Novakova Stoyna S, Mahalingam Vasudevan D, Florida Shelby E, Mendias Christopher L, Allen Answorth, Arruda Ellen M, Bedi Asheesh, Larkin Lisa M
Departments of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan 48109-2200Michigan 48109-2200.
Departments of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan 48109-2200.
J Orthop Res. 2018 Jan;36(1):289-299. doi: 10.1002/jor.23642. Epub 2017 Jul 31.
Current rotator cuff repair commonly involves the use of single or double row suture techniques, and despite successful outcomes, failure rates continue to range from 20 to 95%. Failure to regenerate native biomechanical properties at the enthesis is thought to contribute to failure rates. Thus, the need for technologies that improve structural healing of the enthesis after rotator cuff repair is imperative. To address this issue, our lab has previously demonstrated enthesis regeneration using a tissue-engineered graft approach in a sheep anterior cruciate ligament (ACL) repair model. We hypothesized that our tissue-engineered graft designed for ACL repair also will be effective in rotator cuff repair. The goal of this study was to test the efficacy of our Engineered Tissue Graft for Rotator Cuff (ETG-RC) in a rotator cuff tear model in sheep and compare this novel graft technology to the commonly used double row suture repair technique. Following a 6-month recovery, the grafted and contralateral shoulders were removed, imaged using X-ray, and tested biomechanically. Additionally, the infraspinatus muscle, myotendinous junction, enthesis, and humeral head were preserved for histological analysis of muscle, tendon, and enthesis structure. Our results showed that our ETC-RCs reached 31% of the native tendon tangent modulus, which was a modest, non-significant, 11% increase over that of the suture-only repairs. However, the histological analysis showed the regeneration of a native-like enthesis in the ETG-RC-repaired animals. This advanced structural healing may improve over longer times and may diminish recurrence rates of rotator cuff tears and lead to better clinical outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:289-299, 2018.
目前的肩袖修复通常采用单排或双排缝合技术，尽管手术结果成功，但失败率仍在20%至95%之间。人们认为，在肌腱附着点未能恢复天然生物力学特性是导致失败率的原因之一。因此，迫切需要能够改善肩袖修复后肌腱附着点结构愈合的技术。为了解决这个问题，我们实验室之前在绵羊前交叉韧带（ACL）修复模型中，利用组织工程移植物方法证明了肌腱附着点的再生。我们假设，我们设计用于ACL修复的组织工程移植物在肩袖修复中也将有效。本研究的目的是在绵羊肩袖撕裂模型中测试我们的肩袖工程组织移植物（ETG-RC）的疗效，并将这种新型移植物技术与常用的双排缝合修复技术进行比较。经过6个月的恢复后，将移植侧和对侧肩部切除，进行X射线成像，并进行生物力学测试。此外，保留冈下肌、肌腱-肌肉连接处、肌腱附着点和肱骨头，用于肌肉、肌腱和肌腱附着点结构的组织学分析。我们的结果表明，我们的ETC-RC达到了天然肌腱切线模量的31%，与单纯缝合修复相比，有适度的、不显著的11%的增加。然而，组织学分析显示，在接受ETG-RC修复的动物中，出现了类似天然的肌腱附着点再生。这种先进的结构愈合可能会随着时间的推移而改善，可能会降低肩袖撕裂的复发率，并带来更好的临床结果。©2017骨科学研究协会。由威利期刊公司出版。《矫形外科学研究》36:289 - 299，2018年。
