Shoulder Tendon Repair Biomechanics Using a Polyurethane Patch in a Chronic Ovine Defect Model

2007 ◽  
Author(s):  
Kirk C. McGilvray ◽  
Amy S. Lyons ◽  
A. Simon Turner ◽  
John D. MacGillivray ◽  
Struan H. Coleman ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Tendon Repair ◽  
Soft Tissue Injuries ◽  
High Rate ◽  
Rotator Cuff Tears ◽  
Defect Model ◽  
Lower Back ◽  
System 1 ◽  
Cuff Repair

Rotator cuff disorders are one of the most common soft tissue injuries of the musculoskeletal system [1], second only to lower back pain presentations in clinical frequency [2]. Surgical repairs of chronic, massive rotator cuff tears are associated with a high rate of complications, typically by full or partial re-rupture of the repair [3,4]. The literature is replete with clinical retrospective studies or evaluation of cadaveric shoulders [5], however these studies do not address the in vivo healing characteristics of a given surgical repair. The purpose of this study was to quantitatively describe the degree of shoulder healing via biomechanical analyses using an ovine chronic infraspinatus model that was repaired with and without a polyurethane scaffold rotator cuff repair (RCR) patch.

The Relationship Between In-Vivo Glenohumeral Joint Motion and Joint Morphology in Rotator Cuff Repair Patients and Healthy Control Subjects

2011 ◽  
Author(s):  
Cathryn D. Peltz ◽  
Kristin Ciarelli ◽  
Jeffrey A. Haladik ◽  
Michael J. McDonald ◽  
Nicole Ramo ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Glenohumeral Joint ◽  
Rotator Cuff Tears ◽  
Joint Motion ◽  
Healthy Control ◽  
The Relationship ◽  
Cuff Repair

Rotator cuff tears are a common condition that adversely affect function and quality of life. Altered glenohumeral joint (GHJ) motion is believed to contribute to the development of rotator cuff tears. Previous research has demonstrated relationships between in-vivo joint motion and bony morphology (particularly in the knee [e.g., 1]), and similar relationships have been reported in cadaveric shoulder studies [2, 3]. However, the extent to which these relationships exist under in-vivo conditions or if these relationships are altered in shoulders with pathologic conditions is not known. Thus, the objective of this study was to assess the relationship between glenoid/humerus morphology and in-vivo GHJ motion in healthy control shoulders and rotator cuff repair patients. We hypothesized that a relationship exists between glenoid/humerus morphology and GHJ motion in healthy control shoulders, but that this relationship is altered in rotator cuff patients.

scholarly journals EGR1 Induces Tenogenic Differentiation of Tendon Stem Cells and Promotes Rabbit Rotator Cuff Repair

2015 ◽  
Vol 35 (2) ◽  
pp. 699-709 ◽  
Author(s):  
Xu Tao ◽  
Junpeng Liu ◽  
Lei Chen ◽  
You Zhou ◽  
Kanglai Tang
Keyword(s):  
Stem Cells ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Tendon ◽  
Tenogenic Differentiation ◽  
Tendon Stem Cells ◽  
Cuff Repair

Background/Aims: The rate of healing failure after surgical repair of chronic rotator cuff tears is considerably high. The aim of this study was to investigate the function of the zinc finger transcription factor early growth response 1 (EGR1) in the differentiation of tendon stem cells (TSCs) and in tendon formation, healing, and tendon tear repair using an animal model of rotator cuff repair. Methods: Tenocyte, adipocyte, osteocyte, and chondrocyte differentiation as well as the expression of related genes were determined in EGR1-overexpressing TSCs (EGR1-TSCs) using tissue-specific staining, immunofluorescence staining, quantitative PCR, and western blotting. A rabbit rotator cuff repair model was established, and TSCs and EGR1-TSCs in a fibrin glue carrier were applied onto repair sites. The rabbits were sacrificed 8 weeks after repair operation, and tissues were histologically evaluated and tenocyte-related gene expression was determined. Results: EGR1 induced tenogenic differentiation of TSCs and inhibited non-tenocyte differentiation of TSCs. Furthermore, EGR1 promoted tendon repair in a rabbit model of rotator cuff injury. The BMP12/Smad1/5/8 signaling pathway was involved in EGR1-induced tenogenic differentiation and rotator cuff tendon repair. Conclusion: EGR1 plays a key role in tendon formation, healing, and repair through BMP12/Smad1/5/8 pathway. EGR1-TSCs is a promising treatment for rotator cuff tendon repair surgeries.

Changes in Glenohumeral Joint Mechanics, Shoulder Strength, and Clinical Outcomes Over Two Years After Rotator Cuff Repair

2009 ◽  
Author(s):  
Michael J. Bey ◽  
Stephanie K. Kline ◽  
Jessica M. Deneweth ◽  
Jeffrey R. Haladik ◽  
Patricia A. Kolowich ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Glenohumeral Joint ◽  
Rotator Cuff Tears ◽  
Joint Mechanics ◽  
Medical Care Costs ◽  
Contact Patterns ◽  
Shoulder Strength ◽  
Cuff Repair

Rotator cuff tears are a common injury that have a major impact on function, comfort, and medical care costs. Treatment procedures rely implicitly on the belief that restoring normal glenohumeral joint (GHJ) mechanics is necessary to obtain a satisfactory clinical result. However, it is unknown if rotator cuff repair restores and maintains normal GHJ mechanics. Thus, the objective of this study was to compare in-vivo GHJ contact patterns between the repaired and contralateral shoulders of patients who underwent rotator cuff repair. We hypothesized that GHJ contact patterns would be significantly different between repaired and contralateral shoulders.

Augmentation Devices for Rotator Cuff Repair

2011 ◽  
Author(s):  
Kathleen A. Derwin ◽  
Joseph P. Iannotti
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Soft Tissues ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
Common Cause ◽  
The Us ◽  
Cuff Repair ◽  
Cause Of Pain ◽  
Intended Use

Rotator cuff tears affect 40% or more of those over age 60 and are a common cause of pain and disability. Surgical repairs have high failure rates that range from 20 to 90%. Currently, scaffolds derived from various natural and synthetic biomaterials are being marketed as augmentation devices for rotator cuff repairs at the time of surgery 1–3. The US Food and Drug Administration (FDA) has cleared these devices “to support soft tissues where weakness exists” but not “to provide the full mechanical strength for the tendon repair”. Based on the mechanical connotation of their intended use, it is commonly believed that when applied appropriately, these devices may provide some degree of load sharing of forces across the tendon repair site and thus decrease the likelihood of tendon re-tear.

scholarly journals Systematic Review of Literature on the Efficiency of Using PRP in Arthroscopic Rotator Cuff Repair

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
T M Samy ◽  
A H Khater ◽  
A K M Ahmed
Keyword(s):  
Systematic Review ◽  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Bone Repair ◽  
Platelet Rich Plasma ◽  
Tendon Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Rotator Cuff Tears ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Rotator cuff tears are one of the most common shoulder problems and the incidence of this condition is increasing along with an aging population. Despite satisfactory results for rotator cuff repair the quality and speed of healing remain problematic. Several studies have demonstrated that native tendon-bone insertions were not restored after tendon to bone repair. Healing of repaired tendons occurred via fibrous scar tissue formation rather than via the regeneration of a histologically normal insertion, and thus repaired tendons have inferior mechanical properties and are more susceptible to retear. Presumably, this is the most significant reason that account for tendon repair failure. Despite recent biomechanical advances in fixation, rates of retear are still high. Tendons consume little energy, and as a consequence healing is slow after injury. Increasing the speed of healing would allow earlier return to work, sport, and activities of daily living, which would be helpful for both the elite athlete and general public. Platelet rich plasma was first popularized in maxillofacial and plastic surgery, but now is thought to enhance and accelerate the repair and regeneration of a variety of tissues, such as bone, cartilage, tendon, ligament, and muscle. This systematic review reporting the effect of PRP after arthroscopic rotator cuff repair.

Longitudinal Measurement of In-Vivo Tendon Function Over 17 Weeks Following Repair: Technique and Preliminary Results in a Canine Rotator Cuff Model

2007 ◽  
Author(s):  
Michael J. Bey ◽  
Stephanie K. Brock ◽  
Andrew R. Baker ◽  
Kathleen A. Derwin
Keyword(s):  
Rotator Cuff ◽  
Tendon Repair ◽  
Rotator Cuff Tears ◽  
X Ray ◽  
Longitudinal Measurement ◽  
Joint Range Of Motion ◽  
Normal Tendon ◽  
Joint Range

Rotator cuff tears are a common injury, affecting 30–40% of the population over age 60 and representing a tremendous source of pain and disability. Rotator cuff tears are often repaired surgically, but a significant percentage (perhaps 50% or more) of large cuff tears fail after surgery and result in long-term shoulder disability. The outcome of rotator cuff repair surgery is typically assessed by measuring muscle strength, joint range of motion, pain, and other subjective indicators of function. Although these types of measurements are used extensively, they provide only an indirect assessment of tendon function. We have recently developed new experimental techniques that allow us to use a biplane x-ray system to directly assess in-vivo tendon function. The purpose of this study was to assess the feasibility of using a biplane x-ray system to quantify changes in in-vivo tendon function following tendon repair in a canine rotator cuff model. We hypothesized that tendon function will improve over the healing period (as reflected by changes in measures of repair stiffness and contracture) and approach normal tendon function by 17 weeks.

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

Arthroscopic Subscapularis Tendon Repair Using the Mason-Allen Technique

2021 ◽  
Author(s):  
Junqi Huang ◽  
Jiajia Cheng ◽  
Shitian Tang ◽  
Bo Shi ◽  
Gang Liu ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Tendon Repair ◽  
Shoulder Function ◽  
Arthroscopic Rotator Cuff Repair ◽  
Subscapularis Tendon ◽  
Function Recovery ◽  
The Mean ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.

scholarly journals Biceps Detachment Preserves Joint Function in a Chronic Massive Rotator Cuff Tear Rat Model

2018 ◽  
Vol 46 (14) ◽  
pp. 3486-3494 ◽  
Author(s):  
Mengcun Chen ◽  
Snehal S. Shetye ◽  
Julianne Huegel ◽  
Corinne N. Riggin ◽  
Daniel J. Gittings ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Shoulder Joint ◽  
Shoulder Function ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Joint Function ◽  
Massive Rotator Cuff Tears ◽  
Sham Surgery ◽  
Biceps Tenotomy

Background: Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears (MRCTs), and biceps tenotomy is frequently performed for pain relief and functional reservation. However, the efficacy and safety of biceps tenotomy regarding the effects on the surrounding tissues in chronic MRCT are unclear. Hypothesis: Biceps tenotomy would result in improved mechanical and histological properties of the intact subscapularis tendon and improved in vivo shoulder function while not compromising glenoid cartilage properties. Study Design: Controlled laboratory study. Methods: Right supraspinatus and infraspinatus tendons were detached in 25 male Sprague-Dawley rats, followed by 4 weeks of cage activity to create a chronic MRCT condition. Animals were randomly divided into 2 groups and received either biceps tenotomy (n = 11) or sham surgery (n = 14) and were sacrificed 4 weeks thereafter. Forelimb gait and ground-reaction forces were recorded 1 day before the tendon detachment (baseline), 1 day before the surgical intervention (biceps tenotomy or sham), and 3, 7, 10, 14, 21, and 28 days after the intervention to assess in vivo shoulder joint function. The subscapularis tendon and glenoid cartilage were randomly allocated for mechanical testing or histologic assessment after the sacrifice. Results: Compared with sham surgery, biceps tenotomy partially restored the in vivo shoulder joint function, with several gait and ground-reaction force parameters returning closer to preinjury baseline values at 4 weeks. With biceps tenotomy, mechanical properties of the subscapularis tendons were improved, while mechanical properties and histological Mankin scores of the glenoid cartilage were not diminished when compared with the sham group. Conclusion: Biceps tenotomy in the presence of chronic MRCT partially preserves overall shoulder function and potentially restores subscapularis tendon health without causing detrimental effects to joint cartilage. This laboratory study adds to the growing literature regarding the protective effects of biceps tenotomy on the shoulder joint in a chronic MRCT model. Clinical Relevance: This study provides important basic science evidence supporting the use of biceps tenotomy in patients with massive rotator cuff tears.

Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit

2018 ◽  
Vol 33 (6) ◽  
pp. 792-807 ◽  
Author(s):  
Gabrielle Deprés-Tremblay ◽  
Anik Chevrier ◽  
Martyn Snow ◽  
Scott Rodeo ◽  
Michael D Buschmann
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Platelet Rich Plasma ◽  
Rabbit Model ◽  
Supraspinatus Tendon ◽  
Rotator Cuff Tears ◽  
Polymorphonuclear Cells ◽  
Post Surgery ◽  
Freeze Dried ◽  
Cuff Repair

Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.

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