Hexter Adam T, Pendegrass Catherine, Haddad Fares, Blunn Gordon
Institute of Orthopaedic and Musculoskeletal Sciences, University College London, Royal National Orthopaedic Hospital, Middlesex, UK.
University College Hospital, London, UK.
Orthop J Sports Med. 2017 Oct 25;5(10):2325967117734517. doi: 10.1177/2325967117734517. eCollection 2017 Oct.
Following injury to the rotator cuff and anterior cruciate ligament, a direct enthesis is not regenerated, and healing occurs with biomechanically inferior fibrous tissue. Demineralized bone matrix (DBM) is a collagen scaffold that contains growth factors and is a promising biological material for tendon and ligament repair because it can regenerate a direct fibrocartilaginous insertion via endochondral ossification.
To provide a comprehensive review of the literature investigating the use of DBM to augment tendon-bone healing in tendon repair and anterior cruciate ligament reconstruction (ACLR).
Systematic review.
Electronic databases (MEDLINE and EMBASE) were searched for preclinical and clinical studies that evaluated the use of DBM in tendon repair and ACLR. Search terms included the following: ("demineralized bone matrix" OR "demineralized cortical bone") AND ("tissue scaffold" OR "tissue engineering" OR "ligament" OR "tendon" OR "anterior cruciate ligament" OR "rotator cuff"). Peer-reviewed articles written in English were included, and no date restriction was applied (searches performed February 10, 2017). Methodological quality was assessed with peer-reviewed scoring criteria.
The search strategy identified 339 articles. After removal of duplicates and screening according to inclusion criteria, 8 studies were included for full review (tendon repair, n = 4; ACLR, n = 4). No human clinical studies were identified. All 8 studies were preclinical animal studies with good methodological quality. Five studies compared DBM augmentation with non-DBM controls, of which 4 (80%) reported positive findings in terms of histological and biomechanical outcomes.
Preclinical evidence indicates that DBM can improve tendon-bone healing, although clinical studies are lacking. A range of animal models of tendon repair and ACLR showed that DBM can re-create a direct fibrocartilaginous enthesis, although the animal models are not without limitations. Before clinical trials are justified, research is required that determines the best source of DBM (allogenic vs xenogenic) and the best form of DBM (demineralized cortical bone vs DBM paste) to be used in them.
肩袖和前交叉韧带损伤后，直接的附着点无法再生，而是通过生物力学性能较差的纤维组织愈合。脱矿骨基质（DBM）是一种含有生长因子的胶原支架，是用于肌腱和韧带修复的一种有前景的生物材料，因为它可以通过软骨内成骨再生直接的纤维软骨附着。
对研究使用DBM增强肌腱修复和前交叉韧带重建（ACLR）中肌腱-骨愈合的文献进行全面综述。
系统评价。
检索电子数据库（MEDLINE和EMBASE），查找评估DBM在肌腱修复和ACLR中应用的临床前和临床研究。检索词包括：（“脱矿骨基质”或“脱矿皮质骨”）以及（“组织支架”或“组织工程”或“韧带”或“肌腱”或“前交叉韧带”或“肩袖”）。纳入用英文撰写的经同行评审的文章，且不设日期限制（检索于2017年2月10日进行）。采用经同行评审的评分标准评估方法学质量。
检索策略共识别出339篇文章。在去除重复项并根据纳入标准进行筛选后，纳入8项研究进行全面综述（肌腱修复，n = 4；ACLR，n = 4）。未识别出人体临床研究。所有8项研究均为临床前动物研究，方法学质量良好。5项研究将DBM增强与非DBM对照进行比较，其中4项（80%）在组织学和生物力学结果方面报告了阳性结果。
临床前证据表明DBM可改善肌腱-骨愈合，尽管缺乏临床研究。一系列肌腱修复和ACLR的动物模型表明DBM可重新形成直接的纤维软骨附着点，尽管动物模型并非没有局限性。在进行临床试验之前，需要开展研究以确定用于临床试验的DBM的最佳来源（同种异体与异种）和最佳形式（脱矿皮质骨与DBM糊剂）。
