The scapholunate interosseous ligament (SLIL) is a frequently torn wrist ligament and current surgical options for SLIL tears are suboptimal. This research aims to develop a novel multiphasic bone-ligament-bone scaffold (BLB) with a porous interface using 3D-printing and cell sheet technology for the reconstruction of the dorsal scapholunate interosseous ligament. The BLB scaffold comprised two bone compartments bridged by aligned polycaprolactone fibers mimicking the architecture of the native tissue. Mechanical testing of the BLBs showed their ability to withstand physiological forces. The BLBs were further combined with human bone marrow This article is protected by copyright. All rights reserved.3 mesenchymal stem cell sheet and this demonstrated that the harvesting did not compromise cell viability, while allowing homogeneous distribution in the ligament compartment. The BLBs were loaded with cell sheets and Bone Morphogenetic Protein-2 in the ligament and bone compartment respectively and implanted ectopically into athymic rats. The histology demonstrated a rapid tissue infiltration, high vascularization and more importantly, the maintenance of the compartmentalization as bone formation remained localized to the bone compartment despite the porous interface. The cells in the ligament compartment became preferentially aligned and this proof-of-concept study demonstrated that the BLB can provide sufficient compartmentalization and fiber guiding properties necessary for the regeneration of the dorsal SLIL.

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Background: Collagenase clostridium histolyticum (CCH) injection is an established alternative to surgical fasciectomy in selected patients with Dupuytren’s contracture. Collagenase is currently not listed on the Pharmaceutical Benefits Scheme creating a barrier to its use in the Australian public health system. This study compares the cost of CCH delivered in an outpatient setting with a comparable surgical fasciectomy cohort, calculated retrospectively. Methods: A retrospective audit of hospital data was conducted to determine the cost of single-digit surgical fasciectomy compared to CCH treatment delivered in an outpatient setting. Medicare Benefits Schedule coding was used to identify surgical fasciectomy patients between March 2014 and April 2015. The CCH group was prospectively followed from June 2014 to March 2016. Results: Thirty-seven patients were successfully treated with CCH, with one patient requiring two injections. This group required less follow-up visits (4.0 outpatient clinic and 4.9 allied health) compared to the surgical group (n=38; 4.4 outpatient clinic and 6.1 allied health). The total cost of treatment for the CCH group was AU$2589 compared to a mean total of AU$6155 for the surgical group (AU$3574– AU$14,599)—a potential saving of AU$119,698. Conclusion: The overall cost of CCH is substantially lower than surgical fasciectomy despite the cost of the medication (AU$1206). Additionally, CCH patients avoid a visit to the operating room thereby freeing up theatre time that is generally under pressure with long public waiting lists.

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