Augmentation of Tendon-to-Bone Healing

Abstract

Tendon-to-bone healing is vital to the ultimate success of the various surgical procedures performed to repair injured tendons. Achieving tendon-to-bone healing that is functionally and biologically similar to native anatomy can be challenging because of the limited regeneration capacity of the tendon-bone interface. Orthopaedic basic-science research strategies aiming to augment tendon-to-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches. Low-intensity pulsed ultrasound and extracorporeal shockwave treatment may affect tendon-to-bone healing by means of mechanical forces that stimulate biological cascades at the insertion site. Application of various loading methods and immobilization times influence the stress forces acting on the recently repaired tendon-to-bone attachment, which eventually may change the biological dynamics of the interface. Other approaches, such as the use of coated sutures and interference screws, aim to deliver biological factors while achieving mechanical stability by means of various fixators. Controlled Level-I human trials are required to confirm the promising results from in vitro or animal research studies elucidating the mechanisms underlying tendon-to-bone healing and to translate these results into clinical practice.

The past, present and future in scaffold-based tendon treatments

“…Nonetheless, numerous complications and adverse effects have been reported in clinical setting (e.g. intra-operative fracture, intra-articular complications, extra-articular abscesses) [348], clearly indicating that further research is necessary to elucidate the underlying mechanisms of tendon-to-bone healing and to translate safe and therapeutic interventions [349].…”

Coated Sutures

“…Other studies have looked at coating sutures with arginine-glycine-aspartic acid 10 (RGD) peptides to enhance cellular proliferation or collagen-coated sutures to support tendon-to-bone adhesion. 9,25 bFGF Fibroblastic growth factors, such as bFGF play an important role in tendon healing. The exogenous application of this agent through coated suture may accelerate the structural reorganization of tendon and thereby shorten the healing process.…”

Influence of Low-Intensity Pulsed Ultrasound Stimulation on Expression of Bone-Related Genes in Rat Bone Marrow Cells

“…It was reported that daily LIPUS treatment for 20 min enhanced bone adhesion and shortened the recovery time of fresh fractures, and it is being established as a treatment method in the field of orthopedics 4) . Recent animal studies have also shown that LIPUS accelerates tendon-bone healing 5) . We have reported the effect of LIPUS on bone formation around dental implants inserted into rabbit femur.…”