A Composite PET-matrix Patch Enhances Tendon Regeneration and Tendon-to-bone Integration for Bridging Repair of the Chronic Massive Rotator Cuff Tears in a Rabbit Model

Overview

Journal Regen Biomater

Specialty Biomedical Engineering

Date 2024 Jul 1

PMID 38948337

Authors

Yuyan Na

Hao Jue

Tian Xia

Moxin Li

Xiaoao Xue

Yinghui Hua

Affiliations

Soon will be listed here.

Abstract

In recent years, bridging repair has emerged as an effective approach for the treatment of massive rotator cuff tears (MRCTs). The objective of this study was to develop a composite patch that combines superior mechanical strength and biocompatibility and evaluate its potential for enhancing the outcomes of bridging repair for MRCTs. The composite patch, referred to as the PET-matrix patch (PM), was fabricated by immersing a plain-woven PET patch in decellularized matrix gel and utilizing the freeze-drying technique. The results demonstrated that the PM has reliable mechanical properties, with a maximum failure load of up to 480 N. The decellularized matrix sponge (DMS), present on the surface of the PM, displayed a loose and porous structure, with an average pore size of 62.51 μm and a porosity of 95.43%. experiments showed significant elongation of tenocytes on the DMS, with cells spanning across multiple pores and extending multiple protrusions as observed on SEM images. In contrast, tenocytes on the PET patch appeared smaller in size and lacked significant elongation. Additionally, the DMS facilitated the proliferation, migration and differentiation of tenocytes. In a rabbit model of chronic MRCTs, the PM group showed superior outcomes compared to the PET group at 4, 8 and 12 weeks after bridging repair. The PM group displayed significantly higher tendon maturing score, larger collagen diameter in the regenerated tendon and improved tendon-to-bone healing scores compared to the PET group (<0.05). Moreover, the maximum failure load of the tendon-bone complex in the PM group was significantly higher than that in the PET group (<0.05). In summary, the PM possesses reliable mechanical properties and excellent cytocompatibility, which can significantly improve the outcomes of bridging repair for chronic MRCTs in rabbits. Therefore, it holds great potential for clinical applications.

References

Madaghiele M, Sannino A, V Yannas I, Spector M . Collagen-based matrices with axially oriented pores. J Biomed Mater Res A. 2007; 85(3):757-67. DOI: 10.1002/jbm.a.31517. View

Chen T, Zhang P, Chen J, Hua Y, Chen S . Long-Term Outcomes of Anterior Cruciate Ligament Reconstruction Using Either Synthetics With Remnant Preservation or Hamstring Autografts: A 10-Year Longitudinal Study. Am J Sports Med. 2017; 45(12):2739-2750. DOI: 10.1177/0363546517721692. View

Zheng Z, Ran J, Chen W, Hu Y, Zhu T, Chen X . Alignment of collagen fiber in knitted silk scaffold for functional massive rotator cuff repair. Acta Biomater. 2017; 51:317-329. DOI: 10.1016/j.actbio.2017.01.041. View

Kilkenny C, Browne W, Cuthill I, Emerson M, Altman D . Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research. PLoS Biol. 2010; 8(6):e1000412. PMC: 2893951. DOI: 10.1371/journal.pbio.1000412. View

Vogler T, Andreou D, Gosheger G, Kurpiers N, Velmans C, Ameziane Y . Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears. PLoS One. 2020; 15(11):e0241277. PMC: 7660551. DOI: 10.1371/journal.pone.0241277. View

Lewington M, Ferguson D, Smith T, Burks R, Coady C, Wong I . Graft Utilization in the Bridging Reconstruction of Irreparable Rotator Cuff Tears: A Systematic Review. Am J Sports Med. 2017; 45(13):3149-3157. DOI: 10.1177/0363546517694355. View

Ide J, Tokunaga T . Rotator cuff tendon-to-bone healing at 12 months after patch grafting of acellular dermal matrix in an animal model. J Orthop Sci. 2017; 23(2):207-212. DOI: 10.1016/j.jos.2017.11.018. View

Bi M, Zhou K, Gan K, Ding W, Zhang T, Ding S . Combining fascia lata autograft bridging repair with artificial ligament internal brace reinforcement : a novel healing-improvement technique for irreparable massive rotator cuff tears. Bone Joint J. 2021; 103-B(10):1619-1626. DOI: 10.1302/0301-620X.103B10.BJJ-2020-2546.R2. View

Zhong Y, Jin W, Gao H, Sun L, Wang P, Zhang J . A Knitted PET Patch Enhances the Maturation of Regenerated Tendons in Bridging Reconstruction of Massive Rotator Cuff Tears in a Rabbit Model. Am J Sports Med. 2023; 51(4):901-911. DOI: 10.1177/03635465231152186. View

10.

Kataoka T, Kokubu T, Muto T, Mifune Y, Inui A, Sakata R . Rotator cuff tear healing process with graft augmentation of fascia lata in a rabbit model. J Orthop Surg Res. 2018; 13(1):200. PMC: 6090682. DOI: 10.1186/s13018-018-0900-4. View

11.

Saveh-Shemshaki N, Barajaa M, Otsuka T, Mirdamadi E, Nair L, Laurencin C . Electroconductivity, a regenerative engineering approach to reverse rotator cuff muscle degeneration. Regen Biomater. 2023; 10:rbad099. PMC: 10676522. DOI: 10.1093/rb/rbad099. View

12.

Lin J, Sun Y, Chen Q, Liu S, Ding Z, Chen J . Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review. Am J Sports Med. 2019; 48(11):2828-2838. DOI: 10.1177/0363546519889040. View

13.

Yagmur Ozturk B, Ak S, Gultekin O, Baykus A, Kulduk A . Prospective, randomized evaluation of latissimus dorsi transfer and superior capsular reconstruction in massive, irreparable rotator cuff tears. J Shoulder Elbow Surg. 2021; 30(7):1561-1571. DOI: 10.1016/j.jse.2021.01.036. View

14.

Varvitsiotis D, Dimitrios V, Papaspiliopoulos A, Athanasios P, Antipa E, Eleni A . Results of reconstruction of massive irreparable rotator cuff tears using a fascia lata allograft. Indian J Orthop. 2015; 49(3):304-11. PMC: 4443412. DOI: 10.4103/0019-5413.156202. View

15.

Lee Y, Jeong J, Park C, Kang S, Yoo J . Evaluation of the Risk Factors for a Rotator Cuff Retear After Repair Surgery. Am J Sports Med. 2017; 45(8):1755-1761. DOI: 10.1177/0363546517695234. View

16.

Yokoya S, Mochizuki Y, Natsu K, Omae H, Nagata Y, Ochi M . Rotator cuff regeneration using a bioabsorbable material with bone marrow-derived mesenchymal stem cells in a rabbit model. Am J Sports Med. 2012; 40(6):1259-68. DOI: 10.1177/0363546512442343. View

17.

Pu J, Yuan F, Li S, Komvopoulos K . Electrospun bilayer fibrous scaffolds for enhanced cell infiltration and vascularization in vivo. Acta Biomater. 2014; 13:131-41. DOI: 10.1016/j.actbio.2014.11.014. View

18.

Xu J, Huang K, Han K, Wu X, Li Z, Zheng T . The Plug-Type Patch Results in Immediate and Postoperative Advantages in Graft-to-Bone Integration for Bridging Massive Rotator Cuff Tears in a Chronic Rabbit Model. Am J Sports Med. 2022; 50(9):2497-2507. DOI: 10.1177/03635465221101416. View

19.

Xu J, Han K, Ye Z, Wu C, Wu X, Li Z . Biomechanical and Histological Results of Dual-Suspensory Reconstruction Using Banded Tendon Graft to Bridge Massive Rotator Cuff Tears in a Chronic Rabbit Model. Am J Sports Med. 2022; 50(10):2767-2781. DOI: 10.1177/03635465221102744. View

20.

Albers S, Ono Y, Kirchner F, Farkhondeh Fal M, Kircher J . Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch). J Shoulder Elbow Surg. 2023; 33(2):312-320. DOI: 10.1016/j.jse.2023.06.024. View