Smith Matthew J, Pfeiffer Ferris M, Cook Cristi R, Kuroki Keiichi, Cook James L
Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Ave, Columbia, 65212, Missouri.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
J Orthop Res. 2018 Mar;36(3):906-912. doi: 10.1002/jor.23680. Epub 2017 Aug 29.
This Level II study assessed clinically relevant outcomes for repair of large, retracted infraspinatus tendons (ISTs) using a demineralized bone matrix (DBM) sponge (FlexiGraft) hydrated in platelet-rich plasma (PRP) versus direct repair in a validated canine model. Adult research dogs (n = 10) were used. The IST was transected in each shoulder (n = 20) and randomized to direct repair or repair with DBM-PRP interposition at 4 weeks posttransection. At 12 weeks postrepair, dogs were sacrificed, and the repair evaluated by magnetic resonance imaging (MRI), histology, and biomechanical testing. MRI and histology scores were significantly (p < 0.05) better in the DBM-PRP shoulders. Biomechanical testing revealed significantly improved strength of the DBM-PRP repairs at 5 and 10 mm of displacement, as well as for ultimate failure load. In this canine model of retracted IST repair, DBM-PRP sponge hydrated in PRP was considered safe and effective. In addition, use of DBM-PRP was associated with improved MRI and histologic appearance, and improved strength compared to direct repair.
Based on reported failure rates for repair of large, retracted rotator cuff tears, improving tendon-to-bone healing is critical. Use of DBM combined with PRP shows potential for addressing this critical clinical need. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:906-912, 2018.
这项二级研究在一个经过验证的犬类模型中，评估了使用富含血小板血浆（PRP）水合脱矿骨基质（DBM）海绵（FlexiGraft）修复大型回缩冈下肌腱（IST）与直接修复相比的临床相关结果。使用成年实验犬（n = 10）。在每只犬的双侧肩部（n = 20）横断IST，并在横断后4周随机分为直接修复组或DBM-PRP植入修复组。修复后12周，处死实验犬，并通过磁共振成像（MRI）、组织学和生物力学测试对修复情况进行评估。DBM-PRP修复的肩部MRI和组织学评分显著更好（p < 0.05）。生物力学测试显示，在位移5毫米和10毫米时以及极限破坏载荷方面，DBM-PRP修复的强度显著提高。在这个回缩IST修复的犬类模型中，PRP水合的DBM-PRP海绵被认为是安全有效的。此外，与直接修复相比，使用DBM-PRP可改善MRI和组织学表现，并提高强度。
基于报道的大型回缩性肩袖撕裂修复的失败率，改善肌腱与骨的愈合至关重要。DBM与PRP联合使用显示出满足这一关键临床需求的潜力。© 2017骨科学研究协会。由威利期刊公司出版。《矫形外科学研究》36:906 - 912, 2018。
