Improved time-zero biomechanical properties using poly-L-lactic acid graft augmentation in a cadaveric rotator cuff repair model

McCarron, Jesse A.; Milks, Ryan; Chen, Xi; Iannotti, Joseph P.; Derwin, Kathleen A.

doi:10.1016/j.jse.2009.12.008

Cited by 68 publications

(52 citation statements)

References 45 publications

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“…2 For the cadaveric rotator cuff repairs, a strip of the superior infraspinatus tendon (12 mm wide) was released and repaired to the greater tuberosity using a double-row transosseous technique with 2 Mason Allen sutures per row. 20 The prototypical augmen tation graft used for the augmented repairs was a poly-L-lactic acid (PLLA) scaffold (X-Repair, Synthasome Inc, San Diego, CA, USA). The nonaugmented repair was modeled as 2 springs in series (Fig.1, A and B), and the augmented repair was modeled as a combination of 5 springs in series and parallel (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…The aggregate spring-network models were validated by comparing the model predictions to in vitro experi mental data in the failure-loading region of repair constructs that were preconditioned for 100 cycles from 50 to 150 N at 0.25 Hz and subsequently distracted to failure with uniaxial loading in tension at 30 mm/min. 20 Further details of the model and its validation have previously been described. 2 In the current study, the validated models were varied para metrically to simulate clinically relevant scenarios, namely, changes in tendon quality, altered surgical technique(s) and different scaffold designs.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the surgical repair techniques and model development have previously been reported. 2,20 The dotted lines represent suture markers that were placed on the tendon during experi mental tests, and the black dot represents the optical marker that was placed on the bone for optical displacement measurements. Specifically, to simulate changes in tendon quality and/or surgical repair technique, parameter A of the tendon-to-bone repair (spring #1) or the scaffold-tendon attachment (spring #4) was varied �50% from baseline.…”

Section: Methodsmentioning

confidence: 99%

Section: Synovial Fluidmentioning

confidence: 99%

“…McCarron et al 20 recently showed that augmentation with a polylactic acid scaffold device (X-Repair, Synthasome Inc, San Diego, CA, USA) significantly increased the yield load (56%-92%) and ultimate load (56%-76%) of rotator cuff repairs in a human cadaver model. 20 X-Repair augmentation also altered the mode of repair failure: failure by sutures cutting through the tendon was reduced, occurring in 17 of 20 nonaugmented repairs but in only 7 of 20 augmented repairs. In another study, Barber et al 4 demonstrated a 19% increase in failure load and fewer failures at the sutureetissue interface for supraspinatus repairs augmented with GraftJacket (Human Acellular Dermis, Wright Medical, Arlington, VA, USA) compared with nonaugmented repairs.…”

Section: Synovial Fluidmentioning

confidence: 99%

See 4 more Smart Citations

The biomechanical role of scaffolds in augmented rotator cuff tendon repairs

Aurora¹,

McCarron²,

Bogert³

et al. 2012

Journal of Shoulder and Elbow Surgery

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Synovial Fluidmentioning

confidence: 99%

Section: Synovial Fluidmentioning

confidence: 99%

See 3 more Smart Citations

The biomechanical role of scaffolds in augmented rotator cuff tendon repairs

Aurora¹,

McCarron²,

Bogert³

et al. 2012

Journal of Shoulder and Elbow Surgery

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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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Mechanical characterization and biocompatibility of a novel reinforced fascia patch for rotator cuff repair

Aurora

Mesiha

Tan

et al. 2011

J Biomedical Materials Res

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To provide mechanical augmentation for rotator cuff repair, it is necessary (though perhaps not sufficient) that scaffolds have tendon-like material and suture retention properties, be applied to the repair in a surgically appropriate manner, and maintain their mechanical properties for an acceptable period of time following surgery. While allograft fascia lata has material, structural, and biochemical properties similar to tendon tissue, its poor suture retention properties abrogates its potential as an augmentation device. The goal of this work was to design a novel reinforced fascia patch with suture retention and stiffness properties adequate to provide mechanical augmentation for rotator cuff repair. Fascia was reinforced by stitching with PLLA or PLLA/PGA polymer braids. Reinforced fascia patches had a maximum construct load greater than (or equal to) the suture retention properties of human rotator cuff tendon (∼250N) at time zero and after in vivo implantation for 12 weeks in a rat subcutaneous model. The patches were able to withstand the 2500 loading cycles projected for the early post-operative period. The patches also demonstrated biocompatibility with the host using a rat abdominal wall defect model. These studies suggest the potential use of reinforced fascia patches to provide mechanical augmentation, minimize tendon retraction and possibly reduce the incidence of rotator cuff repair failure.

show abstract

Improved time-zero biomechanical properties using poly-L-lactic acid graft augmentation in a cadaveric rotator cuff repair model

Cited by 68 publications

References 45 publications

The biomechanical role of scaffolds in augmented rotator cuff tendon repairs

The biomechanical role of scaffolds in augmented rotator cuff tendon repairs

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

Mechanical characterization and biocompatibility of a novel reinforced fascia patch for rotator cuff repair

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