The Effect of Mechanical Load on Tendon-to-Bone Healing in a Rat Model

Hettrich, Carolyn M.; Gasinu, Selom; Beamer, Brandon S.; Stasiak, Mark; Fox, Allison M.; Birmingham, Patrick K.; Ying, Olivia; Deng, Xiang‐Hua; Rodeo, Scott A.

doi:10.1177/0363546514526138

Cited by 54 publications

(48 citation statements)

References 23 publications

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“…Generally, the repair processes during tendon healing seem to follow other paths than during normal developmental or true regeneration processes. The healing process is influenced by various factors, for example, the time point of surgical repair (Cavinatto et al, ; Gimbel et al, ) or the mechanical load (Hettrich et al, ). Structurally, the repairing cells had a different morphology than those of the normal tendon insertion at any time point, and these differences do not only affect the healing process but most probably also contribute to re‐tearing at the repair site (Kanazawa et al, ; Neves, Demaria, Campisi, & Jasper, ).…”

Section: Discussionmentioning

confidence: 99%

Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair

Willbold

Wellmann

Welke

et al. 2019

J Tissue Eng Regen Med

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Acute and chronic rotator cuff tears remain challenging for therapy. A wide range of therapeutic approaches were developed but re-tears and postoperative complications occur regularly. Especially in elderly people, the natural regeneration processes are decelerated, and graft materials are often necessary to stabilize the tendon-to-bone attachment and to improve the healing process. We here investigated in a small animal model a newly developed electrospun polycaprolactone fiber implant coated with a chitosan-polycaprolactone graft copolymer and compared these implants biomechanically and histologically with either a commercially available porous polyurethane implant (Biomerix 3D Scaffold) or suture-fixed tendons. Fifty-one rats were divided into three groups of 17 animals each. In the first surgery, the left infraspinatus tendons of all rats were detached, and the animals recovered for 4 weeks. In the second surgery, the tendons were fixed with suture material only (suture-fixed group; n = 17), whereas in the two experimental groups, the tendons were fixed with suture material and the polyurethane implant (Biomerix scaffold group; n = 17) or the modified electrospun polycaprolactone fiber implant (CS-g-PCL scaffold group; n=17), respectively. The unaffected right infraspinatus tendons were used as native controls. After a recovery of 8 weeks, all animals were clinically inconspicuous. In 12 animals of each group, repaired entheses were biomechanically tested for force at failure, stiffness, and modulus of elasticity, and in five animals, repaired entheses were analyzed histologically. Biomechanically, all parameters did not differ statistically significant between both implant groups, and the entheses failed typically at the surgical site.However, with respect to the force at failure, the median values of the two implant groups were smaller than the median value of the suture-fixed group. Histologically, the modified polycaprolactone fiber implant showed no acute inflammation processes, a good infiltration with cells, ingrowth of blood vessels and tendinous tissue, and a normal fibrous ensheathment. Further improvement of the implant material could be achieved by additional implementation of drug delivery systems. Therewith, the used CS-g-PCL fiber mat is a promising basic material to reach the goal of a clinically usable graft for rotator cuff tear repair.Elmar Willbold and Mathias Wellmann contributed equally to this work

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Section: Discussionmentioning

confidence: 99%

Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair

Willbold

Wellmann

Welke

et al. 2019

J Tissue Eng Regen Med

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“…To identify potential therapeutics, the relationship between tenocytes and exogenous factors needs to be elucidated. Additionally, it is known that mechanical loading influences tendon healing 114 , disease progression 95 , differentiation of stem cells into tenocytes 99 , and tendon development 86 , yet the optimal duration and amount mechanical loading to produce therapeutic effects needs to be investigated. Reaching a field-wide consensus on the pathology of the disease state will allow physicians to create standardized clinical practices to more efficiently diagnose and treat tendinopathy.…”

Section: Overviewmentioning

confidence: 99%

Tendinopathy: Investigating the Intersection of Clinical and Animal Research to Identify Progress and Hurdles in the Field

Titan

Andarawis‐Puri

2016

JBJS Rev

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Biological treatments, surgical interventions, and rehabilitation exercises have been successfully used to treat tendinopathy, but the development of effective treatments has been hindered by the lack of mechanistic data regarding the pathogenesis of the disease.While insightful, clinical studies are limited in their capacity to provide data regarding the pathogenesis of tendinopathies, emphasizing the value of animal models and cell culture studies to fill this essential gap in knowledge.Clinical pathological findings from imaging studies or histological analysis are not universal across patients with tendinopathy and have not been clearly associated with the onset of symptoms.There are several unresolved controversies, including the cellular changes that accompany the tendinopathic disease state and the role of inflammation.Additional research is needed to correlate the manifestations of the disease with its pathogenesis, with the goal of reaching a field-wide consensus on the pathology of the disease state. Such a consensus will allow standardized clinical practices to more effectively diagnose and treat tendinopathy.

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“…It has been shown in a rat model that prolonged repetitive loading at the repaired tendon complex has been associated with significantly increased collagen fibre organization, decreased matrix metalloproteinase expression and less fibrocartilage 21 days postoperatively. 10 The Mason-Allen repair has been shown to exhibit larger gap formation compared with the traditional double-row repair 11 and the SutureBridge repair, 12 while other studies have shown the SutureBridge and double row repairs to exhibit equivalent gap formation. Because double-row repairs are associated with higher material expenses and prolonged operating time and are technically more difficult for the surgeon, greater emphasis has been placed on improving the functional performance and clinical outcome of single-row procedures.…”

Section: Introductionmentioning

confidence: 98%

“…Gap formation under cyclic loading has been used as a measure of repair integrity and longevity, because motion at the tendon‐bone interface can delay or inhibit tendon‐bone healing. It has been shown in a rat model that prolonged repetitive loading at the repaired tendon complex has been associated with significantly increased collagen fibre organization, decreased matrix metalloproteinase expression and less fibrocartilage 21 days postoperatively . The Mason‐Allen repair has been shown to exhibit larger gap formation compared with the traditional double‐row repair and the SutureBridge repair, while other studies have shown the SutureBridge and double row repairs to exhibit equivalent gap formation.…”

Section: Introductionmentioning

confidence: 99%

Load response and gap formation in a single‐row cruciate suture rotator cuff repair

Huntington

Richardson

Sobol

et al. 2017

ANZ Journal of Surgery

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The Effect of Mechanical Load on Tendon-to-Bone Healing in a Rat Model

Abstract: Given the relatively high rate of failure after rotator cuff and other tendon-to-bone repairs, identification of optimal rehabilitation programs postoperatively is an important research goal.

Cited by 54 publications

References 23 publications

Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair

Possibilities and limitations of electrospun chitosan‐coated polycaprolactone grafts for rotator cuff tear repair

Tendinopathy: Investigating the Intersection of Clinical and Animal Research to Identify Progress and Hurdles in the Field

Load response and gap formation in a single‐row cruciate suture rotator cuff repair

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