Tendon to bone tunnel healing—A study on the time‐dependent changes in biomechanics, bone remodeling, and histology in a rat model

Hjorthaug, Geir Aasmund; Madsen, Jan Erik; Nordsletten, Lars; Reinholt, Finn P.; Steen, Harald; Dimmen, Sigbjørn

doi:10.1002/jor.22756

Cited by 29 publications

(36 citation statements)

References 21 publications

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“…Besides, tendon–bone ruptures such as in rotator cuff tendon injuries require surgeries to fix the tendon–bone interface by attaching a tendon graft to the bone (Lu and Thomopoulos, ). However, these surgeries usually fail to effectively secure the attachment between the tendon graft and bone (Atesok et al , ; Fu et al , ; Galatz et al , , ; Hjorthaug et al , ) because of the lack of fibrocartilage zone formation in the tendon–bone interface.…”

Section: Introductionmentioning

confidence: 99%

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface

Zhou

Zhang

Yang

et al. 2017

J Tissue Eng Regen Med

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Treatment of tendon-bone junction injuries is a challenge because tendon-bone interface often heals poorly and the fibrocartilage zone, which reduces stress concentration, at the interface is not formed. In this study, we used a compound called kartogenin (KGN) with platelet-rich plasma (PRP) to induce the formation of fibrocartilage zone in a rat tendon graft-bone tunnel model. The experimental rats received KGN-PRP or PRP injections in the tendon graft-bone tunnel interface. The control group received saline. After 4, 8 and 12 weeks, Safranin O staining of the tendon graft-bone tunnels revealed abundant proteoglycans in the KGN-PRP group indicating the formation of cartilage-like transition zone. Immunohistochemical and immuno-fluorescence staining revealed collagen types I (Col-I) and II (Col-II) in the newly formed fibrocartilage zone. Both fibrocartilage zone formation and maturation were healing time dependent. In contrast, the PRP and saline control groups had no cartilage-like tissues and minimal Col-I and Col-II staining. Some gaps were also present in the saline control group. Finally, pull-out strength in the KGN-PRP-treated group at 8 weeks was 1.4-fold higher than the PRP-treated group and 1.6-fold higher than the saline control group. These findings indicate that KGN, with PRP as a carrier, promotes the formation of fibrocartilage zone between the tendon graft and bone interface. Thus, KGN-PRP may be used as a convenient cell-free therapy in clinics to promote fibrocartilage zone formation in rotator calf repair and anterior cruciate ligament reconstruction, thereby enhancing the mechanical strength of the tendon-bone interface and hence the clinical outcome of these procedures. Copyright

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Section: Introductionmentioning

confidence: 99%

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface

Zhou

Zhang

Yang

et al. 2017

J Tissue Eng Regen Med

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“…Tendons and ligaments attach to bone through a transitional fibrocartilage zone that has complex biomechanical properties. This unique tissue structure is often not regenerated during the healing of an injury and/or surgical reattachment [ 19 ]. A natural, porous, easy-to-use, multilayered, decellularized “book” fibrocartilage scaffold was developed.…”

Section: Discussionmentioning

confidence: 99%

Preparation and Characterization of a Novel Decellularized Fibrocartilage “Book” Scaffold for Use in Tissue Engineering

et al. 2015

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At the tendon-to-bone insertion, there is a unique transitional structure: tendon, non-calcified fibrocartilage, calcified fibrocartilage, and bone. The reconstruction of this special graded structure after defects or damage is an important but challenging task in orthopedics. In particular, reconstruction of the fibrocartilage zone has yet to be successfully achieved. In this study, the development of a novel book-shape scaffold derived from the extracellular matrix of fibrocartilage was reported. Specifically, fibrocartilage from the pubic symphysis was obtained from rabbits and sliced into the shape of a book (dimensions: 10 mm × 3 mm × 1 mm) with 10 layers, each layer (akin to a page of a book) with a thickness of 100-μm. These fibrocartilage “book” scaffolds were decellularized using sequentially 3 freeze-thaw cycles, 0.1% Triton X-100 with 1.5 M KCl, 0.25% trypsin, and a nuclease. Histology and DNA quantification analysis confirmed substantial removal of cells from the fibrocartilage scaffolds. Furthermore, the quantities of DNA, collagen, and glycosaminoglycan in the fibrocartilage were markedly reduced following decellularization. Scanning electron microscopy confirmed that the intrinsic ultrastructure of the fibrocartilage tissue was well preserved. Therefore, the results of this study suggest that the novel “book” fibrocartilage scaffold could have potential applications in tissue engineering.

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“…The graft was pulled manually into the bone tunnel. The ends of grafts were sutured into the adjacent periosteum and soft tissue and wound were closed in layers ( Figure 1(c) ) [ 27 ]. The experiment group was treated intragastrically with baicalein (10 mg/kg/d) for 3 weeks or 6 weeks, while the control group was treated with normal saline.…”

Section: Methodsmentioning

confidence: 99%

Baicalein Accelerates Tendon-Bone Healing via Activation of Wnt/β-Catenin Signaling Pathway in Rats

Tian

Jiang

Chen

et al. 2018

BioMed Research International

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Background Tendon-bone healing is a reconstructive procedure which requires a tendon graft healing to a bone tunnel or to the surface of bone after the junction injury between tendon, ligament, and bone. The surgical reattachment of tendon to bone often fails due to regeneration failure of the specialized tendon-bone junction. Materials and Methods An extra-articular tendon-bone healing rat model was established to discuss the effect of the baicalein 10 mg/(kg·d) in accelerating tendon-bone healing progress. Also, tendon-derived stem cells (TDSCs) were treated with various concentrations of baicalein or dickkopf-1 (DKK-1) to stimulate differentiation for 14 days. Results In vivo, tendon-bone healing strength of experiment group was obviously stronger than the control group in 3 weeks as well as in 6 weeks. And there were more mature fibroblasts, more Sharpey fibers, and larger new bone formation area treated intragastrically with baicalein compared with rats that were treated with vehicle for 3 weeks and 6 weeks. In vitro, after induction for 14 days, the expressions of osteoblast differentiation markers, that is, alkaline phosphatase (ALP), runt-related transcription factor 2 (Runx2), osteocalcin (OCN), osterix (OSX), and collagen I, were upregulated and Wnt/β-catenin signaling pathway was enhanced in TDSCs. The effect of DKK-1 significantly reduced the effect of baicalein on the osteogenic differentiation. Conclusion These data suggest that baicalein may stimulate TDSCs osteogenic differentiation via activation of Wnt/β-catenin signaling pathway to accelerate tendon-bone healing.

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Tendon to bone tunnel healing—A study on the time‐dependent changes in biomechanics, bone remodeling, and histology in a rat model

Cited by 29 publications

References 21 publications

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface

Kartogenin with PRP promotes the formation of fibrocartilage zone in the tendon-bone interface

Preparation and Characterization of a Novel Decellularized Fibrocartilage “Book” Scaffold for Use in Tissue Engineering

Baicalein Accelerates Tendon-Bone Healing via Activation of Wnt/β-Catenin Signaling Pathway in Rats

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