Reconstruction of large chronic rotator cuff tear can benefit from the bone–tendon composite autograft to restore the native bone–tendon interface

Abstract

Purpose We designed a paired controlled study to investigate the advantages of using bone–tendon composite autograft to reconstruct chronic rotator cuff tear compared with primary repair and provide some evidence to use the bone–tendon composite autograft. Method Thirty-eight Sprague–Dawley rats were used. The native bone–tendon junctions of supraspinatus and Achilles tendon insertion from two rats were harvested for gross and histological observation. Another thirty-six rats had bilateral supraspinatus tenotomy from the great tuberosity. Three weeks later, primary repair (simple tendon pullout direct repair to bone) was performed on one side and the other side was reconstructed using an Achilles–calcaneus composite autograft from the ipsilateral leg. Nine rats were sacrificed for biomechanical testing and another three were sacrificed for histological evaluation at 3, 6, and 9 weeks after surgery, respectively. Results The Achilles–calcaneus composite autograft group showed significantly better biomechanical characteristics at 3 and 6 weeks in terms of maximum load and stiffness. Tissue histology demonstrated an organised extracellular matrix, a clear tidemark, and distinct fibrocartilage layers in the composite graft group, similar to those of the native bone–tendon interface. Additionally, clear bone-to-bone healing and tendon-to-tendon healing were observed. By contrast, the conventional primary repair could not regenerate the structure of the native bone–tendon interface. Conclusions Bone–tendon autograft for chronic rotator cuff reconstruction is superior to the primary repair regarding biomechanical property and histological structure. Our study may provide some evidence in support of the reconstruction of a chronic rotator cuff tear using bone–tendon composite autografts in clinical practice. The Translational potential of this article The current study finds the bone-tendon autograft can restore the normal bone-tendon interface, which can not regenerate after repair and is the key factor affecting re-tear. The bone-tendon autografts from our body can be the candidates for rotator cuff tear reconstruction especially the large to massive rotator cuff tear in the future to reduce the re-tear after rotator cuff tear.

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

“…Ficklscherer, A [ 124 ] found that comparing autologous Achilles tendon bursa tissue with simple suture, the former resulted in higher content of collagen Ⅱ in the repaired site. Sun, Y [ 125 ] demonstrated that the bone-tendon composite autograft group had a higher tendon maturity score than simple suture. Chen, Y [ 126 ] discussed the stem cell sheets derived from urine of the patient, and the comparison with the tendon-bone suture showed that the cell sheet group presented more collagen fibers at the tendon-bone interface.…”

Nano-calcium silicate mineralized fish scale scaffolds for enhancing tendon-bone healing

“…Recently, there have been a number of promising new advances and strategies for the enhancement of tendon-bone healing. For example, novel decellularised matrix scaffolds with a special structure have shown the advantage of improved enthesis regeneration [ 52 , 53 ]. Some researchers proposed a book-shaped acellular scaffold by sectioning the natural fibrocartilage to fabricate a book-shaped decellularised matrix scaffold, which displayed an excellent capability of cell delivery and inducibility of fibrocartilage formation [ 54 , 55 ].…”

Engineering an extracellular matrix-functionalized, load-bearing tendon substitute for effective repair of large-to-massive tendon defects

“…Firstly, creating a large segmental defect in the rat SSPT posed a considerable challenge. Despite the rat's SSPT having a total length of approximately 16.2 mm [ 67 ], the majority of the tendon is embedded within the supraspinatus muscle, resulting in less than 3.5 mm of exposed tendon length [ 41 , 68 ]. Due to the small size of the rat SSPT, our assessment options are limited to employing a bone-to-tendon defect approach to assess the therapeutic effect of the BioTenoForce scaffold.…”