Augmentation with an ovine forestomach matrix scaffold improves histological outcomes of rotator cuff repair in a rat model

Abstract

BackgroundRotator cuff tears can cause significant pain and functional impairment. Without surgical repair, the rotator cuff has little healing potential, and following surgical repair, they are highly prone to re-rupture. Augmenting such repairs with a biomaterial scaffold has been suggested as a potential solution. Extracellular matrix (ECM)-based scaffolds are the most commonly used rotator cuff augments, although to date, reports on their success are variable. Here, we utilize pre-clinical in vitro and in vivo assays to assess the efficacy of a novel biomaterial scaffold, ovine forestomach extracellular matrix (OFM), in augmenting rotator cuff repair.MethodsOFM was assessed in vitro for primary tenocyte growth and adherence, and for immunogenicity using an assay of primary human dendritic cell activation. In vivo, using a murine model, supraspinatus tendon repairs were carried out in 34 animals. Augmentation with OFM was compared to sham surgery and unaugmented control. At 6- and 12-week time points, the repairs were analysed biomechanically for strength of repair and histologically for quality of healing.ResultsOFM supported tenocyte growth in vitro and did not cause an immunogenic response. Augmentation with OFM improved the quality of healing of the repaired tendon, with no evidence of excessive inflammatory response. However, there was no biomechanical advantage of augmentation.ConclusionsThe ideal rotator cuff tendon augment has not yet been identified or clinically implemented. ECM scaffolds offer a promising solution to a difficult clinical problem. Here, we have shown improved histological healing with OFM augmentation. Identifying materials that offset the poorer mechanical properties of the rotator cuff post-injury/repair and enhance organised tendon healing will be paramount to incorporating augmentation into surgical treatment of the rotator cuff.

A novel chemotactic factor derived from the extracellular matrix protein decorin recruits mesenchymal stromal cells in vitro and in vivo

“…Ovine forestomach matrix (OFM) is a dECM derived from the rumen of sheep, specially the propria submucosa, and has been shown to contain a number of ECM proteins including 24 different collagens, proteoglycans, including perlecan and decorin (DCN), cytokines and growth factors [ 22 , 23 ]. In vivo studies have demonstrated that OFM is anti-inflammatory [ 24 ], stimulates angiogenesis [ 25 ] and is remodeled over time [ 26 ]. Clinically, OFM has found a range of applications in soft tissue repair, including wound healing [ 27 – 33 ], reconstructive surgery [ 34 ], and abdominal wall repair [ 35 ].…”

Modelling gluteus medius tendon degeneration and repair in a large animal model

“…Tendon degeneration following 6 and 16 weeks of detachment was graded using the modified Movin's score for tendinopathy [33]. Tendon-bone healing was graded using a semi-quantitative grading system as previously described and compared to four un-operated control samples (Table 1) [34].…”

Extracellular matrix graft for the surgical management of Hurley stage III hidradenitis suppurativa: a pilot case series

“…Decellularised ECM bioscaffolds, such as OFM, that are typically produced from human or animal tissues, have been shown to increase the rate of healing in hard-to-heal wounds, and it is thought that this is due to the material's ability to promote angiogenesis, control inflammation and provide a structural scaffold for remodelling. 15,16,18,21 As it relates to the pathology seen in HS, studies have shown that an important factor in ECM bioscaffold-mediated healing is the impact on chronic inflammation. 22 ECM bioscaffolds can promote constructive remodelling by changing the phenotype of inflammatory cells, leading to an increase in the population of macrophages that display a remodelling anti-inflammatory phenotype (M2) versus a pro-inflammatory phenotype (M1).…”

“…Ovine forestomach matrix (OFM) is an extracellular matrix (ECM) bioscaffold widely used in wound management and implant procedures. [10][11][12][13] OFM has excellent biophysical performance, 14 is antiinflammatory, 15,16 recruits mesenchymal stem cells, 17 stimulates angiogenesis, 18 aids tissue infill and undergoes complete remodelling. 18 OFM is available as a graft (Myriad Soft Tissue Matrix, Aroa Biosurgery Limited, New Zealand) designed as a dermal substitute for the surgical management of deep partial or fullthickness defects in plastic and reconstructive surgery and for implant procedures to reinforce soft tissues.…”