Rotator Cuff Repair With Autologous Tenocytes and Biodegradable Collagen Scaffold: A Histological and Biomechanical Study in Sheep
Rotator Cuff Repair With Autologous Tenocytes and Biodegradable Collagen Scaffold: A Histological and Biomechanical Study in Sheep
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DOI：
10.1177/0363546519892580
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发表时间：
2019-12-16
影响因子：
4.8
通讯作者：
Mueller, Peter E.
中科院分区：
文献类型：
--
作者：
Rossbach, Bjoern P.;Guelecyuez, Mehmet F.;Mueller, Peter E.
背景：肩袖大撕裂在骨科仍是一个具有挑战性的问题。肌腱细胞在生物材料/支架上应用于修复较大的肩袖缺损可能是肌腱再生领域的一种有前途的方法。假设：在绵羊模型的肩袖修复后，种植在胶原支架上的培养的自体肌腱细胞与急性环境中未种植的支架相比，导致组织学和生物力学结果增强。研究设计：对照实验室研究。方法：在24只绵羊右前肢冈下肌腱的肌腱-骨交界处造成3.5×1.5 cm的肌腱缺损区。将绵羊随机分为三组，第一组为缺损组，第二组植入未种植的胶原支架，第三组植入自体肌腱细胞种植的胶原支架。术后12周，对肌腱再生进行组织学和生物力学检查。结果：与第1、2组相比，第3组新生肌腱具有更好的纤维形态、更多的蛋白多糖生成和更多的III型胶原生成。免疫组织化学染色显示，第3组与第1、2组相比，组织脱分化较少，软骨层结构更规整，软骨-骨过渡均匀。生物力学测试显示，第3组重建肌腱的拉伸强度(平均载荷为2516N；SD为407.5 N)约为天然肌腱的84%(平均载荷为2995N；SD为223.1 N)，但无统计学意义。第1组(66.9%，平均载荷为2004N；SD，273.8 N)和第2组(69.7%，平均载荷为2088N；SD，675.4 N)与自然肌腱之间的平均极限拉伸强度有显著差异(P=0.0095)。在断裂应力方面，第1组(平均断裂应力1335N/mm(2)；SD，182.7 N/mm(2))和第2组(断裂应力，1392N/mm(2)；SD，450.2 N/mm(2))与自然肌腱(平均断裂应力，1996N/mm(2)；SD，148.7 N/mm(2))之间有显著差异(P=0.0095)。同样，第3组(平均断裂应力为1677N/mm(2)；SD为271.7 N/mm(2))与天然肌腱无显著差异。结论：在急性环境下，肌腱-骨重建后，在胶原支架上种植自体肌腱细胞的生物力学效果优于未种植的支架。生物力学结果和组织学结果显示，自体肌腱细胞与特定载体基质的使用可能是修复肩袖撕裂的一种新方法。
Background: Large rotator cuff tears still represent a challenging problem in orthopaedics. The use of tenocytes on biomaterials/scaffolds for the repair of large rotator cuff defects might be a promising approach in the field of tendon regeneration. Hypothesis: Cultivated autologous tenocytes seeded on a collagen scaffold lead to enhanced histological and biomechanical results after rotator cuff repair in a sheep model as compared with unseeded scaffolds in an acute setting. Study Design: Controlled laboratory study. Methods: At the tendon-bone junction of the infraspinatus tendon of the right foreleg of 24 sheep, a 3.5 x 1.5-cm tendon defect was created. Sheep were randomly allocated to group 1, a defect; group 2, where an unseeded collagen scaffold was implanted; or group 3, which received the implantation of a collagen scaffold seeded with autologous tenocytes. Twelve weeks postoperatively, tendon regeneration was examined histologically and biomechanically. Results: The histology of the neotendons of group 3 showed better fiber patterns, a higher production of proteoglycans, and an increased genesis of collagen III in contrast to groups 1 and 2. Immunostaining revealed less tissue dedifferentiation, a more structured cartilage layer, and homogeneous cartilage-bone transition in group 3 in comparison with groups 1 and 2. Biomechanically, the tensile strength of the reconstructed tendons in group 3 (mean load to failure, 2516 N; SD, 407.5 N) was approximately 84% that of the native tendons (mean load to failure, 2995 N; SD, 223.1 N) without statistical significance. A significant difference (P = .0095) was registered between group 1 (66.9% with a mean load to failure of 2004 N; SD, 273.8 N) and the native tendons, as well as between group 2 (69.7% with a mean load to failure of 2088 N; SD, 675.4 N) and the native tendons for mean ultimate tensile strength. In breaking stress, a significant difference (P = .0095) was seen between group 1 (mean breaking stress, 1335 N/mm(2); SD, 182.7 N/mm(2)) and the native tendons, as well as between group 2 (breaking stress, 1392 N/mm(2); SD, 450.2 N/mm(2)) and the native tendons (mean breaking stress, 1996 N/mm(2); SD, 148.7 N/mm(2)). Again, there was no significant difference between group 3 (mean breaking stress, 1677 N/mm(2); SD, 271.7 N/mm(2)) and the native tendons. Conclusion: Autologous tenocytes seeded on collagen scaffolds yield enhanced biomechanical results after tendon-bone reconstruction as compared with unseeded scaffolds in an acute setting. Biomechanical results and histological outcomes were promising, showing that the use of autologous tenocytes with specific carrier matrices could be a novel approach for repairing rotator cuff tears.