Tissue-Engineered Rotator Cuff Tendon Using Porcine Small Intestine Submucosa

Abstract

To determine its efficacy in stimulating the regeneration of a rotator cuff tendon, an implant of 10-ply porcine small intestinal submucosa was used to replace a completely resected infraspinatus tendon in 21 adult mongrel dogs. The contralateral infraspinatus tendon was elevated and then reattached to the greater tubercle with sutures to mimic conventional repair (sham operation). Mechanical evaluations were performed at 0, 3, and 6 months (five specimens at each time period). Histologic comparisons were made at 3 and 6 months (three specimens). At both times, the gross appearance, histologic continuity, and failure mode of the constructs mimicked those of sham-operated and native infraspinatus tendons, thus suggesting host tissue ingrowth and implant remodeling with solid integration of the regenerated tissue to muscular and bony interfaces. Tissue ingrowth occurred without histologic evidence of foreign body or immune-mediated reactions or adhesions to peripheral tissues. Sham operations simulated tendon mobilization and reimplantation procedures routinely performed to treat chronic rotator cuff tendon injuries. Although the ultimate strength of small intestinal submucosa-regenerated tendons was significantly less than that of native infraspinatus tendons (P < 0.001), it was similar to that of reimplanted tendons at 3 (P > 0.05) and 6 months (P > 0.05).

Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device

“…Experimental Design E ight adult, male mongrel dogs (25 to 30 kg) underwent bilateral shoulder surgery 30,31 as approved by the Institutional Animal Care and Use Committee at our institution. Both shoulders received the same tendon injury: partial release of the superior 8 to 9 mm of the infraspinatus tendon, which constitutes approximately two-thirds of the full tendon width.…”

“…The humeri were secured in aluminum pots with Cerrobend (Cerro bismuth alloy; McMaster-Carr, Robinsonville, New Jersey). The cross-sectional area of the repair construct was estimated from caliper measurements 31 of the width and thickness of the tissue at the bone repair site, assuming an elliptical cross-section. A custom cryo-clamp was used to grip the muscle belly 32 .…”

“…To address these challenges, natural and synthetic devices have been investigated for the reinforcement of rotator cuff repairs. Rotator cuff repair with devices derived from polylactic acid [26][27][28] , polytetrafluoroethylene 29 , extracellular matrix [30][31][32][33][34][35] , chitin 36 , and chitosanhyaluronan 37 have been studied in animal models over the past decade. Of these, only extracellular matrix derived from dermis, small intestine submucosa, fascia lata, and pericardium are commercially available for rotator cuff repair at the current time 38 .…”

Use of a bioscaffold to improve healing of a patellar tendon defect after graft harvest for ACL reconstruction: A study in rabbits

“…[16][17][18] An extracellular matrix derived bioscaffold, namely the porcine small intestinal submucosa (SIS), has been successfully used to enhance the repair of ligaments and tendons. [19][20][21][22][23] SIS possesses unique properties including a preferentially aligned collagen type I matrix which is thought to provide contact guidance for the healing cells. Additionally, SIS contains a variety of growth factors capable of attracting healing cells through chemotaxis.…”

In vitro study comparing two collageneous membranes in view of their clinical application for rotator cuff tendon regeneration

“…14 Many experimental studies support the use of SIS in musculoskeletal soft tissue healing such as meniscus, Achilles tendon, and rotator cuff tears. [15][16][17][18] GJ is reported to retain the major biological component of dermis including collagen types I, III, IV, VII, elastin, proteoglycans (chondroytin sulphate and hyaluronic acid), laminin, tenacin, fibroblast growth factor (bFGF), and blood vessel channels. 19 Therefore, both biomaterials mimic ECM by providing structural components that can physically and biologically support tenocyte growth and function also with the addition of growth factors favoring cell proliferation and ECM synthesis.…”