Effects of Allogenic Dermal Fibroblasts on Rotator Cuff Healing in a Rabbit Model of Chronic Tear

2018 ◽  
Vol 46 (8) ◽  
pp. 1901-1908 ◽  
Author(s):  
Jieun Kwon ◽  
Yun Hee Kim ◽  
Sung-Min Rhee ◽  
Tae In Kim ◽  
Jimin Lee ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Laboratory Study ◽  
Bone Healing ◽  
Rabbit Model ◽  
Dermal Fibroblasts ◽  
The Other ◽  
Histological Evaluation ◽  
Load To Failure ◽  
Group A ◽  
Group B

Background: The failure of rotator cuffs to heal after repair is an unresolved surgical issue. There have been substantial efforts, including the use of biological supplements, to enhance tendon healing. Dermal fibroblasts are a good candidate for tendon tissue engineering because they are similar to the tenocytes used for collagen synthesis. In addition, they are easily accessible because autologous dermal fibroblasts can be obtained from individual skin without major skin defects and allogenic dermal fibroblasts (ADFs) have already been commercialized in the field of skin engineering. Purpose: To determine the effects of dermal fibroblasts on tendon-to-bone healing in a rabbit model of a chronic rotator cuff tear. Study Design: Controlled laboratory study. Methods: A total of 33 rabbits were randomly allocated into 3 groups (n = 11 each). Supraspinatus tendons were detached and left for 6 weeks to establish a chronic rotator tear model. Torn tendons were repaired in a transosseous manner with the injection of 5 × 106 ADFs with fibrin in group A, fibrin only in group B, and saline only in group C. At 12 weeks after repair, the mechanical test and histological evaluation were performed. Results: Seven rabbits died before the evaluation (1 in group A, 2 in group B, 4 in group C). In the final evaluation, the mean ± SD load to failure was 48.1 ± 13.3 N/kg for group A, 34.5 ± 8.9 N/kg for group B, and 31.1 ± 8.3 N/kg for group C, and group A showed significantly higher load-to-failure values than the other groups ( P = .011). The midsubstance tear rate, which presented stronger tendon-to-bone healing than insertional tear, was 50.0% in group A, 22.2% in group B, 28.6% in group C, but the differences were not statistically significant ( P = .413). In the histological evaluation, group A showed greater collagen fiber continuity and better orientation than the other groups. Conclusion: This controlled laboratory study verified, on the basis of biomechanics and histology, the potential for the use of ADFs in rotator cuff healing. The current results suggest a new biological supplement to increase the rate of rotator cuff healing. Clinical Relevance: The most important finding of this study was the potential for a new biological supplement to enhance rotator cuff healing—a continuing challenge.

Atelocollagen Enhances the Healing of Rotator Cuff Tendon in Rabbit Model

2017 ◽  
Vol 45 (9) ◽  
pp. 2019-2027 ◽  
Author(s):  
Dong-Sam Suh ◽  
Jun-Keun Lee ◽  
Ji-Chul Yoo ◽  
Sang-Hun Woo ◽  
Ga-Ram Kim ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rapid Development ◽  
Rabbit Model ◽  
Supraspinatus Tendon ◽  
Histological Evaluation ◽  
Control Group ◽  
Patch Type ◽  
Load To Failure ◽  
Cuff Repair ◽  
Experimental Group

Background: Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. Purpose: To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. Study Design: Controlled laboratory study. Methods: A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits. They were then randomly allocated into 2 groups (23 rabbits per group; 15 for histological and 8 for biomechanical test). In the experimental group, patch-type atelocollagen was implanted between bone and tendon during repair; in the control group, the torn tendon was repaired without atelocollagen. Each opposite shoulder served as a sham (tendon was exposed only). Histological evaluation was performed at 4, 8, and 12 weeks. Biomechanical tensile strength was tested 12 weeks after surgery. Results: Histological evaluation scores of the experimental group (4.0 ± 1.0) were significantly superior to those of the control group (7.7 ± 2.7) at 12 weeks ( P = .005). The load to failure was significantly higher in the experimental group (51.4 ± 3.9 N) than in the control group (36.4 ± 5.9 N) ( P = .001). Conclusion: Histological and biomechanical studies demonstrated better results in the experimental group using atelocollagen in a rabbit model of the supraspinatus tendon tear. Clinical Relevance: Atelocollagen patch could be used in the cuff repair site to enhance healing.

scholarly journals Enhancement of Rotator Cuff Tendon-bone Healing with Graphene Oxide/PRP Composite Scaffold in a Rabbit Model: A Histological and Biomechanical Study

2020 ◽  
Author(s):  
Bo Qin ◽  
Dingsu Bao ◽  
Shengqiang Zeng ◽  
Kai Deng ◽  
Gang Liu ◽  
...  
Keyword(s):  
Graphene Oxide ◽  
Rotator Cuff ◽  
Bone Healing ◽  
Surgical Repair ◽  
Composite Scaffold ◽  
Rabbit Model ◽  
Control Groups ◽  
Significant Difference ◽  
Load To Failure ◽  
And Control

Abstract Background: Application of platelet-rich plasma (PRP) can improve tendon-bone healing (TBH) after rotator cuff surgical repair. Graphene Oxide (GO) is a steady, controlled, and sustained carrier. The purpose of this study is to determine whether GO/PRP Composite Scaffold enhances the TBH after RC surgical repair in a rabbit model.Methods: A full-thickness tear of the supraspinatus tendon was created and repaired in 36 adult male New Zealand rabbits. They were divided into three groups: Control group, PRP group, and GO/PRP Composite Scaffold group (GO group). The effect of GO/PRP Composite Scaffold on TBH was assessed using histological and biomechanical evaluations at 8 and 12 weeks postoperatively.Results: Histological analysis showed that greater continuity, better orientation, and more density of collagen fiber were detected in the GO group than PRP and Control groups at 8 and 12 weeks, respectively. Results of biomechanical evaluations showed that the load to failure and stiffness of the GO group were statistically higher than those of PRP and Control groups at both 8 and 12 weeks (P<0.05). Compared with 8 weeks in the GO group, there was no significant difference in load to failure at 12 weeks (P>0.05), while the stiffness at 12 weeks was higher than that at 8 weeks (P<0.05). Conclusions: These results demonstrated that GO/PRP Composite Scaffold enhanced the TBH following rotator cuff surgical repair in a rabbit model. The GO may be an effective carrier for PRP into repair sites.

scholarly journals Does Manual Drilling Improve the Healing of Bone–Hamstring Tendon Grafts in Anterior Cruciate Ligament Reconstruction? A Histological and Biomechanical Study in a Rabbit Model

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091160
Author(s):  
Matteo Maria Tei ◽  
Giacomo Placella ◽  
Marta Sbaraglia ◽  
Roberto Tiribuzi ◽  
Anastasios Georgoulis ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Bone Healing ◽  
Ultimate Load ◽  
Cruciate Ligament ◽  
Hamstring Tendon ◽  
Tendon Graft ◽  
Load To Failure ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Heat necrosis due to motorized drilling during anterior cruciate ligament (ACL) reconstruction could be a factor in delayed healing at the bone–tendon graft interface. Hypothesis: The process of osteointegration could be enhanced using manual drilling. It reduces the invasiveness of mechanical-thermal stress normally caused by the traditional motorized drill bit. Study Design: Controlled laboratory study. Methods: ACL reconstruction using semitendinosus tendon autografts was performed in 28 skeletally mature female New Zealand white rabbits, which were randomly divided into 3 groups. In group A (n = 12), the tunnels were drilled using a motorized device; in group B (n = 12), the tunnels were drilled using a manual drill bit; and group C (n = 4) served as a control with sham surgical procedures. The healing process in the tunnels was assessed histologically at 2, 4, 8, and 12 weeks and graded according to the Tendon–Bone Tunnel Healing (TBTH) scoring system. In addition, another 25 rabbits were used for biomechanical testing. The structural properties of the femur–ACL graft–tibia complex, from animals sacrificed at 8 weeks postoperatively, were determined using uniaxial tests. Stiffness (N/mm) and ultimate load to failure (N) were determined from the resulting load-elongation curves. Results: The time course investigation showed that manual drilling (group B) had a higher TBTH score and improved mechanical behavior, reflecting better organized collagen fiber continuity at the bone–fibrous tissue interface, better integration between the graft and bone, and early mineralized chondrocyte-like tissue formation at all the time points analyzed with a maximum difference at 4 weeks (TBTH score: 5.4 [group A] vs 12.3 [group B]; P < .001). Stiffness (23.1 ± 8.2 vs 17.8 ± 6.3 N/mm, respectively) and ultimate load to failure (91.8 ± 60.4 vs 55.0 ± 18.0 N, respectively) were significantly enhanced in the specimens treated with manual drilling compared with motorized drilling ( P < .05 for both). Conclusion: The use of manual drilling during ACL reconstruction resulted in better tendon-to-bone healing during the crucial early weeks. Manual drilling was able to improve the biological and mechanical properties of bone–hamstring tendon graft healing and was able to restore postoperative graft function more quickly. Tunnel drilling results in bone loss and deficient tendon-bone healing, and heat necrosis after tunnel enlargement may cause mechanical stress, contributing to a delay in healing. Manual drilling preserved the bone stock inside the tunnel, reduced heat necrosis, and offered a better microenvironment for faster healing at the interface. Clinical Relevance: Based on study results, manual drilling could be used successfully in human ACL reconstruction, but further clinical studies are needed. A clinical alternative, called the original “all-inside” technique, has been developed for ACL reconstruction. In this technique, the femoral and tibial tunnels are manually drilled only halfway through the bone for graft fixation, reducing bone loss. Data from this study suggest that hamstring tendon–to–bone healing can be improved using a manual drilling technique to form femoral and tibial tunnels.

scholarly journals Short-term evaluation of an intra-articular technique for cranial cruciate ligament rupture in dogs using nylon or polyester

2018 ◽  
Vol 39 (2) ◽  
pp. 593
Author(s):  
Tiago Carmagnani Prada ◽  
Anderson Coutinho da Silva ◽  
Bruno Watanabe Minto
Keyword(s):  
Cruciate Ligament ◽  
The Other ◽  
Polyester Yarn ◽  
Short Term ◽  
Limb Function ◽  
Cranial Cruciate Ligament ◽  
Ligament Rupture ◽  
Group A ◽  
Group B ◽  
Cranial Cruciate Ligament Rupture

Cranial cruciate ligament rupture (CCrLR) is a common condition found in the small animal routine, being correlated to traumas, obesity, genetic factors, and primary osteoarthritis (OA) in dogs. Affected animals show articular instability that, if not corrected surgically, may cause secondary OA and loss of limb function. The aim of this study was to compare short-term results of the intra-articular technique for knee stabilization after CCrLR using a surgical button associated with polyester yarn (Group A), the surgical button associated with nylon yarn (Group B), and surgical toggle associated with polyester yarn (Group C). Eighteen dogs presenting CCrLR, weight varying from 5 to 35 kg, and different sex and breed were divided into three groups of six individuals. OA radiographic grade, pre- and post-operative lameness, surgical time, and the macroscopic aspect of cartilage were assessed. The intra-articular technique was performed by passing a suture through two tunnels, drilled in the femoral condyle and tibial crest to stabilize the knee joint. Twelve animals presented a decreased lameness and normal limb function after 15 days. On the other hand, four dogs from Group B presented complications: two dogs had suture rupture after 30 days and other two showed muscular contracture with decreased range of motion, followed by loss of limb function. In Group A, one dog showed suture rupture after 15 days and other had suture infection after 30 days. In Group C, dogs recovered normal limb function without complications. Therefore, surgical toggle associated with polyester yarn was better than the other studied materials.

scholarly journals Surgeon-operated ultrasonography in a one-stop shoulder clinic

2011 ◽  
Vol 93 (7) ◽  
pp. 528-531 ◽  
Author(s):  
R Seagger ◽  
T Bunker ◽  
P Hamer
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Financial Cost ◽  
Time Saving ◽  
One Stop ◽  
Group A ◽  
Group B ◽  
Portable Ultrasonography

INTRODUCTION Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation to the end of the treatment episode (be it surgery, injection or conservative management). METHODS A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery. RESULTS For all outcomes (surgery, irreparable tears and conservative treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department, those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient. CONCLUSIONS The use of a portable ultrasonography machine by an orthopaedic surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.

scholarly journals Efficacy of High-Power Laser in Alleviating Pain and Improving Function of Patients With Patellofemoral Pain Syndrome: A Single-Blind Randomized Controlled Trial

2018 ◽  
Vol 10 (1) ◽  
pp. 37-43
Author(s):  
Farshad Nouri ◽  
Seyed Ahmad Raeissadat ◽  
Dariush Eliaspour ◽  
Seyed Mansoor Rayegani ◽  
Maryam Sadat Rahimi ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Pain Syndrome ◽  
The Other ◽  
Short Term ◽  
Randomized Controlled ◽  
Group A ◽  
Laser Group ◽  
Group B ◽  
Single Blind ◽  
Post Therapy

Introduction: In this study, a single-blind and randomized controlled trial (RCT) for assessing the effectiveness of high-power (up to 12 W) laser therapy (HPLT) on patients with patellofemoral pain syndrome (PFPS) was carried out. Methods: Forty-four patients were randomly assigned to two treatment groups by generating random numbers with MATLAB 2014b software, where odd and even numbers were attributed to sham laser group (group A) and actual laser group (group B), respectively. Group B patients underwent HPLT with total dose of 300 J/session for 5 consecutive sessions separated by a 2-day interval. On the other hand, sham laser was applied to group A patients. Both groups had the same exercise therapy programs during the study period (3 months). The exercise therapy program included isometric knee exercise for 3 sets per day and 10 times in each set, with duration of 10 seconds per time and straight leg raise for 15 seconds 10 times a day. The group codes of patients were not revealed to subjects and data analyzer until completion of the study. Kujala, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and visual analog scale (VAS) questionnaires were chosen as outcome measures. These questionnaires were completed at three points during the study; at the beginning of the study to obtain the pre-therapy conditions and one month and three months after the start of the study to evaluate post-therapy conditions. Results: Two main analyses were conducted: within-group and between-group analyses. Withingroup analyses indicated significant improvements in respect to all measurements where pretherapy and post-therapy comparisons were conducted in both groups (P < 0.05). On the other hand, between-group comparisons did not reveal any statistically significant functional difference between group A and group B regarding the evaluative criteria (P > 0.05) except for pain VAS (P < 0.05). Conclusion: This study indicated that short-term HPLT accompanied by appropriate exercise regimen significantly decreased pain in patients with PFPS. But it was not recommended as an efficient modality in functional improvement. Also, it was observed that, in the short-term period of study, HPLT was a safe modality.

scholarly journals Enhanced Tendon-to-Bone Healing of Chronic Rotator Cuff Tears by Bone Marrow Aspirate Concentrate in a Rabbit Model

2018 ◽  
Vol 10 (1) ◽  
pp. 99 ◽  
Author(s):  
Xiao Ning Liu ◽  
Cheol-Jung Yang ◽  
Ji Eui Kim ◽  
Zhen Wu Du ◽  
Ming Ren ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Rotator Cuff ◽  
Bone Healing ◽  
Bone Marrow Aspirate ◽  
Rabbit Model ◽  
Rotator Cuff Tears ◽  
Bone Marrow Aspirate Concentrate

Sequential versus Alternating Regimens in the Treatment of Advanced Breast Cancer

1989 ◽  
Vol 75 (2) ◽  
pp. 137-140 ◽  
Author(s):  
Omar Fernández Giachella ◽  
Carlos Gálvez ◽  
Carlos Rufino ◽  
Adelina Rufino ◽  
Federico Morera ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Advanced Breast Cancer ◽  
Response Rate ◽  
Advanced Breast ◽  
The Other ◽  
Trial Group ◽  
Duration Of Response ◽  
Group A ◽  
Alternate Forms ◽  
Group B

With the object of proving whether seqeuntial or alternate forms of chemotherapy would be advantageous one over the other in treating advanced breast cancer and with the purpose of evaluating two different anthracyclines at equimolecular doses in the above-mentioned alternating regimens, 250 patients who had received no prior chemo- or hormonotherapy were entered in a prospective randomized trial. Group A was administered 4-epiadriamycin and cyclophosphamide for 8 courses, followed by 6 cycles of CMF, and medroxyprogesterone acetate (MPA) from the beginning of therapy until progression. In group B, adriamycin + cyclophosphamide were alternated with CMF every two courses until 14 cycles were completed. Group C received 4'-epiadriamycin + cyclophosphamide alternated with CMF for 14 courses. In groups B and C, MPA was administered as in group A. Two hundred and twenty-four patients were evaluated. CR+PR were observed in 55.8 % of group A, 43.4 % of group B, and 46.4 % of group C. Median duration of responses was 16 months (m) in group A, 13 m in group B and 20 m in group C., and median survival (CR + PR) was 16.5 m in group A, 16 m in group B and 24 m in group C. There were no statsitically significant differences among the three groups in terms of response rate, duration of response and survival; furthermore, toxicity was moderate in all groups. At equimolecular doses there were no differences between adriamycin and epirubicin in the alternating schedules.

Small Subchondral Drill Holes Improve Marrow Stimulation of Rotator Cuff Repair in a Rabbit Model of Chronic Rotator Cuff Tear

2020 ◽  
Vol 48 (3) ◽  
pp. 706-714 ◽  
Author(s):  
Yucheng Sun ◽  
Jae-Man Kwak ◽  
Erica Kholinne ◽  
Youlang Zhou ◽  
Jun Tan ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Large Diameter ◽  
Biomechanical Testing ◽  
Rabbit Model ◽  
Small Diameter ◽  
Histological Evaluation ◽  
Control Group ◽  
Greater Tuberosity ◽  
Cuff Repair

Background: Microfracture of the greater tuberosity has been proved effective for enhancing tendon-to-bone healing after rotator cuff repair. However, no standard diameter for the microfracture has been established. Purpose/Hypothesis: This study aimed to assess treatment with large- and small-diameter microfractures to enhance healing during rotator cuff repair surgery in a rabbit model of chronic rotator cuff tear. It was hypothesized that a small-diameter microfracture had advantages in terms of tendon-to-bone integration, bone-tendon interface maturity, microfracture healing, and biomechanical properties compared with a large-diameter microfracture. Study Design: Controlled laboratory study. Methods: Bilateral supraspinatus tenotomy from the greater tuberosity was performed on 21 New Zealand White rabbits. Bilateral supraspinatus repair was performed 6 weeks later. Small-diameter (0.5 mm) microfracture and large-diameter microfracture (1 mm) were performed on the left side and right side, respectively, in 14 rabbits as a study group, and simple repair without microfracture was performed in 7 rabbits as a control group. At 12 weeks later, 7 of 14 rabbits in the study group were sacrificed for micro–computed tomography evaluation and biomechanical testing. Another 6 rabbits were sacrificed for histological evaluation. In the control group, 3 of the 7 rabbits were sacrificed for histological evaluation and the remaining rabbits were sacrificed for biomechanical testing. Results: Significantly better bone-to-tendon integration was observed in the small-diameter microfracture group. Better histological formation and maturity of the bone-tendon interface corresponding to better biomechanical results (maximum load to failure and stiffness) were obtained on the small-diameter microfracture side compared with the large-diameter side and the control group. The large-diameter microfracture showed worse radiographic and histological properties for healing of the microfracture holes on the greater tuberosity. Additionally, the large-diameter microfracture showed inferior biomechanical properties but similar histological results compared with the control group. Conclusion: Small-diameter microfracture showed advantages with enhanced rotator cuff healing for biomechanical, histological, and radiographic outcomes compared with large-diameter microfracture, and large-diameter microfracture may worsen the rotator cuff healing. Clinical Relevance: This animal study suggested that a smaller diameter microfracture may be a better choice to enhance healing in clinical rotator cuff repair surgery in humans.

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