Small Subchondral Drill Holes Improve Marrow Stimulation of Rotator Cuff Repair in a Rabbit Model of Chronic Rotator Cuff Tear
Small Subchondral Drill Holes Improve Marrow Stimulation of Rotator Cuff Repair in a Rabbit Model of Chronic Rotator Cuff Tear
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DOI：
10.1177/0363546519896350
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发表时间：
2020-01-13
影响因子：
4.8
通讯作者：
Jeon, In-Ho
中科院分区：
文献类型：
--
作者：
Sun, Yucheng;Kwak, Jae-Man;Jeon, In-Ho
背景：大结节微骨折已被证明可有效促进肩袖修复后肌腱至骨骼的愈合。然而，尚未建立微裂缝的标准直径。目的/假设：本研究旨在评估大直径和小直径微骨折的治疗，以增强慢性肩袖撕裂兔模型肩袖修复手术期间的愈合。据推测，与大直径微骨折相比，小直径微骨折在肌腱-骨整合、骨-肌腱界面成熟度、微骨折愈合和生物力学特性方面具有优势。研究设计：受控实验室研究。方法：对 21 只新西兰白兔进行双侧冈上肌大结节肌腱切断术。 6周后进行双侧冈上肌修复。 14只兔子作为研究组，分别在左侧和右侧进行小直径（0.5 mm）微骨折和大直径微骨折（1 mm），7只兔子进行简单的无微骨折修复作为对照组。 12周后，研究组的14只兔子中的7只被处死进行显微计算机断层扫描评估和生物力学测试。另外6只兔子被处死用于组织学评估。对照组中，7只兔子中处死3只进行组织学评估，其余兔子处死进行生物力学测试。结果：小直径微骨折组观察到明显更好的骨与肌腱整合。与大直径侧和对照组相比，小直径微骨折侧获得了更好的骨-肌腱界面组织学形成和成熟度，对应于更好的生物力学结果（最大破坏载荷和刚度）。大直径微骨折对于大结节上微骨折孔的愈合表现出较差的放射学和组织学特性。此外，与对照组相比，大直径微骨折显示出较差的生物力学性能，但组织学结果相似。结论：与大直径微骨折相比，小直径微骨折在生物力学、组织学和影像学结果方面显示出增强肩袖愈合的优势，并且大直径微骨折可能会恶化肩袖愈合。
Background: Microfracture of the greater tuberosity has been proved effective for enhancing tendon-to-bone healing after rotator cuff repair. However, no standard diameter for the microfracture has been established. Purpose/Hypothesis: This study aimed to assess treatment with large- and small-diameter microfractures to enhance healing during rotator cuff repair surgery in a rabbit model of chronic rotator cuff tear. It was hypothesized that a small-diameter microfracture had advantages in terms of tendon-to-bone integration, bone-tendon interface maturity, microfracture healing, and biomechanical properties compared with a large-diameter microfracture. Study Design: Controlled laboratory study. Methods: Bilateral supraspinatus tenotomy from the greater tuberosity was performed on 21 New Zealand White rabbits. Bilateral supraspinatus repair was performed 6 weeks later. Small-diameter (0.5 mm) microfracture and large-diameter microfracture (1 mm) were performed on the left side and right side, respectively, in 14 rabbits as a study group, and simple repair without microfracture was performed in 7 rabbits as a control group. At 12 weeks later, 7 of 14 rabbits in the study group were sacrificed for micro-computed tomography evaluation and biomechanical testing. Another 6 rabbits were sacrificed for histological evaluation. In the control group, 3 of the 7 rabbits were sacrificed for histological evaluation and the remaining rabbits were sacrificed for biomechanical testing. Results: Significantly better bone-to-tendon integration was observed in the small-diameter microfracture group. Better histological formation and maturity of the bone-tendon interface corresponding to better biomechanical results (maximum load to failure and stiffness) were obtained on the small-diameter microfracture side compared with the large-diameter side and the control group. The large-diameter microfracture showed worse radiographic and histological properties for healing of the microfracture holes on the greater tuberosity. Additionally, the large-diameter microfracture showed inferior biomechanical properties but similar histological results compared with the control group. Conclusion: Small-diameter microfracture showed advantages with enhanced rotator cuff healing for biomechanical, histological, and radiographic outcomes compared with large-diameter microfracture, and large-diameter microfracture may worsen the rotator cuff healing.