Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA.
J Shoulder Elbow Surg. 2018 Jun;27(6):1105-1111. doi: 10.1016/j.jse.2017.12.016. Epub 2018 Feb 3.
A reinforced biologic strip graft was designed to mechanically augment the repair of rotator cuff tears that are fully reparable by arthroscopic techniques yet have a likelihood of failure. This study assessed the extent to which augmentation of human supraspinatus repairs with a reinforced fascia strip can reduce gap formation during in vitro cyclic loading.
The supraspinatus tendon was sharply released from the proximal humerus and repaired back to its insertion with anchors in 9 matched pairs of human cadaveric shoulders. One repair from each pair was also augmented with a reinforced fascia strip. All repairs were subjected to cyclic mechanical loading of 5 to 180 N for 1000 cycles.
All augmented and nonaugmented repair constructs completed 1000 cycles of loading. Augmentation with a reinforced fascia strip graft significantly decreased the amount of gap formation compared with nonaugmented repairs. The average gap formation of augmented repairs was 1.5 ± 0.7 mm after the first cycle vs. 3.0 ± 1.2 mm for nonaugmented repairs (P = .003) and 5.0 ± 1.5 mm after 1000 cycles of loading, which averaged 24% ± 21% less than the gap formation of nonaugmented repairs (7.0 ± 2.8 mm, P = .014).
Cadaveric human supraspinatus repairs augmented with a reinforced fascia strip have significantly less initial stroke elongation and gap formation than repairs without augmentation. Augmentation limited gap formation to the greatest extent early in the testing protocol. Human studies are necessary to confirm the appropriate indications and effectiveness of augmentation scaffolds for rotator cuff repair healing in the clinical setting.
设计了一种增强型生物带移植物，用于机械增强通过关节镜技术完全可修复但有失败可能的肩袖撕裂的修复。本研究评估了在体外循环加载过程中，用增强筋膜带增强人冈上肌腱修复物可以减少间隙形成的程度。
将冈上肌腱从肱骨头近端锐性切断，并通过锚钉将其重新修复到其插入处，共 9 对匹配的人尸体肩关节。每对中的一个修复物还用增强型筋膜带进行了增强。所有修复物均接受 5 至 180 N 的循环机械加载 1000 个周期。
所有增强和非增强修复物均完成了 1000 个周期的加载。与非增强修复物相比，增强型筋膜带移植物的增强显著减少了间隙形成量。增强修复物的平均间隙形成量在第 1 个周期后为 1.5±0.7mm，而非增强修复物为 3.0±1.2mm（P=0.003），在 1000 个周期的加载后为 5.0±1.5mm，比非增强修复物的间隙形成量少 24%±21%（7.0±2.8mm，P=0.014）。
与未增强修复物相比，用增强型筋膜带增强的尸体人冈上肌腱修复物初始冲程伸长和间隙形成明显减少。增强在测试方案早期最大限度地限制了间隙形成。需要进行人体研究以确认增强支架在临床环境中修复肩袖愈合的适当适应证和有效性。
