WITHDRAWN: Interventions for tears of the rotator cuff in adults

A new decellularized tendon scaffold for rotator cuff tears - evaluation in rabbits

Background

Scaffolds have considerably advanced in recent years. In orthopaedic surgery, scaffolds have been used as grafts in procedures involving tendon and ligament reconstruction. This paper aimed to produce and evaluate decellularized tendon scaffolds (DTSs) from biomechanical, microscopic, macroscopic and in vivo perspectives.

Methods

Bilateral gastrocnemius muscle tendons from 18 adult New Zealand rabbits were collected. Of these 36 tendons, 11 were used as controls (Group A - control), and 25 were used in the decellularization protocol (Group B - DTS). The groups were subjected to histological, biomechanical and macroscopic analyses, and Group B - DTS was subjected to an additional in vivo evaluation. In the decellularization protocol, we used a combination of aprotinin, ethylenediamine tetraacetic acid (EDTA), sodium dodecyl sulfate (SDS) and t-octyl-phenoxypolyethoxyethanol (Triton X-100) for six days. During this period, the scaffolds were kept at room temperature on an orbital shaker with constant motion.

Results

The DTSs showed an increased cross-sectional area and inter-fascicular distance and no change in parallelism or matrix organization. The nuclear material was not organized in the DTSs as it was in the control. In the biomechanical analysis, no significant differences were found between the groups after analysing the ultimate tensile load, stiffness, and elongation at the ultimate tensile load. During the in vivo evaluation, mononuclear cell infiltration was noted.

Conclusions

The evaluated decellularization protocol generated a tendon scaffold, maintained the most important biomechanical characteristics and permitted cell infiltration.

Operatively treated traumatic versus non-traumatic rotator cuff ruptures: a registry study

BACKGROUND

Operative treatment of traumatic rotator cuff ruptures, i.e. ruptures with a predisposing traumatic event, is reported to yield superior results compared to operative treatment of non-traumatic, degenerative ruptures.

AIM

The purpose of this study was to evaluate the difference of outcome, peroperative findings, and demographics after operative treatment of traumatic versus non-traumatic rotator cuff rupture.

METHODS

A total of 306 consecutive shoulders with an operated rotator cuff rupture (124 traumatic and 182 non-traumatic) were followed up. Constant and Murley score, size of the rupture, and age of the patients were used as an outcome measure.

RESULTS

A total of 112 traumatic and 167 non-traumatic rotator cuff rupture shoulders were available for 1-year follow-up (91%). Mean Constant and Murley score was preoperatively lower in the traumatic group (46 versus 52, P = 0.01). At 3 months postoperatively, Constant and Murley scores were 61 and 60 (P = 0.72) and at 1 year 73 and 77 (P = 0.03), respectively. Altogether 91% of the patients in the traumatic and 93% in the non-traumatic group were satisfied with the final outcome (P = 0.45). In 94% of traumatic and 95% of a non-traumatic cases the rupture involved the supraspinatus tendon. In the traumatic group the rupture was larger and involved more frequently the whole supraspinatus insertion area (41% versus 17%, P < 0.0001). Mean age of patients was 58 and 57 years, respectively.

CONCLUSION

Operative treatment of both traumatic and non-traumatic rotator cuff ruptures gives essentially good results. In our cohort, patients' recollection of predisposing trauma reflects the size of the rotator cuff rupture, but does not reflect the age of the patients.