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Pinto I, Kostretzis L, Katakalos K, Kazakos G, Cheva A, Chatzisotiriou A, Papadopoulos P, Ditsios K. Repair of chronic and large rotator cuff tears using extra-synovial autografts: An experimental study in rabbits. J Exp Orthop 2024; 11:e12010. [PMID: 38455456 PMCID: PMC10900185 DOI: 10.1002/jeo2.12010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose To investigate whether and how extra-synovial autografts can enhance the reconstruction of chronic and large rotator cuff tears in a rabbit subscapularis model. Methods Twenty rabbits were used to create a large subscapularis tear bilaterally. Six weeks later, the right shoulder of each rabbit was operated to repair the tear with an extra-synovial autograft, whereas the left shoulder did not undergo any surgery. At 6 and 12 weeks after the second procedure, the specimens underwent biomechanical and histological evaluation. Six more rabbits were used only as a normal reference. Results Biomechanical evaluation demonstrated that the ultimate load to failure of the Graft group (184.1 ± 35.7 N) was significantly higher (p = 0.04) than that of the Defect group (144.5 ± 32.2 N) at 12 weeks after repair, rising to 76% of the normal subscapularis tendon tensile strength. Histological analysis revealed an enhanced healing environment with neoangiogenesis and decreased inflammatory response at the repair site. Moreover, the tendon maturing score of the Graft group increased substantially from 6 (15.8 ± 0.9) to 12 (23.1 ± 0.6) weeks after repair (p = 0.01). Conclusion In vivo data support the efficacy of extra-synovial autograft interposition in repairing chronic and large rotator cuff tears in a rabbit subscapularis model. The autografts were capable of enhancing the biomechanical properties of the repaired tendons, as evidenced by increased tensile strength, and forming new connective tissue simulating a fibrocartilage zone, as revealed by histological evaluation. Level of Evidence N/A.
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Affiliation(s)
- Iosafat Pinto
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Konstantinos Katakalos
- Laboratory for Strength of Materials and Structures, Civil Engineering DepartmentAristotle University of ThessalonikiThessalonikiGreece
| | - George Kazakos
- School of Veterinary MedicineAristotle University of ThessalonikiThessalonikiGreece
| | - Angeliki Cheva
- Pathology Department, School of MedicineAristotle University of ThessalonikiThessalonikiGreece
| | | | - Pericles Papadopoulos
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, Aristotle University of ThessalonikiGeneral Hospital of Thessaloniki “G.Gennimatas”ThessalonikiGreece
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Liu WC, Chang CH, Chen CH, Lu CK, Ma CH, Huang SI, Fan WL, Shen HH, Tsai PI, Yang KY, Fu YC. 3D-Printed Double-Helical Biodegradable Iron Suture Anchor: A Rabbit Rotator Cuff Tear Model. MATERIALS 2022; 15:ma15082801. [PMID: 35454494 PMCID: PMC9027822 DOI: 10.3390/ma15082801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/16/2022]
Abstract
Suture anchors are extensively used in rotator cuff tear surgery. With the advancement of three-dimensional printing technology, biodegradable metal has been developed for orthopedic applications. This study adopted three-dimensional-printed biodegradable Fe suture anchors with double-helical threads and commercialized non-vented screw-type Ti suture anchors with a tapered tip in the experimental and control groups, respectively. The in vitro study showed that the Fe and Ti suture anchors exhibited a similar ultimate failure load in 20-pound-per-cubic-foot polyurethane foam blocks and rabbit bone. In static immersion tests, the corrosion rate of Fe suture anchors was 0.049 ± 0.002 mm/year. The in vivo study was performed on New Zealand white rabbits and SAs were employed to reattach the ruptured supraspinatus tendon. The in vivo ultimate failure load of the Fe suture anchors was superior to that of the Ti suture anchors at 6 weeks. Micro-computed tomography showed that the bone volume fraction and bone surface density in the Fe suture anchors group 2 and 6 weeks after surgery were superior, and the histology confirmed that the increased bone volume around the anchor was attributable to mineralized osteocytes. The three-dimensional-printed Fe suture anchors outperformed the currently used Ti suture anchors.
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Affiliation(s)
- Wen-Chih Liu
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (W.-C.L.); (C.-H.C.)
- Department Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Chih-Hau Chang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
| | - Chung-Hwan Chen
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (W.-C.L.); (C.-H.C.)
- Department Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 912301, Taiwan
- Department of Orthopedic Surgery, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80145, Taiwan
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
| | - Chun-Kuan Lu
- Department of Orthopedic Surgery, Park One International Hospital, Kaohsiung 81367, Taiwan;
| | - Chun-Hsien Ma
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
| | - Shin-I Huang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
| | - Wei-Lun Fan
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
| | - Hsin-Hsin Shen
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
| | - Pei-I Tsai
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
| | - Kuo-Yi Yang
- Biomedical Technology and Device Research Laboratories, Industrial Technology Research Institute, Hsinchu 31057, Taiwan; (C.-H.M.); (S.-I.H.); (W.-L.F.); (H.-H.S.); (P.-I.T.)
- Correspondence: (K.-Y.Y.); (Y.-C.F.)
| | - Yin-Chih Fu
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan; (W.-C.L.); (C.-H.C.)
- Department Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Orthopedic Research Center, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan;
- Department of Orthopedics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (K.-Y.Y.); (Y.-C.F.)
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Sgroi M, Kranz ,M, Seitz AM, Ludwig M, Faschingbauer M, Zippelius T, Reichel H, Kappe T. Comparison of Knotless and Knotted Single-Anchor Repair for Ruptures of the Upper Subscapularis Tendon: Outcomes at 2-Year Follow-up. Orthop J Sports Med 2022; 10:23259671221083591. [PMID: 35309232 PMCID: PMC8928393 DOI: 10.1177/23259671221083591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Both knotted and knotless single-anchor repair techniques are used to repair transmural ruptures of the upper subscapularis (SSC) tendon. However, it is still unclear which technique provides better clinical and radiological results. Purpose/Hypothesis: To compare the clinical and magnetic resonance imaging (MRI) outcomes of knotless and knotted single-anchor repair techniques in patients with a transmural rupture of the upper SSC tendon at 2-year follow-up. It was hypothesized that the 2 techniques would not differ significantly in outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Forty patients with a transmural tear of the upper SSC tendon (grade 2 or 3 according to Fox and Romeo) were retrospectively enrolled. Depending on the repair technique, patients were assigned to either the knotless single-anchor or knotted single-anchor group. After a mean follow-up of 2.33 ± 0.43 years, patients were assessed by the ASES, WORC, OSS, CS, and SSV. A clinical examination that included the bear-hug, the lift-off, and the belly-press tests was performed, in which the force exerted by the subjects was measured. In addition, all patients underwent MRI of the affected shoulder to assess repair integrity, tendon width, fatty infiltration, signal-to-signal ratio of the upper and lower SSC muscle, and atrophy of the SSC muscle. Results: No significant difference was found between the 2 groups on any of the clinical scores [ASES (P = .272), WORC (P = .523), OSS (P = .401), CS (P = .328), SSV (P = .540)] or on the range-of-motion or force measurements. Apart from a higher signal-to-signal ratio of the lower SSC muscle in the knotless group (P = .017), no significant difference on imaging outcomes was found between the 2 groups. Conclusion: Both techniques can be used in surgical practice, as neither was found to be superior to the other in terms of clinical or imaging outcomes at 2-year follow-up.
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Affiliation(s)
- Mirco Sgroi
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - , Marilena Kranz
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Marius Ludwig
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | | | - Timo Zippelius
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Heiko Reichel
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
| | - Thomas Kappe
- Department for Orthopaedic Surgery, University of Ulm, RKU, Ulm, Germany
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Deng H, Mi Y, Lu B, Xu P. Application of virtual touch tissue imaging quantification in diagnosis of supraspinatus tendon injury. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2021; 29:881-890. [PMID: 34120947 DOI: 10.3233/xst-210865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the value of virtual touch imaging and quantification (VTIQ) shear wave elastography (SWE) in diagnosis of supraspinatus tendon tear. METHODS Eighty patients with unilateral supraspinatus tendon tear underwent shoulder arthroscopy were prospective studied. Tendinopathy, partial-thickness tear or full-thickness tear of supraspinatus tendon were diagnosed according 2D ultrasound examination. Sensitivity, specificity and accuracy of ultrasonic diagnosis of supraspinatus tendon tear were calculated by arthroscopy as the gold standard. VTIQ was applied to measure the shear-wave velocity (SWV) of both normal and affected supraspinatus tendon. The differences of SWV in three types of supraspinatus tendon tear and receiver operating characteristic (ROC) curves were analyzed. RESULTS Among 80 patients, there were 20 tendinopathy, 31 partial tears and 29 full-thickness tears diagnosed by shoulder arthroscopy. Sensitivity, specificity and accuracy of 2D ultrasound in diagnosis of tendinopathy, partial tear and full-thickness tear groups were 78%, 90%and 83%; 71%, 86%and 73%; 86%, 88%and 88%, respectively. SWV of 80 supraspinatus tendon tears was 4.59±1.00 m/s, which was lower than that of normal supraspinatus tendon (4.59±1.00 m/s vs. 6.68±1.05 m/s, P < 0.01). SWV of supraspinatus tendon in tendinopathy, partial tear and full-thickness tear groups respectively were 5.66±0.97, 4.66±1.00, and 3.78±0.55 m/s, all lower than that of the contralateral normal supraspinatus tendon (all P < 0.05). In addition, the analysis of variance and pairwise comparison showed that SWV of supraspinatus tendon among three different degree of injury was statistically significant (all P < 0.001). The cutoff thresholds of SWV was 4.83 m/s to identify tendinopathy tear from partial tear and was 4.08 m/s to identify full-thickness tear from partial-thickness tear. CONCLUSION VTIQ SWE with SWV might identify degree of supraspinatus tendon tear and improve the value of ultrasonography, which should be further evaluated in large multicenter studies.
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Affiliation(s)
- Heping Deng
- Department of Ultrasonography, Hebei Medical Universitiy Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Yaru Mi
- Department of Ultrasonography, Hebei Medical Universitiy Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Bo Lu
- Department of Orthopaedics, Hebei Medical Universitiy Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - Ping Xu
- Department of Ultrasonography, Hebei Medical Universitiy Third Affiliated Hospital, Shijiazhuang, Hebei, China
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