Effect of a poloxamer-based thermosensitive gel on rotator cuff repair in a rabbit model: a controlled laboratory study

Abstract

Background A common complication after rotator cuff repair is postoperative stiffness, which can be reduced by a simple application of an anti-adhesive agent. However, anti-adhesive agents may affect rotator cuff healing by preventing fibrosis. This experimental animal study evaluated the effect of the application of a poloxamer-based thermosensitive anti-adhesive gel and its influence on the healing of an acute rotator cuff repair in a rabbit model. Methods Acute rotator cuff repair (supraspinatus tendon) was performed using a transosseous suturing method. One shoulder on a randomly selected side was treated with a local application of the anti-adhesive agent (applied side), and saline was applied to the contralateral side (control side). Biomechanical testing and histological analyses were performed at 4 and 8 weeks postoperatively. Eight rabbits were included for each testing and time point, for a total of 32 rabbits. Results The failure load at 4 weeks was lower in the experimental group (95.2 ± 19.6 N vs. 110.0 ± 20.5 N; P = 0.017). Conversely, at 8 weeks, the failure load was higher in the experimental group (148.3 ± 16.2 N) than in the control group (122.4 ± 16.9 N; P = 0.002). Histological analyses revealed no statistically significant differences in the tendon maturing scores at 4 and 8 weeks between the two groups (all P > 0.05). The thickness of the fibrosis between the rotator cuff tendon and deltoid was thinner in the experimental group at both time points (0.50 ± 0.25 vs. 1.27 ± 0.47; P = 0.002 at 4 weeks, and 0.37 ± 0.35 vs. 1.39 ± 0.50; P = 0.003 at 8 weeks). Conclusions Application of an anti-adhesive agent in this rotator cuff model confirmed the agent’s effectiveness at reducing fibrosis in the subacromial space. The healing of the tendon showed interesting results, as the experimental group had poorer biomechanical strength at 4 weeks but superior strength at 8 weeks.

Effects of a Thermosensitive Antiadhesive Agent on Single-Row Arthroscopic Rotator Cuff Repair

“…11 Antiadhesives have been reported to prevent scar formation in other surgical fields. 5,24,27 However, the prevention of adhesion or scar formation did not lead to improved recovery of functional outcome in the current study. We assumed that in rotator cuff repair, adhesion after the operation is responsible for restricted ROM or recovery.…”

“…12,23 Therefore, the use of antiadhesive agents to reduce postoperative stiffness is becoming more popular. 27,31 However, the current study showed no intergroup difference in the occurrence of postoperative stiffness or recovery of ROM except FF at 6 months postoperatively. Previous studies showed similar results using an antiadhesive agent.…”

“…A previous preclinical study using a rabbit model found that rotator cuff tendon failure loads of shoulders injected with an antiadhesive agent containing chitosan were greater than those of contralateral control sides at 8 weeks after cuff repair surgery. 27 In the current study, the blood cholesterollowering effect of chitosan might be a reason for the low retear rate observed in the injection group, as the association between blood cholesterol and rotator cuff tears has been demonstrated in previous studies. It is generally assumed that localized chitosan binds to cholesterol, thus lowering the retear rate, but further work is needed to confirm this assumption.…”

“…In several previous studies, chitosan, the primary antiadhesive component in the antiadhesive agent used in the present study, has been suggested to positively affect tendon-bone healing. 27,37 Raftery et al 37 reported that the injection of chitosan into collagen scaffolds enhanced chondrogenesis and osteogenesis, which might enhance their mechanical strength. A previous preclinical study using a rabbit model found that rotator cuff tendon failure loads of shoulders injected with an antiadhesive agent containing chitosan were greater than those of contralateral control sides at 8 weeks after cuff repair surgery.…”

A Randomized Controlled Trial of Thermo-Sensitive Sol–Gel Anti-Adhesion Agent after Gynecologic Surgery

“…The anti-adhesion effect and safety of Mediclore have been proven in preclinical animal studies [ 27 , 28 ] as well as in clinical studies including transurethral prostate resection (TURP) [ 29 ], total knee arthroplasty [ 30 ], and parotidectomy [ 31 ]. For example, use of Mediclore during TURP in patients with prostatic hyperplasia was significantly associated with a decreased risk of urethral stricture and a higher peak urine flow rate, compared to the instillation of lubricant [ 29 ].…”