the properties and indications of scaffold-based extracellular matrix (ECM) technologies as alternatives to autogenous soft tissue grafts for periodontal and peri-implant plastic surgical reconstruction. The different processing methods for the creation of cell-free constructs resulting in preservation of the extracellular matrices influence the characteristics and behavior of scaffolding biomaterials. The aim of this review is to discuss the properties, clinical application, and limitations of ECM-based scaffold technologies in periodontal and peri-implant soft tissue augmentation when used as alternatives to autogenous soft tissue grafts.
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Affiliation(s)
- Lorenzo Tavelli
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - Michael K McGuire
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA.,Private practice, Houston, TX, USA.,Department of Periodontics, University of Texas, Dental Branch Houston and Health Science Center, San Antonio, TX, USA
| | - Giovanni Zucchelli
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giulio Rasperini
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical, Surgical and Dental Sciences, University of Milan, Foundation IRCCS Ca' Granda Policlinic, Milan, Italy
| | - Stephen E Feinberg
- Department of Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA
| | - William V Giannobile
- Department of Periodontics & Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, MI, USA.,Department of Biomedical Engineering & Biointerfaces Institute, College of Engineering, University of Michigan, Ann Arbor, MI, USA
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26
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Croom WP, Adamson GJ, Lin CC, Patel NA, Kantor A, McGarry MH, Itami Y, Lee TQ. A biomechanical cadaveric study of patellar tendon allograft as an alternative graft material for superior capsule reconstruction. J Shoulder Elbow Surg 2019; 28:1241-1248. [PMID: 30902593 DOI: 10.1016/j.jse.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS In a cadaveric irreparable rotator cuff tear model, patellar tendon allograft-superior capsule reconstruction (PT-SCR) will restore glenohumeral stability and reduce subacromial contact pressures without significant graft deformation during testing. METHODS Eight cadaveric shoulders were tested in a custom shoulder testing system. Rotational range of motion (ROM), superior translation, and subacromial contact pressure were measured in the following experimental conditions: intact rotator cuff, irreparable supraspinatus tear (massive cuff tear [MCT]), and PT-SCR. RESULTS MCT and PT-SCR resulted in significantly increased total ROM at all degrees of abduction compared with the intact state (P < .001). In both 0° and 30° of glenohumeral abduction, MCT showed a significant increase in superior translation compared with the intact state (P < .001). Application of the PT-SCR resulted in a decrease of superior translation compared with MCT (P < .001). At 0° abduction/60° external rotation and 0° abduction/90° external rotation, MCT showed significantly greater peak subacromial contact pressure compared with the intact state (P < .006). At both of these positions, PT-SCR was able to reduce peak pressure to lower than or no significant difference from the intact state. There was no statistically significant change in graft thickness, length, or width after testing. CONCLUSION PT-SCR was able to reduce superior translation of the humeral head and peak subacromial contact pressure without restricting ROM. Furthermore, there was no significant graft deformation during testing. PT-SCR in this validated cadaveric model demonstrates favorable biomechanical properties and is a viable source of graft material for SCR.
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Affiliation(s)
- William P Croom
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
| | - Charles C Lin
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Nilay A Patel
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California at Irvine, Irvine, CA, USA
| | - Adam Kantor
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California at Irvine, Irvine, CA, USA
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27
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Laskovski J, Abrams J, Bogdanovska A, Taliwal N, Taylor M, Fisher M. Arthroscopic Rotator Cuff Repair With Allograft Augmentation: Making It Simple. Arthrosc Tech 2019; 8:e597-e603. [PMID: 31334016 PMCID: PMC6624125 DOI: 10.1016/j.eats.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/03/2019] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff tears are increasing in frequency in the aging population and are a common issue seen by orthopaedic surgeons. In patients with large, multi-tendon rotator cuff tears or retears, treatment can be challenging. Failure rates of up to 90% have been reported for rotator cuff repair (RCR) of large, multi-tendon tears. Biological augmentation has been an area of interest because of the distinctly different biology of the repaired tendon compared with the native tendon. These biological differences affect the ultimate tensile properties of the repair and may contribute to gap formation and the high failure rate of repairs. RCR with allograft augmentation is a technique that shows potential benefit to healing and preventing retears. Arthroscopic augmentation of RCRs can be challenging. The technique described in this Technical Note illustrates a simple and easily reproducible method for augmenting RCRs with human acellular dermal allograft.
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Affiliation(s)
- Jovan Laskovski
- Crystal Clinic Orthopedic Center, Akron, Ohio, U.S.A.,Address correspondence to Jovan Laskovski, M.D., Crystal Clinic Orthopedic Center, 1622 E Turkeyfoot Rd, Akron, OH 44312, U.S.A.
| | - Jeffrey Abrams
- University Medical Center at Princeton, Princeton, New Jersey, U.S.A
| | | | - Neal Taliwal
- Crystal Clinic Orthopedic Center, Akron, Ohio, U.S.A
| | - Mathew Taylor
- Orthopaedic Department, Summa Health, Akron, Ohio, U.S.A
| | - Michael Fisher
- Division of Orthopaedic Surgery, Western Reserve Hospital, Cuyahoga Falls, Ohio, U.S.A
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28
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Wound healing effects of paste type acellular dermal matrix subcutaneous injection. Arch Plast Surg 2018; 45:504-511. [PMID: 30466229 PMCID: PMC6258974 DOI: 10.5999/aps.2018.00948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/23/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Acellular dermal matrix (ADM) helps wound healing by stimulating angiogenesis, acting as a chemoattractant for endothelial cells, providing growth factors, and permitting a substrate for fibroblasts to attach. The current standard for using paste-type ADM (CG Paste) in wound healing is direct application over the wounds. The major concerns regarding this method are unpredictable separation from the wounds and absorption into negativepressure wound therapy devices. This study aimed to investigate the effects of subcutaneous injection of paste-type ADM on wound healing in rats. METHODS Full-thickness skin defects were created on the dorsal skin of rats. Eighteen rats were randomly divided into three groups and treated using different wound coverage methods: group A, with a saline dressing; group B, standard application of CG Paste; and group C, injection of CG Paste. On postoperative days 3, 5, 7, 10, and 14, the wound areas were analyzed morphologically. Histological and immunohistochemical tissue analyses were performed on postoperative days 3 and 7. RESULTS Groups B and C had significantly less raw surface than group A on postoperative days 10 and 14. Collagen fiber deposition and microvessel density were significantly higher in group C than in groups A and B on postoperative days 3 and 7. CONCLUSIONS This study showed comparable effectiveness between subcutaneous injection and the conventional dressing method of paste-type ADM. Moreover, the injection of CG Paste led to improved wound healing quality through the accumulation of collagen fibers and an increase in microvessel density.
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29
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The Surgical Applications of Biologics in Sports Medicine. Sports Med Arthrosc Rev 2018; 26:196-199. [PMID: 30395067 DOI: 10.1097/jsa.0000000000000219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the past 25 years an increased appreciation of the positive impact of biologic interventions has driven significant advances in the surgical treatment of shoulder and knee conditions. These biologic adjuncts to treatment promote improved outcomes and have set the stage and increased research and development in this arena.
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30
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Gabler C, Saß JO, Gierschner S, Lindner T, Bader R, Tischer T. In Vivo Evaluation of Different Collagen Scaffolds in an Achilles Tendon Defect Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6432742. [PMID: 30175138 PMCID: PMC6106734 DOI: 10.1155/2018/6432742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/04/2018] [Accepted: 07/18/2018] [Indexed: 01/09/2023]
Abstract
In the present study, a newly introduced bovine cross-linked collagen scaffold (test material) was investigated in vivo in an Achilles tendon defect model and compared to a commercially available porcine collagen scaffold (control material). In total, 28 male Sprague Dawley rats (about 400 g) were examined. The defined Achilles tendon defect of 5 mm of the right hind limb was replaced by one of the scaffold materials. After euthanasia, the hind limbs were transected for testing. Biomechanical evaluation was carried out via tensile testing (n = 8 each group, observation time: 28 days). Nonoperated tendons from the bilateral side were used as a control (native tendon, n = 4). For the histological evaluation, 12 animals were sacrificed at 14 and 28 days postoperatively (n = 3 each group and time point). Stained slices (Hematoxylin & Eosin) were evaluated qualitatively in terms of presence of cells and cell migration into scaffolds as well as structure and degradation of the scaffold. All transected hind limbs were additionally analyzed using MRI before testing to verify if the tendon repair using a collagen scaffold was still intact after the observation period. The maximum failure loads of both scaffold materials (test material: 54.5 ± 16.4 N, control: 63.1 ± 19.5 N) were in the range of native tendon (76.6 ± 11.6 N, p ≥ 0.07). The stiffness of native tendons was twofold higher (p ≤ 0.01) and the tear strength was approximately fivefold higher (p ≤ 0.01) compared to the repaired tendons with both scaffolds. Histological findings indicated that neither the test nor the control material induced inflammation, but the test material underwent a slower remodeling process. An overall repair failure rate of 48% was observed via MRI. The experimental data of the newly developed test material showed similar outcomes compared to the commercially available control material. The high repair failure rate indicated that MRI is recommended as an auxiliary measurement tool to validate experimental data.
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Affiliation(s)
- Carolin Gabler
- Rostock University Medical Center, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Jan-Oliver Saß
- Rostock University Medical Center, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Susann Gierschner
- Rostock University Medical Center, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Tobias Lindner
- Rostock University Medical Center, Core Facility Multimodal Small Animal Imaging, 18057 Rostock, Germany
| | - Rainer Bader
- Rostock University Medical Center, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
| | - Thomas Tischer
- Rostock University Medical Center, Department of Orthopedics, Biomechanics and Implant Technology Laboratory, Rostock, Germany
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Biomechanical, Biochemical, and Cell Biological Evaluation of Different Collagen Scaffolds for Tendon Augmentation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7246716. [PMID: 29854782 PMCID: PMC5966701 DOI: 10.1155/2018/7246716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/19/2018] [Indexed: 11/17/2022]
Abstract
Tendon augmentation is increasingly clinically relevant due to rising amount of tendon ruptures because of the aging and more demanding population. Therefore, newly developed scaffolds based on bovine epoxide stabilized collagen maintaining the native fibril-like collagen structure were characterized and compared to two commercially available porcine collagen scaffolds. For biomechanical testing (ultimate load, ultimate stress, stiffness, and elastic modulus), bovine collagen scaffolds were hydrated and compared to reference products. Cell viability and proliferation were assessed by seeding human primary fibroblasts on each collagen-based scaffold and cultured over various time periods (3 d, 7 d, and 14 d). Live/dead staining was performed and metabolic cell activity (WST-1 assay) was measured. Biochemical degradability was investigated by enzymatic digestion. The bovine collagen scaffold showed significantly enhanced biomechanical properties. These persisted over different rehydration times. Cell biological tests revealed that the bovine collagen scaffolds support reproducible cell colonization and a significant increase in the number of viable cells during cultivation. The results are comparable with the viability and proliferation rate of cells grown on porcine reference materials. With regard to biochemical degradability, all tested materials showed comparable resistance to enzymatic degradation in vitro. Due to imitating the natural tendon structure the new scaffold material is supposed to provide beneficial effects in future clinical application.
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Cengiz IF, Pereira H, de Girolamo L, Cucchiarini M, Espregueira-Mendes J, Reis RL, Oliveira JM. Orthopaedic regenerative tissue engineering en route to the holy grail: disequilibrium between the demand and the supply in the operating room. J Exp Orthop 2018; 5:14. [PMID: 29790042 PMCID: PMC5964057 DOI: 10.1186/s40634-018-0133-9] [Citation(s) in RCA: 23] [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: 12/22/2017] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
Orthopaedic disorders are very frequent, globally found and often partially unresolved despite the substantial advances in science and medicine. Their surgical intervention is multifarious and the most favourable treatment is chosen by the orthopaedic surgeon on a case-by-case basis depending on a number of factors related with the patient and the lesion. Numerous regenerative tissue engineering strategies have been developed and studied extensively in laboratory through in vitro experiments and preclinical in vivo trials with various established animal models, while a small proportion of them reached the operating room. However, based on the available literature, the current strategies have not yet achieved to fully solve the clinical problems. Thus, the gold standards, if existing, remain unchanged in the clinics, notwithstanding the known limitations and drawbacks. Herein, the involvement of regenerative tissue engineering in the clinical orthopaedics is reviewed. The current challenges are indicated and discussed in order to describe the current disequilibrium between the needs and solutions made available in the operating room. Regenerative tissue engineering is a very dynamic field that has a high growth rate and a great openness and ability to incorporate new technologies with passion to edge towards the Holy Grail that is functional tissue regeneration. Thus, the future of clinical solutions making use of regenerative tissue engineering principles for the management of orthopaedic disorders is firmly supported by the clinical need.
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Affiliation(s)
- Ibrahim Fatih Cengiz
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal. .,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Hélder Pereira
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Madrid, Spain.,Orthopedic Department Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center, Kirrbergerstr Bldg 37, D-66421, Homburg/Saar, Germany
| | - João Espregueira-Mendes
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopedic Department, University of Minho, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
| | - Joaquim Miguel Oliveira
- 3B's Research Group, I3Bs - Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017 Barco, Guimarães, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,The Discoveries Centre for Regenerative and Precision Medicine, Headquarters at University of Minho, Avepark, 4805-017 Barco, Guimarães, Portugal
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Jenkins TL, Meehan S, Pourdeyhimi B, Little D. * Meltblown Polymer Fabrics as Candidate Scaffolds for Rotator Cuff Tendon Tissue Engineering. Tissue Eng Part A 2018; 23:958-967. [PMID: 28816097 DOI: 10.1089/ten.tea.2016.0470] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Various biomaterial technologies are promising for tissue engineering, including electrospinning, but commercial scale-up of throughput is difficult. The goal of the study was to evaluate meltblown fabrics as candidate scaffolds for rotator cuff tendon tissue engineering. Meltblown poly(lactic acid) fabrics were produced with several polymer crystallinities and airflow velocities [500(low), 900(medium) or 1400(high) m3air/h/m fabric]. Fiber diameter, alignment, and baseline bidirectional tensile mechanical properties were evaluated. Attachment and spreading of human adipose-derived stem cells (hASCs) were evaluated over 3 days immediately following seeding. After initial screening, the fabric with the greatest Young's modulus and yield stress was selected for 28-day in vitro culture and for evaluation of tendon-like extracellular matrix production and development of mechanical properties. As expected, airflow velocity of the polymer during meltblowing demonstrated an inverse relationship with fiber diameter. All fabrics exhibited fiber alignment parallel to the direction of collector rotation. All fabrics demonstrated mechanical anisotropy at baseline. Cells attached, proliferated, and spread on all fabrics over the initial three-day culture period. Consistent with the observed loss of integrity of the unseeded biomaterial, hASC-seeded scaffolds demonstrated a significant decrease in Young's modulus over 28 days of culture. However, dsDNA, sulfated glycosaminoglycan, and collagen content increased significantly over 28 days. Histology and polarized light microscopy demonstrated collagen deposition and alignment throughout the thickness of the scaffolds. While fiber diameters approximated an order of magnitude greater than those previously reported for electrospun scaffolds intended for tendon tissue engineering, they were still within the range of collagen fiber diameters found in healthy tendon. The extent of matrix production and alignment was similar to that previously observed for multilayered electrospun scaffolds. While the Young's modulus of scaffolds after 28 days of culture was lower than native rotator cuff tendon, it approximated that reported previously following culture of electrospun scaffolds and was on the same order of magnitude as of current Food and Drug Administration-approved patches for rotator cuff augmentation. Together, these data suggest that with minor polymer and parameter modifications, meltblown scaffolds could provide an economical, high-throughput production alternative method to electrospinning for use in rotator cuff tendon tissue engineering.
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Affiliation(s)
- Thomas L Jenkins
- 1 Department of Basic Medical Science, Purdue University College of Veterinary Medicine and Department of Biomedical Engineering, Weldon School of Engineering, Purdue University , West Lafayette, Indiana.,2 Department of Orthopaedic Surgery, Duke University , Durham, North Carolina
| | - Sean Meehan
- 2 Department of Orthopaedic Surgery, Duke University , Durham, North Carolina
| | - Behnam Pourdeyhimi
- 3 The Nonwovens Institute, North Carolina State University , Raleigh, North Carolina
| | - Dianne Little
- 1 Department of Basic Medical Science, Purdue University College of Veterinary Medicine and Department of Biomedical Engineering, Weldon School of Engineering, Purdue University , West Lafayette, Indiana.,2 Department of Orthopaedic Surgery, Duke University , Durham, North Carolina
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Laskovski J, Urchek R. Endoscopic Gluteus Medius and Minimus Repair With Allograft Augmentation Using Acellular Human Dermis. Arthrosc Tech 2018; 7:e225-e230. [PMID: 29876243 PMCID: PMC5989483 DOI: 10.1016/j.eats.2017.08.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
Recently, attention has been given to recalcitrant lateral hip pain, also known as greater trochanteric pain syndrome. Although, historically, this has been attributed to greater trochanteric bursitis, the literature has shown that many patients will have a lesion of the gluteus medius and minimus tendons. Endoscopic hip abductor tendon repair has been shown to provide good outcomes with decreasing overall morbidity and is becoming more popular. However, failure rates have been reported to be as high as 35%, likely due to the poor tissue quality in this older population. Acellular human dermal allograft has been used to augment rotator cuff repairs in an attempt to improve tendon healing. The technique described in this Technical Note shows endoscopic gluteus medius and minimus repair with acellular human dermal allograft augmentation focusing on graft preparation, implantation, and fixation in a safe and reproducible manner.
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Affiliation(s)
- Jovan Laskovski
- Sports Medicine Department, Crystal Clinic Orthopaedic Center, Akron, Ohio, U.S.A.,Address correspondence to Jovan Laskovski, M.D., Crystal Clinic Orthopaedic Center, 3975 Embassy Parkway, Suite 102, Akron, OH 44333, U.S.A.
| | - Ryan Urchek
- Orthopaedic Department, Summa Health System, Akron, Ohio, U.S.A
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Desai VS, Southam BR, Grawe B. Complications Following Arthroscopic Rotator Cuff Repair and Reconstruction. JBJS Rev 2018; 6:e5. [DOI: 10.2106/jbjs.rvw.17.00052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
This present article summarizes established and current developments and aspects of rotator cuff surgery. Achieved milestones as well as current approaches are presented and assessed with respect to their clinical and radiographic impact. Despite biomechanical and technical improvements in modern rotator cuff repair techniques, re-defect and re-tearing rates could not be fully eliminated. Meanwhile, the importance of biological processes around successful tendon-bone reintegration has been increasingly recognized. Hence, this article presents the current scientific standing regarding biological growth factors, platelet-rich plasma and rotator cuff augmentation techniques (with allogenic/autologous grafts). In summary, there are clear biomechanical advantages as well as many promising approaches to biological augmentation; however, the latter have not yet been transferred into regular clinical application.
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Kuo S, Kim HM, Wang Z, Bingham EL, Miyazawa A, Marcelo CL, Feinberg SE. Comparison of two decellularized dermal equivalents. J Tissue Eng Regen Med 2017; 12:983-990. [DOI: 10.1002/term.2530] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 01/27/2023]
Affiliation(s)
- Shiuhyang Kuo
- Department of Oral and Maxillofacial Surgery, School of DentistryUniversity of Michigan Ann Arbor MI USA
| | - Hyungjin Myra Kim
- Consulting for Statistics, Computing & Analytics ResearchUniversity of Michigan Ann Arbor MI USA
| | - Zhifa Wang
- Department of Surgery, Medical SchoolUniversity of Michigan Ann Arbor MI USA
| | - Eve L. Bingham
- Department of Oral and Maxillofacial Surgery, School of DentistryUniversity of Michigan Ann Arbor MI USA
| | - Atsuko Miyazawa
- Department of Oral and Maxillofacial Surgery, School of DentistryUniversity of Michigan Ann Arbor MI USA
| | - Cynthia L. Marcelo
- Department of Surgery, Medical SchoolUniversity of Michigan Ann Arbor MI USA
| | - Stephen E. Feinberg
- Department of Oral and Maxillofacial Surgery, School of DentistryUniversity of Michigan Ann Arbor MI USA
- Department of Surgery, Medical SchoolUniversity of Michigan Ann Arbor MI USA
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Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair. J Shoulder Elbow Surg 2017; 26:2038-2046. [PMID: 28865966 DOI: 10.1016/j.jse.2017.06.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 05/18/2017] [Accepted: 06/19/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retearing after rotator cuff surgery is a major clinical problem. Numerous scaffolds are being used to try to reduce retear rates. However, few have demonstrated clinical efficacy. We hypothesize that this lack of efficacy is due to insufficient mechanical properties. Therefore, we compared the macro and nano/micro mechanical properties of 7 commercially available scaffolds to those of the human supraspinatus tendons, whose function they seek to restore. METHODS The clinically approved scaffolds tested were X-Repair, LARS ligament, Poly-Tape, BioFiber, GraftJacket, Permacol, and Conexa. Fresh frozen cadaveric human supraspinatus tendon samples were used. Macro mechanical properties were determined through tensile testing and rheometry. Scanning probe microscopy and scanning electron microscopy were performed to assess properties of materials at the nano/microscale (morphology, Young modulus, loss tangent). RESULTS None of the scaffolds tested adequately approximated both the macro and micro mechanical properties of human supraspinatus tendon. Macroscale mechanical properties were insufficient to restore load-bearing function. The best-performing scaffolds on the macroscale (X-Repair, LARS ligament) had poor nano/microscale properties. Scaffolds approximating tendon properties on the nano/microscale (BioFiber, biologic scaffolds) had poor macroscale properties. CONCLUSION Existing scaffolds failed to adequately approximate the mechanical properties of human supraspinatus tendons. Combining the macroscopic mechanical properties of a synthetic scaffold with the micro mechanical properties of biologic scaffold could better achieve this goal. Future work should focus on advancing techniques to create new scaffolds with more desirable mechanical properties. This may help improve outcomes for rotator cuff surgery patients.
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Conroy C, Sethi P, Macken C, Wei D, Kowalsky M, Mirzayan R, Pauzenberger L, Dyrna F, Obopilwe E, Mazzocca AD. Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model. Am J Sports Med 2017; 45:2028-2033. [PMID: 28419811 DOI: 10.1177/0363546517701426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. HYPOTHESIS Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. STUDY DESIGN Controlled laboratory study. METHODS Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon's width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. RESULTS The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. CONCLUSION In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon's biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation. CLINICAL RELEVANCE Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.
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Affiliation(s)
- Christine Conroy
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Paul Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Craig Macken
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - David Wei
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Marc Kowalsky
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | | | - Leo Pauzenberger
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Felix Dyrna
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- University of Connecticut Health Center, Farmington, Connecticut, USA
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Suh DS, Lee JK, Yoo JC, Woo SH, Kim GR, Kim JW, Choi NY, Kim Y, Song HS. Atelocollagen Enhances the Healing of Rotator Cuff Tendon in Rabbit Model. Am J Sports Med 2017; 45:2019-2027. [PMID: 28586622 DOI: 10.1177/0363546517703336] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. PURPOSE To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. STUDY DESIGN Controlled laboratory study. METHODS A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits. They were then randomly allocated into 2 groups (23 rabbits per group; 15 for histological and 8 for biomechanical test). In the experimental group, patch-type atelocollagen was implanted between bone and tendon during repair; in the control group, the torn tendon was repaired without atelocollagen. Each opposite shoulder served as a sham (tendon was exposed only). Histological evaluation was performed at 4, 8, and 12 weeks. Biomechanical tensile strength was tested 12 weeks after surgery. RESULTS Histological evaluation scores of the experimental group (4.0 ± 1.0) were significantly superior to those of the control group (7.7 ± 2.7) at 12 weeks ( P = .005). The load to failure was significantly higher in the experimental group (51.4 ± 3.9 N) than in the control group (36.4 ± 5.9 N) ( P = .001). CONCLUSION Histological and biomechanical studies demonstrated better results in the experimental group using atelocollagen in a rabbit model of the supraspinatus tendon tear. CLINICAL RELEVANCE Atelocollagen patch could be used in the cuff repair site to enhance healing.
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Affiliation(s)
- Dong-Sam Suh
- RMS Research Institute, Seoul, Republic of Korea
| | - Jun-Keun Lee
- RMS Research Institute, Seoul, Republic of Korea
| | - Ji-Chul Yoo
- RMS Research Institute, Seoul, Republic of Korea
| | - Sang-Hun Woo
- RMS Research Institute, Seoul, Republic of Korea
| | - Ga-Ram Kim
- RMS Research Institute, Seoul, Republic of Korea
| | - Ju-Won Kim
- RMS Research Institute, Seoul, Republic of Korea
| | - Nam-Yong Choi
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yongdeok Kim
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Seok Song
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Rothrauff BB, Lauro BB, Yang G, Debski RE, Musahl V, Tuan RS. Braided and Stacked Electrospun Nanofibrous Scaffolds for Tendon and Ligament Tissue Engineering. Tissue Eng Part A 2017; 23:378-389. [PMID: 28071988 PMCID: PMC5444507 DOI: 10.1089/ten.tea.2016.0319] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022] Open
Abstract
Tendon and ligament injuries are a persistent orthopedic challenge given their poor innate healing capacity. Nonwoven electrospun nanofibrous scaffolds composed of polyesters have been used to mimic the mechanics and topographical cues of native tendons and ligaments. However, nonwoven nanofibers have several limitations that prevent broader clinical application, including poor cell infiltration, as well as tensile and suture-retention strengths that are inferior to native tissues. In this study, multilayered scaffolds of aligned electrospun nanofibers of two designs-stacked or braided-were fabricated. Mechanical properties, including structural and mechanical properties and suture-retention strength, were determined using acellular scaffolds. Human bone marrow-derived mesenchymal stem cells (MSCs) were seeded on scaffolds for up to 28 days, and assays for tenogenic differentiation, histology, and biochemical composition were performed. Braided scaffolds exhibited improved tensile and suture-retention strengths, but reduced moduli. Both scaffold designs supported expression of tenogenic markers, although the effect was greater on braided scaffolds. Conversely, cell infiltration was superior in stacked constructs, resulting in enhanced cell number, total collagen content, and total sulfated glycosaminoglycan content. However, when normalized against cell number, both designs modulated extracellular matrix protein deposition to a similar degree. Taken together, this study demonstrates that multilayered scaffolds of aligned electrospun nanofibers supported tenogenic differentiation of seeded MSCs, but the macroarchitecture is an important consideration for applications of tendon and ligament tissue engineering.
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Affiliation(s)
- Benjamin B. Rothrauff
- Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Brian B. Lauro
- Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania
| | - Guang Yang
- Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania
| | - Richard E. Debski
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Pittsburgh, Pennsylvania
| | - Volker Musahl
- Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Pittsburgh, Pennsylvania
| | - Rocky S. Tuan
- Department of Orthopaedic Surgery, Center for Cellular and Molecular Engineering, Pittsburgh, Pennsylvania
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Bioengineering, Swanson School of Engineering, Pittsburgh, Pennsylvania
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Rashtbar M, Hadjati J, Ai J, Jahanzad I, Azami M, Shirian S, Ebrahimi‐Barough S, Sadroddiny E. Characterization of decellularized ovine small intestine submucosal layer as extracellular matrix‐based scaffold for tissue engineering. J Biomed Mater Res B Appl Biomater 2017; 106:933-944. [DOI: 10.1002/jbm.b.33899] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Morteza Rashtbar
- Department of Tissue Engineering and Applied Cell SciencesSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
| | - Jamshid Hadjati
- Department of Tissue Engineering and Applied Cell SciencesSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
- Department of Immunology, School of MedicineTehran University of Medical SciencesTehran Iran
| | - Jafar Ai
- Department of Tissue Engineering and Applied Cell SciencesSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
| | - Issa Jahanzad
- Department of Pathology, Immunohistochemistry LaboratoryCancer Institute of Iran, Tehran University of Medical SciencesTehran Iran
| | - Mahmoud Azami
- Department of Tissue Engineering and Applied Cell SciencesSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
| | - Sadegh Shirian
- Department of Pathology, School of Veterinary MedicineShahrekord University, Shahrekord Iran
- Shiraz Molecular Pathology Research Center, Dr Daneshbod Lab PathologyShiraz Iran
| | - Somayeh Ebrahimi‐Barough
- Department of Tissue Engineering and Applied Cell SciencesSchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
| | - Esmaeil Sadroddiny
- Department of Medical BiotechnologySchool of Advanced Technologies in Medicine, Tehran University of Medical SciencesTehran Iran
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Jung C, Spreiter G, Audigé L, Ferguson SJ, Flury M. Patch-augmented rotator cuff repair: influence of the patch fixation technique on primary biomechanical stability. Arch Orthop Trauma Surg 2016; 136:609-16. [PMID: 26983721 DOI: 10.1007/s00402-016-2436-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is an ongoing debate about the potential of patch augmentation to improve biomechanical stability and healing associated with rotator cuff repair. The biomechanical properties of three different patch-augmented rotator cuff repair techniques were assessed in vitro and compared with a standard repair. Dermal collagen patch augmentation may increase the primary stability and strength of the repaired tendon in vitro, depending on the technique used for patch application. METHODS AND MATERIALS Forty cadaveric sheep shoulders with dissected infraspinatus tendons were randomized into four groups (n = 10/group) for tendon repair using a knotless double-row suture anchor technique. A xenologous dermal extracellular matrix patch was used for augmentation in the three test groups using an "integrated", "cover", or "hybrid" technique. Tendons were preconditioned, cyclically loaded from 10 to 30 N at 1 Hz, and then loaded monotonically to failure. Biomechanical properties and the mode of failure were evaluated. RESULTS Patch augmentation significantly increased the maximum load at failure by 61 % in the "cover" technique test group (225.8 N) and 51 % in the "hybrid" technique test group (211.4 N) compared with the non-augmented control group (140.2 N) (P ≤ 0.015). For the test group with "integrated" patch augmentation, the load at failure was 28 % lower (101.6 N) compared with the control group (P = 0.043). There was no significant difference in initial and linear stiffness among the four experimental groups. The most common mode of failure was tendon pullout. No anchor dislocation, patch disruption or knot breakage was observed. CONCLUSION Additional patch augmentation with a collagen patch influences the biomechanical properties of a rotator cuff repair in a cadaveric sheep model. Primary repair stability can be significantly improved depending on the augmentation technique.
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Affiliation(s)
- Christian Jung
- Department of Orthopaedics-Upper Extremities, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Gregor Spreiter
- Institute for Biomechanics, ETH Zurich, 8093, Zurich, Switzerland
| | - Laurent Audigé
- Department of Orthopaedics-Upper Extremities, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | | | - Matthias Flury
- Department of Orthopaedics-Upper Extremities, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
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Acellularization-Induced Changes in Tensile Properties Are Organ Specific - An In-Vitro Mechanical and Structural Analysis of Porcine Soft Tissues. PLoS One 2016; 11:e0151223. [PMID: 26960134 PMCID: PMC4784745 DOI: 10.1371/journal.pone.0151223] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/23/2016] [Indexed: 12/18/2022] Open
Abstract
Introduction Though xenogeneic acellular scaffolds are frequently used for surgical reconstruction, knowledge of their mechanical properties is lacking. This study compared the mechanical, histological and ultrastructural properties of various native and acellular specimens. Materials and Methods Porcine esophagi, ureters and skin were tested mechanically in a native or acellular condition, focusing on the elastic modulus, ultimate tensile stress and maximum strain. The testing protocol for soft tissues was standardized, including the adaption of the tissue’s water content and partial plastination to minimize material slippage as well as templates for normed sample dimensions and precise cross-section measurements. The native and acellular tissues were compared at the microscopic and ultrastructural level with a focus on type I collagens. Results Increased elastic modulus and ultimate tensile stress values were quantified in acellular esophagi and ureters compared to the native condition. In contrast, these values were strongly decreased in the skin after acellularization. Acellularization-related decreases in maximum strain were found in all tissues. Type I collagens were well-preserved in these samples; however, clotting and a loss of cross-linking type I collagens was observed ultrastructurally. Elastins and fibronectins were preserved in the esophagi and ureters. A loss of the epidermal layer and decreased fibronectin content was present in the skin. Discussion Acellularization induces changes in the tensile properties of soft tissues. Some of these changes appear to be organ specific. Loss of cross-linking type I collagen may indicate increased mechanical strength due to decreasing transverse forces acting upon the scaffolds, whereas fibronectin loss may be related to decreased load-bearing capacity. Potentially, the alterations in tissue mechanics are linked to organ function and to the interplay of cells and the extracellular matrix, which is different in hollow organs when compared to skin.
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Hammer N, Huster D, Boldt A, Hädrich C, Koch H, Möbius R, Schulze-Tanzil G, Scheidt HA. A preliminary technical study on sodium dodecyl sulfate-induced changes of the nano-structural and macro-mechanical properties in human iliotibial tract specimens. J Mech Behav Biomed Mater 2016; 61:164-173. [PMID: 26866452 DOI: 10.1016/j.jmbbm.2016.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/12/2016] [Accepted: 01/20/2016] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Acellular scaffolds are frequently used for the surgical repair of ligaments and tendons. Even though data on the macro-mechanical properties related to the acellularization process exist, corresponding data on the nano-structural properties are still lacking. Such data would help identify target proteins of the formed extracellular matrix that are chemically altered by the acellularization. In this study we examined the altered structure by comparing molecular properties of collagens from native and acellular iliotibial tract samples to the macroscopic stress-strain behavior of tract samples. MATERIAL AND METHODS Matched pairs of five human iliotibial tract samples were obtained from five donors (mean age 28.2±4.7 years). One of each pair was acellularized using 1vol% sodium dodecyl sulfate (SDS) for 7 days. (13)C magic angle spinning nuclear magnetic resonance spectroscopy ((13)C CP MAS NMR) was utilized to compare the collagen overall secondary structure and internal dynamics of collagen-typical amino acid proteins. The resulting data was compared to age-matched stress-strain data of tract samples obtained in an uniaxial tensile setup and histologically. RESULTS Typical and nearly identical collagen (13)C CP MAS NMR spectra were found in the tract samples before and after acellularization with SDS. The characteristic collagen backbone remained intact in the native and acellular samples. Collagen molecular composition was largely unaltered in both conditions. Furthermore, a similar dynamic behavior was found for the amino acids Hyp γ, Pro α/Hyp α, Ala α, Gly α and Ala β. These minute alterations in the collagens' molecular properties related to acellularization with SDS were in line with the similarly minute changes in the macro-mechanical tensile behavior, such as the elastic modulus and ultimate stress. Histology showed intact type I collagens, minute amounts of elastins before and after acellularization and evidence for acellularization-induced reductions of proteoglycans. DISCUSSION Nano-structural properties of collagens are minutely affected by SDS treatment for acellularization, indicated by the molecular composition and dynamics. The lacking acellularization-related changes in the molecular structure properties of collagens in iliotibial tract samples are in line with the small alterations in their macro-mechanical tensile behavior. Though the given setup approaches soft tissue mechanics from both scaling extremes of mechanical testing, further structural analyzes are needed in a larger sample size to substantiate these findings.
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Affiliation(s)
- Niels Hammer
- Department of Anatomy, University of Otago, 270 Great King Street, Dunedin 9054, New Zealand.
| | - Daniel Huster
- Institute of Medical Physics and Biophysics, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Andreas Boldt
- Institute of Clinical Immunology, University of Leipzig, Faculty of Medicine, Leipzig, Germany; Translational Centre for Regenerative Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Carsten Hädrich
- Institute of Forensic Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Holger Koch
- Translational Centre for Regenerative Medicine, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Robert Möbius
- Institute of Anatomy, University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Gundula Schulze-Tanzil
- Department of Anatomy, Nuremberg Hospital Medical School, Paracelsus Medical University, Nuremburg, Germany and Salzburg, Austria
| | - Holger A Scheidt
- Institute of Medical Physics and Biophysics, University of Leipzig, Faculty of Medicine, Leipzig, Germany
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Engineering Tendon: Scaffolds, Bioreactors, and Models of Regeneration. Stem Cells Int 2015; 2016:3919030. [PMID: 26839559 PMCID: PMC4709784 DOI: 10.1155/2016/3919030] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/20/2015] [Indexed: 12/23/2022] Open
Abstract
Tendons bridge muscle and bone, translating forces to the skeleton and increasing the safety and efficiency of locomotion. When tendons fail or degenerate, there are no effective pharmacological interventions. The lack of available options to treat damaged tendons has created a need to better understand and improve the repair process, particularly when suitable autologous donor tissue is unavailable for transplantation. Cells within tendon dynamically react to loading conditions and undergo phenotypic changes in response to mechanobiological stimuli. Tenocytes respond to ultrastructural topography and mechanical deformation via a complex set of behaviors involving force-sensitive membrane receptor activity, changes in cytoskeletal contractility, and transcriptional regulation. Effective ex vivo model systems are needed to emulate the native environment of a tissue and to translate cell-matrix forces with high fidelity. While early bioreactor designs have greatly expanded our knowledge of mechanotransduction, traditional scaffolds do not fully model the topography, composition, and mechanical properties of native tendon. Decellularized tendon is an ideal scaffold for cultivating replacement tissue and modeling tendon regeneration. Decellularized tendon scaffolds (DTS) possess high clinical relevance, faithfully translate forces to the cellular scale, and have bulk material properties that match natural tissue. This review summarizes progress in tendon tissue engineering, with a focus on DTS and bioreactor systems.
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Shelke NB, Lee P, Anderson M, Mistry N, Nagarale RK, Ma XM, Yu X, Kumbar SG. Neural tissue engineering: nanofiber-hydrogel based composite scaffolds. POLYM ADVAN TECHNOL 2015. [DOI: 10.1002/pat.3594] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Namdev B. Shelke
- Department of Orthopaedic Surgery, UConn Health, Farmington; CT 06030 USA
- Institute for Regenerative Engineering, UConn Health, Farmington; CT 06030 USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington; CT 06030 USA
| | - Paul Lee
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology; Hoboken NJ 07030 USA
| | - Matthew Anderson
- Department of Orthopaedic Surgery, UConn Health, Farmington; CT 06030 USA
- Institute for Regenerative Engineering, UConn Health, Farmington; CT 06030 USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington; CT 06030 USA
| | - Nikhil Mistry
- Department of Orthopaedic Surgery, UConn Health, Farmington; CT 06030 USA
| | - Rajaram K. Nagarale
- Reverse Osmosis Division; Central Salt and Marine Chemicals Research Institute; Bhavnagar Gujarat 364002 India
| | - Xin-Ming Ma
- Department of Neuroscience; University of Connecticut Health Center; Farmington CT 06030 USA
| | - Xiaojun Yu
- Department of Chemistry, Chemical Biology and Biomedical Engineering; Stevens Institute of Technology; Hoboken NJ 07030 USA
| | - Sangamesh G. Kumbar
- Department of Orthopaedic Surgery, UConn Health, Farmington; CT 06030 USA
- Institute for Regenerative Engineering, UConn Health, Farmington; CT 06030 USA
- Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, UConn Health, Farmington; CT 06030 USA
- Department of Biomedical Engineering; University of Connecticut; Storrs CT 06269 USA
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Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. INTERNATIONAL ORTHOPAEDICS 2015; 39:2403-14. [PMID: 25931202 DOI: 10.1007/s00264-015-2796-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT. METHOD Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT. RESULTS Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis. CONCLUSION There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Rue J.-D. Maillard 3, 1217, Meyrin, Switzerland. .,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211, Geneva 4, Switzerland. .,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.
| | - Patrick J Denard
- Southern Oregon Orthopedics, Medford, OR, USA.,Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Philippe Collin
- Saint-Grégoire Private Hospital Center, Boulevard Boutière 6, 35768, Saint-Grégoire Cedex, France
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Proctor CS. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 2014; 23:1508-13. [PMID: 24725892 DOI: 10.1016/j.jse.2014.01.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff repair is a procedure with varying outcomes, and there has been subsequent interest in devices that reinforce the repair and enhance structural and functional outcomes. The objective of this study was to determine these outcomes for arthroscopic repair of large and massive rotator cuff tears augmented with a synthetic absorbable mesh designed specifically for reinforcement of tendon repair by imaging and clinical assessments. MATERIALS AND METHODS Consecutive arthroscopic repairs were performed on 18 patients with large to massive rotator cuff tears by use of a poly-l-lactic acid synthetic patch as a reinforcement device and fixation with 4 sutures. Patients were assessed preoperatively and at 6 months, 12 months, and a mean of 42 months after surgery by the American Shoulder and Elbow Surgeons (ASES) shoulder score to evaluate clinical performance and at 12 months by ultrasound to assess structural repair. RESULTS Ultrasound showed that 15 of 18 patients had intact rotator cuff repair at 12 months; at 42 months, an additional patient had a failed repair. Patients showed improvement in the ASES shoulder score from 25 preoperatively to 71 at 12 months and 70 at 42 months after surgery. Patients with intact rotator cuff (n = 14) at 42 months had an ASES shoulder score of 82. DISCUSSION The poly-l-lactic acid bioabsorbable patch designed specifically to reinforce the surgical repair of tendons supported successful repair of large to massive rotator cuff tears in 83% of patients at 12 months after surgery and 78% of patients at 42 months after surgery, with substantial functional improvement.
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