Sun Yucheng, Jung Hui-Won, Kwak Jae-Man, Tan Jun, Wang Zhe, Jeon In-Ho
Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China.
Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
J Orthop Translat. 2020 Jan 30;24:175-182. doi: 10.1016/j.jot.2020.01.001. eCollection 2020 Sep.
We designed a paired controlled study to investigate the advantages of using bone-tendon composite autograft to reconstruct chronic rotator cuff tear compared with primary repair and provide some evidence to use the bone-tendon composite autograft.
Thirty-eight Sprague-Dawley rats were used. The native bone-tendon junctions of supraspinatus and Achilles tendon insertion from two rats were harvested for gross and histological observation. Another thirty-six rats had bilateral supraspinatus tenotomy from the great tuberosity. Three weeks later, primary repair (simple tendon pullout direct repair to bone) was performed on one side and the other side was reconstructed using an Achilles-calcaneus composite autograft from the ipsilateral leg. Nine rats were sacrificed for biomechanical testing and another three were sacrificed for histological evaluation at 3, 6, and 9 weeks after surgery, respectively.
The Achilles-calcaneus composite autograft group showed significantly better biomechanical characteristics at 3 and 6 weeks in terms of maximum load and stiffness. Tissue histology demonstrated an organised extracellular matrix, a clear tidemark, and distinct fibrocartilage layers in the composite graft group, similar to those of the native bone-tendon interface. Additionally, clear bone-to-bone healing and tendon-to-tendon healing were observed. By contrast, the conventional primary repair could not regenerate the structure of the native bone-tendon interface.
Bone-tendon autograft for chronic rotator cuff reconstruction is superior to the primary repair regarding biomechanical property and histological structure. Our study may provide some evidence in support of the reconstruction of a chronic rotator cuff tear using bone-tendon composite autografts in clinical practice.
The current study finds the bone-tendon autograft can restore the normal bone-tendon interface, which can not regenerate after repair and is the key factor affecting re-tear. The bone-tendon autografts from our body can be the candidates for rotator cuff tear reconstruction especially the large to massive rotator cuff tear in the future to reduce the re-tear after rotator cuff tear.
我们设计了一项配对对照研究，以探讨与一期修复相比，使用骨-肌腱复合自体移植物重建慢性肩袖撕裂的优势，并为使用骨-肌腱复合自体移植物提供一些依据。
使用38只Sprague-Dawley大鼠。从两只大鼠身上获取冈上肌和跟腱止点的天然骨-肌腱结合部进行大体和组织学观察。另外36只大鼠进行双侧冈上肌从大结节处切断。三周后，一侧进行一期修复（简单的肌腱拔出直接修复至骨），另一侧使用同侧腿部的跟腱-跟骨复合自体移植物进行重建。分别在术后3、6和9周处死9只大鼠进行生物力学测试，另外3只大鼠处死进行组织学评估。
跟腱-跟骨复合自体移植物组在术后3周和6周时，在最大负荷和刚度方面显示出明显更好的生物力学特性。组织学显示复合移植物组有有序的细胞外基质、清晰的潮线和明显的纤维软骨层，类似于天然骨-肌腱界面。此外，观察到清晰的骨-骨愈合和腱-腱愈合。相比之下，传统的一期修复无法再生天然骨-肌腱界面的结构。
用于慢性肩袖重建的骨-肌腱自体移植在生物力学性能和组织结构方面优于一期修复。我们的研究可能为临床实践中使用骨-肌腱复合自体移植物重建慢性肩袖撕裂提供一些依据。
当前研究发现骨-肌腱自体移植可恢复正常的骨-肌腱界面，该界面在修复后无法再生，是影响再撕裂的关键因素。我们身体的骨-肌腱自体移植可成为未来肩袖撕裂重建的候选方法，尤其是对于大至巨大的肩袖撕裂，以减少肩袖撕裂后的再撕裂。
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