Department of Orthopedics, University of Zurich, Zürich, Switzerland.
J Shoulder Elbow Surg. 2012 Feb;21(2):209-17. doi: 10.1016/j.jse.2011.10.002.
Collagen cross-links are fundamental to the mechanical integrity of tendon, with orderly and progressive enzymatic cross-linking being central to healthy development and injury repair. However, the nonenzymatic cross-links that form as we age are associated with increased tendon brittleness, diminished mechanical resistance to injury, and impaired matrix remodeling. Collagen cross-linking thus sits at the center of tendon structure and function, with important implications to age, disease, injury, and therapy. The current review touches on these aspects from the perspective of their potential relevance to the shoulder surgeon. We first introduce the most well-characterized endogenous collagen cross-linkers that enable fibrillogenesis in development and healing. We also discuss the glycation-mediated cross-links that are implicated in age- and diabetes-related tendon frailty and summarize work toward therapies against these disadvantageous cross-links. Conversely, we discuss the introduction of exogenous collagen cross-links to augment the mechanical properties of collagen-based implants or native tendon tissue. We conclude with a summary of our early results using exogenous collagen cross-linkers to prevent tendon tear enlargement and eventual failure in an in vitro model of partial tendon tear.
胶原交联是肌腱机械完整性的基础，有序且渐进的酶促交联是健康发育和损伤修复的核心。然而，随着年龄的增长而形成的非酶促交联与肌腱脆性增加、机械损伤抵抗力降低以及基质重塑受损有关。因此，胶原交联位于肌腱结构和功能的中心，对年龄、疾病、损伤和治疗都有重要影响。本综述从对肩部外科医生的潜在相关性的角度探讨了这些方面。我们首先介绍了最具特征性的内源性胶原交联剂，这些交联剂在发育和愈合过程中促进原纤维形成。我们还讨论了糖基化介导的交联，这些交联与年龄和糖尿病相关的肌腱脆弱有关，并总结了针对这些不利交联的治疗方法。相反，我们讨论了引入外源性胶原交联剂来增强基于胶原的植入物或天然肌腱组织的机械性能。我们以使用外源性胶原交联剂预防部分肌腱撕裂的体外模型中肌腱撕裂扩大和最终失效的早期结果总结结束。
