Bone Morphogenetic Proteins-Signaling Plays a Role in Tendon-to-Bone Healing

Benjamin, C.; Kawamura, Syosuke; Deng, Xiang‐Hua; Ling, Ying; Schneidkraut, Jason; Hays, Peyton L.; Rodeo, Scott A.

doi:10.1177/0363546506296312

Cited by 99 publications

(68 citation statements)

References 30 publications

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“…Improved mechanical strength has been reported in association with increased bone formation in bone-tendon junction healing [14,19,21,27]. In our study, bone formation did not differ between the two groups.…”

Section: Discussionsupporting

confidence: 60%

“…Bone formation is reportedly an essential step in the process of bone-tendon junction healing [26]. The application of bone morphogenetic proteins (BMP) increases bone formation and mechanical strength of tendon healing inside the bone tunnel [19,21,27]. BMP-7, which is expressed in adult human, bovine, rabbit, and goat articular cartilage [7], promotes tendon-graft integration in anterior cruciate ligament reconstruction in sheep [21].…”

Section: Discussionmentioning

confidence: 99%

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Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

Wong

Qin

Lee

et al. 2008

Clin Orthop Relat Res

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The fibrocartilage transition zone in the direct bone-tendon junction reduces stress concentration and protects the junction from failure. Unfortunately, bonetendon junctions often heal without fibrocartilage transition zone regeneration. We hypothesized articular cartilage grafts could increase fibrocartilage transition zone regeneration. Using a goat partial patellectomy repair model, autologous articular cartilage was harvested from the excised distal third patella and interposed between the residual proximal two-thirds bone fragment and tendon during repair in 36 knees. We evaluated fibrocartilage transition zone regeneration, bone formation, and mechanical strength after repair at 6, 12, and 24 weeks and compared them with direct repair. Autologous articular cartilage interposition resulted in more fibrocartilage transition zone regeneration (69.10% ± 14.11% [mean ± standard deviation] versus 8.67% ± 7.01% at 24 weeks) than direct repair at all times. There was no difference in the amount of bone formation and mechanical strength achieved. Autologous articular cartilage interposition increases fibrocartilage transition zone regeneration in bone-tendon junction healing, but additional research is required to ascertain the mechanism of stimulation and to establish the clinical applicability.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

Wong

Qin

Lee

et al. 2008

Clin Orthop Relat Res

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“…Tendon healing in a bone tunnel is a priority concern in the orthopaedic and biomedical field after ACL reconstruction [18][19][20][21][22][23]. Fibrous scar tissue formation has been shown to be an incomplete healing response [24].…”

Section: Discussionmentioning

confidence: 99%

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Cho

Chen

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to investigate whether cationised gelatin and hyaluronic acid (CH) coating could induce polyethylene terephthalate (PET) artificial ligament graft osseointegration in the bone tunnel. Methods Surface modification of PET artificial ligament graft was performed by layer-by-layer (LBL) self-assembly CH coating. Six pigs underwent anterior cruciate ligament (ACL) reconstruction on the right knees, with three pigs receiving the CH-coated PET grafts and the other three pigs non-CH-coated PET grafts as controls. They were sacrificed at three months after surgery and the graft-bone complexes were acquired for computed tomography (CT) scan and histological examination. Results CT scans showed a significant difference at the distal femoral site (p00.031) or at the distal tibial site (p00.0078), but no significant difference in the bone tunnel areas' enlargement at other sites (p>0.05) between the CH group and the control group. Histologically, application of CH coating induced new bone formation between graft and bone at three months compared with the controls at the distal site. The interface width of the CH group was significantly lower than that of the control group at the distal femoral site (p00.0327) and at the distal tibial site (p00.0047). ConclusionsThe study has shown that CH coating on the PET artificial ligament surface has a positive biological effect in the induction of artificial ligament osseointegration within the bone tunnel at the distal site of the bone tunnel.

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“…It inhibits tendon-to-bone healing and is therefore more likely expressed in the enthesis rather than the midportion of the tendon we examined [9]. Loading decreased follistatin expression which could lead to increased signaling.…”

Section: Discussionmentioning

confidence: 99%

Mechanical Load and BMP Signaling During Tendon Repair: A Role for Follistatin?

Eliasson

Fahlgren

Aspenberg

2008

Clinical Orthopaedics &Amp; Related Research

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Healing of the rat Achilles tendon is sensitive to mechanical loading, and the callus strength is reduced by 3 = 4 after 14 days, if loading is prevented. Exogenous GDFs stimulate tendon healing. This response is influenced by loading: without loading, cartilage and bone formation is initiated. This implies BMP signaling is crucial during tendon healing and influenced by mechanical loading. We therefore asked if mechanical loading influences the gene expression of the BMP signaling system in intact and healing tendons, and how the BMP signaling system changes during healing. The genes were four BMPs (OP-1/BMP-7, GDF-5/CDMP-1/BMP-14, GDF-6/CDMP-2/BMP-13, and GDF-7/CDMP-3/BMP-12), two receptors (BMPR1b and BMPR2), and the antagonists follistatin and noggin. The Achilles tendon was transected in rats and left to heal. Half of the rats had one Achilles tendon unloaded by injection of Botox in the calf muscles. Ten tendons were analyzed before transection and for each of four time points. All genes except noggin were expressed at all time points, but followed different patterns during healing. Loading strongly decreased the expression of follistatin, which could lead to increased signaling. The BMP system appears involved in tendon maintenance and healing, and may respond to mechanical loading.

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Bone Morphogenetic Proteins-Signaling Plays a Role in Tendon-to-Bone Healing

Abstract: Further studies are needed to investigate the potential clinical application of enhancing healing and decreasing recovery time using bone morphogenetic proteins in soft tissue ligament reconstruction.

Cited by 99 publications

References 30 publications

Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

Articular Cartilage Increases Transition Zone Regeneration in Bone-tendon Junction Healing

Cationised gelatin and hyaluronic acid coating enhances polyethylene terephthalate artificial ligament graft osseointegration in porcine bone tunnels

Mechanical Load and BMP Signaling During Tendon Repair: A Role for Follistatin?

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