Mechanical Augmentation With Absorbable Alginate Sheet Enhances Healing of the Rotator Cuff

Abstract

For anatomical restoration of a repaired rotator cuff, mechanical augmentation of the repaired structure is essential. Using histological and biomechanical evaluation in a rat model, the authors sought to determine the efficacy of an absorbable alginate sheet at the supraspinatus tendon-to-bone repair site for healing of the rotator cuff tear. Forty adult (12 weeks old) male Sprague– Dawley wild-type rats were used in this study. The animals were randomly separated into 2 groups: group 1, conventional supraspinatus repair with acute repair; or group 2, supraspinatus repair with absorbable alginate sheet. Biomechanical and histological analyses were performed at 6 and 12 weeks after index rotator cuff surgery. Compared with group 1, group 2 exhibited a significantly greater mean ultimate failure load (group 1, 23.70±3.87 N; group 2, 61.44±43.67 N; P =.023) and mean ultimate stress (group 1, 2.83±0.50 MPa; group 2, 7.36±2.87 MPa; P =.020). However, 6-week outcomes were not significantly different. On histological scoring, compared with group 1, group 2 exhibited a significantly greater mean 6-week score (group 1, 4.10±1.72 points; group 2, 7.80±1.47 points; P <.001) and mean 12-week score (group 1, 3.50±1.00 points; group 2, 5.25±2.62 points; P =.020). Mechanical augmentation with absorbable alginate may improve tendon healing after surgical repair of the rotator cuff. [ Orthopedics . 2019; 42(1):e104–e110.]

Evaluation of patches for rotator cuff repair: A systematic review and meta-analysis based on animal studies

“…6 Mos. Harada, Y 2017 [ 70 ] Japan Rat (Mean weight 250g, 12 WKS) Self-con 30/30 IS Acute tear (full thickness) 1 WKS 8 WKS Hee, C. K 2011 [ 71 ] USA Ovine (F, 65–105 kg, 3.5+Years) Self-con 60/60 IS Acute tear (full thickness) 12 WKS 12 WKS Huang, C 2020 [ 22 ] China Rabbit/NZW (F, 2.8–3.5 kg, Adult) Ran 18/18 SS Acute tear (full thickness) 4, 8, 12 WKS 4, 8, 12 WKS Huang, C 2020 [ 72 ] China Rabbit/NZW (2.8–3.5 kg, Adult) Self-con 24/24 SS Acute tear (full thickness) 4, 8 WKS 4, 8 WKS Kim, D. H 2019 [ 73 ] Korea Rat/SD (M, 300–350 g, 12 WKS) Ran 20/20 SS Acute tear (full thickness) 6, 12 WKS 6, 12 WKS Kim, S. Y 2014 [ 74 ] Korea Rat/SD (M, 410–500 g, Adult) Ran 19/19 SS Acute tear (full thickness) 1, 2, 4, 8 WKS 2, 4, 8...…”

“…Nuss, C. A [ 89 ] found that the results of Poly-N-acetyl Glucosamine (sNAG) were superior to those of simple suture. One study [ 73 ] demonstrated that alginate scaffolds had better results than simple suture. Lopitz, Y [ 78 ] found that alginate-chitin combined with recombinant human bone morphogenetic protein-2 (rhBMP-2) had better results than bare scaffolds.…”

Effects of a graphene oxide-alginate sheet scaffold on rotator cuff tendon healing in a rat model

“…Overall, the total score for a given slide could vary between 0 (a ruptured tendon) and 18 (most marked regeneration). 9 To eliminate observer error, a pathologist with at least 10 years of experience examined all slides in a randomized, blinded fashion 3 times at the same position and area of rotator cuff tissue using a microscope (Leica DM IL LED, Leica Microsystems, Wetzlar, Germany) and image system (LAS V4.8, Leica Microsystems, Wetzlar, Germany) at ×50 magnification. 40…”

“…7,8 However, natural polymers used to enhance rotator cuff healing have advantages in biocompatibility and biodegradability but often may not provide sufficient strength to serve as supports. 9–11…”

“…8,21 We previously used an alginate hydrogel scaffold to improve rotator cuff healing in a rat model of acute rotator cuff tears. 4,9 However, as alginate is a biodegradable polymer with relatively low strength and structural integrity, 22 it may not provide sufficient support for reconstructive surgery of the rotator cuff. In addition, biodegradation may occur before the healing of the rotator cuff tear is complete.…”