Human Growth Hormone May Be Detrimental When Used to Accelerate Recovery from Acute Tendon-Bone Interface Injuries

Baumgarten, Keith M.; Oliver, Harvey A; Foley, Jack L.; Chen, Ding‐Geng; Autenried, P; Duan, Shanzhong; Heiser, Patrick W.

doi:10.2106/jbjs.l.00222

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…The supraspinatus tendon was fixed between sandpaper using cyanoacrylate glue and held vertically in a custom clamp. Specimens were preconditioned from 0 to 5% strain at a rate of 1% strain/sec for five cycles, followed by a displacement ramp to failure at a rate of 1% strain/sec …”

Section: Methodsmentioning

confidence: 99%

“…Specimens were preconditioned from 0 to 5% strain at a rate of 1% strain/sec for five cycles, followed by a displacement ramp to failure at a rate of 1% strain/sec. [21][22][23] Micro-CT Analysis Eight weeks after repair surgery (Surgery 2), eight rats per group were sacrificed and the bilateral humeral bones with SSp muscles were harvested. Specimens were fixed in 10% formalin for 48 h at room temperature.…”

Section: Biomechanical Testingmentioning

confidence: 99%

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Augmentation of chronic rotator cuff healing using adipose‐derived stem cell‐seeded human tendon‐derived hydrogel

Kaizawa

Franklin

Leyden

et al. 2019

Journal Orthopaedic Research

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Rotator cuff (RTC) repair outcomes are unsatisfactory due to the poor healing capacity of the tendon bone interface (TBI). In our preceding study, tendon hydrogel (tHG), which is a type I collagen rich gel derived from human tendons, improved biomechanical properties of the TBI in a rat chronic RTC injury model. Here we investigated whether adipose‐derived stem cell (ASC)‐seeded tHG injection at the repair site would further improve RTC healing. Rats underwent bilateral supraspinatus tendon detachment. Eight weeks later injured supraspinatus tendons were repaired with one of four treatments. In the control group, standard transosseous suture repair was performed. In the ASC, tHG, tHGASC groups, ASC in media, tHG, and ASC‐seeded tHG were injected at repair site after transosseous suture repair, respectively. Eight weeks after repair, the TBI was evaluated biomechanically, histologically, and via micro CT. Implanted ASCs were detected in ASC and tHGASC groups 7 weeks after implantation. ACS implantation improved bone morphometry at the supraspinatus insertion on the humerus. Injection of tHG improved biomechanical properties of the repaired TBI. RTC healing in tHGASC group was significantly better than control but statistically equivalent to the tHG group based on biomechanical properties, fibrocartilage area at the TBI, and bone morphometry at the supraspinatus insertion. In a rat RTC chronic injury model, no biomechanical advantage was gained with ASC augmentation of tHG. Clinical Significance: Tendon hydrogel augmentation with adipose derived stem cells does not significantly improve TBI healing over tHG alone in a chronic rotator cuff injury model. © 2019 Orthopaedic Research Society. This article has been contributed to by US Government employees and their work is in the public domain in the USA.

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Section: Methodsmentioning

confidence: 99%

Section: Biomechanical Testingmentioning

confidence: 99%

Augmentation of chronic rotator cuff healing using adipose‐derived stem cell‐seeded human tendon‐derived hydrogel

Kaizawa

Franklin

Leyden

et al. 2019

Journal Orthopaedic Research

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“…The test protocol was similar to that used in previous studies . Specimens were preloaded to 0.2 N and preconditioned for five cycles to 5% strain at a rate of 1% strain/s.…”

Section: Methodsmentioning

confidence: 99%

Functionally Graded, Bone‐ and Tendon‐Like Polyurethane for Rotator Cuff Repair

Ker

Wang

Behn

et al. 2018

Adv Funct Materials

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Critical considerations in engineering biomaterials for rotator cuff repair include bone-tendon-like mechanical properties to support physiological loading and biophysicochemical attributes that stabilize the repair site over the long-term. In this study, UV-crosslinkable polyurethane based on quadrol (Q), hexamethylene diisocyante (H), and methacrylic anhydride (M; QHM polymers), which are free of solvent, catalyst, and photoinitiator, is developed. Mechanical characterization studies demonstrate that QHM polymers possesses phototunable bone- and tendon-like tensile and compressive properties (12–74 MPa tensile strength, 0.6–2.7 GPa tensile modulus, 58–121 MPa compressive strength, and 1.5–3.0 GPa compressive modulus), including the capability to withstand 10 000 cycles of physiological tensile loading and reduce stress concentrations via stiffness gradients. Biophysicochemical studies demonstrate that QHM polymers have clinically favorable attributes vital to rotator cuff repair stability, including slow degradation profiles (5–30% mass loss after 8 weeks) with little-to-no cytotoxicity in vitro, exceptional suture retention ex vivo (2.79–3.56-fold less suture migration relative to a clinically available graft), and competent tensile properties (similar ultimate load but higher normalized tensile stiffness relative to a clinically available graft) as well as good biocompatibility for augmenting rat supraspinatus tendon repair in vivo. This work demonstrates functionally graded, bone-tendon-like biomaterials for interfacial tissue engineering.

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“…29,30 While these findings allude to potential for GH use in direct tendon healing, in vivo studies by Baumgarten et al and Oh et al have respectively shown detrimental effects on rats and insignificant effects on humans with RCRs. 27,28 Baumgarten et al carried out a two cohort treatment study on rats who underwent repair of acute RCTs. 27 The first cohort (n= 72) received postoperative treatment of placebo or subcutaneous GH at doses ranging between 0.1 to 10 mg/kg/day while the second cohort (n= 24) underwent either placebo or seven days preoperatively and twenty eight days postoperatively of 5 ml/kg of GH.…”

Section: Hormones: Estrogenmentioning

confidence: 99%

Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review

et al. 2022

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Introduction As rotator cuff repairs (RCRs) are among the most common procedures in upper extremity orthopedics, healing augmentation using pharmacologic enhancement of the repaired rotator cuff muscle is of particular interest. Objective The purpose of this study is to review the current understanding of Matrix Metalloproteinases (MMPs), Doxycycline, Testosterone, Estrogen, Growth hormone/ IGF-1, Vitamin D, and Vitamin C as a means to mitigate deleterious effects and propagate factors that support healing following RCR. Methods A review of English language articles in PubMed and Medline was conducted in December of 2020. All articles describing the current understanding of the aforementioned therapies were reviewed. Studies were excluded if they were non-English or reported incomplete results. Results Matrix metalloproteinases (MMP’s) are fundamental to the healing process after rotator cuff tears through a delicate balance of various proteases that can be modulated by doxycycline through inhibition. While testosterone has shown to induce replication and differentiation of the tendon stem-cells, estrogen agonists have been shown to decrease inflammation and muscle atrophy. Though growth hormone being associated with elevated collagen synthesis and decreased anoxic damage when present, clinical studies have shown inconclusive and adverse effects on rotator cuff healing. Patients with Vitamin D deficiency have shown to have increased fatty infiltration in rotator cuff muscle while Vitamin C functions as an antioxidant that increases collagen and fibroblast proliferation. Conclusion As manipulation of pharmacologic factors shows potential for enhancing healing following RCRs, future studies are needed to establish a viable augmentation strategy to improve patient outcomes

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Human Growth Hormone May Be Detrimental When Used to Accelerate Recovery from Acute Tendon-Bone Interface Injuries

Cited by 13 publications

References 43 publications

Augmentation of chronic rotator cuff healing using adipose‐derived stem cell‐seeded human tendon‐derived hydrogel

Augmentation of chronic rotator cuff healing using adipose‐derived stem cell‐seeded human tendon‐derived hydrogel

Functionally Graded, Bone‐ and Tendon‐Like Polyurethane for Rotator Cuff Repair

Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review

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