Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Am J Sports Med. 2012 May;40(5):1148-54. doi: 10.1177/0363546512437835. Epub 2012 Feb 28.
Rotator cuff reconstructions may be improved by adding growth factors, cells, or other biologic factors into the repair zone. This usually requires a biological carrier (scaffold) to be integrated into the construct and placed in the area of tendon-to-bone healing. This needs to be done without affecting the constructs mechanics. Hypothesis/
The hypothesis was that scaffold placement, as an interposition, has no adverse effects on biomechanical properties of double-row rotator cuff repair. The purpose of this study was to examine the effect of scaffold interposition on the initial strength of rotator cuff repairs.
Controlled laboratory study.
Twenty-five fresh-frozen shoulders (mean age: 65.5 ± 8.9 years) were randomly assigned to 5 groups. Groups were chosen to represent a broad spectrum of commonly used scaffold types: (1) double-row repair without augmentation, (2) double-row repair with interposition of a fibrin clot (Viscogel), (3) double-row repair with interposition of a collagen scaffold (Mucograft) between tendon and bone, (4) double-row repair with interposition of human dermis patch (ArthroFlex) between tendon and bone, and (5) double-row repair with human dermis patch (ArthroFlex) placed on top of the repair. Cyclic loading to measure displacement was performed to 3000 cycles at 1 Hz with an applied 10- to 100-N load. The ultimate load to failure was determined at a rate of 31 mm/min.
There were no significant differences in mean displacement under cyclic loading, slope, or energy absorbed to failure between all groups (P = .128, P = .981, P = .105). Ultimate load to failure of repairs that used the collagen patch as an interposition (573.3 ± 75.6 N) and a dermis patch on top of the reconstruction (575.8 ± 22.6 N) was higher compared with the repair without a scaffold (348.9 ± 98.8 N; P = .018 and P = .025). No significant differences were found for repairs with the fibrin clot as an interposition (426.9 ± 103.6 N) and the decellularized dermis patch as an interposition (469.9 ± 148.6 N; P = .73 and P = .35).
Scaffold augmentation did not adversely affect the zero time strength of the tested standard double-row rotator cuff repairs. An increased ultimate load to failure was observed for 2 of the augmentation methods (collagen patch as an interposition and decellularized dermis patch on top of the reconstruction) compared with the nonaugmented repairs.
Scaffolds intended for application of growth factors or cellular components in a repair situation did not adversely jeopardize the stability of the operative construct.
在修复区域添加生长因子、细胞或其他生物因子可改善肩袖重建。这通常需要将生物载体（支架）整合到构建物中，并放置在肌腱-骨愈合区域。这需要在不影响构建物力学的情况下完成。假设/目的：假设支架的放置作为一种介入，不会对双排肩袖修复的生物力学特性产生不良影响。本研究的目的是检查支架介入对肩袖修复初始强度的影响。
对照实验室研究。
25 个新鲜冷冻的肩膀（平均年龄：65.5±8.9 岁）被随机分配到 5 组。选择组来代表广泛使用的支架类型：（1）无增强的双排修复，（2）在纤维蛋白凝块（Viscogel）之间插入双排修复，（3）在肌腱和骨之间插入胶原支架（Mucograft）的双排修复，（4）在肌腱和骨之间插入人真皮补丁（ArthroFlex）的双排修复，以及（5）在修复物顶部放置人真皮补丁（ArthroFlex）的双排修复。以 1Hz 的频率施加 10-100N 的负载，进行循环加载以测量 3000 个循环的位移。以 31mm/min 的速度确定失效时的极限载荷。
在循环加载、斜率或失效时吸收的能量下，所有组之间的平均位移没有显著差异（P=0.128，P=0.981，P=0.105）。使用胶原贴片作为介入（573.3±75.6N）和在重建顶部使用真皮补丁（575.8±22.6N）的修复的极限失效载荷高于无支架修复（348.9±98.8N；P=0.018 和 P=0.025）。使用纤维蛋白凝块作为介入（426.9±103.6N）和脱细胞真皮补丁作为介入（469.9±148.6N）的修复之间没有发现显著差异（P=0.73 和 P=0.35）。
支架增强并没有对测试的标准双排肩袖修复的零时刻强度产生不利影响。与非增强修复相比，观察到 2 种增强方法（胶原贴片作为介入和脱细胞真皮补丁在重建顶部）的极限失效载荷增加。
旨在应用生长因子或细胞成分的支架在修复情况下并没有对手术构建物的稳定性产生不利影响。
