Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device
Rotator Cuff Repair Augmentation in a Canine Model with Use of a Woven Poly-L-Lactide Device
复制标题
DOI：
10.2106/jbjs.h.00775
复制
发表时间：
2009-05-01
影响因子：
5.3
通讯作者：
Iannotti, Joseph P.
中科院分区：
文献类型：
--
作者：
Derwin, Kathleen A.;Codsi, Michael J.;Iannotti, Joseph P.
背景：尽管手术治疗方案取得了进展，但肩袖修复术的失败率仍然在20%到90%之间。因此，需要新的修复策略，其提供肩袖修复的有效机械加强以及刺激和增强患者的内在愈合潜力。本研究的目的是评估在何种程度上增加急性修复肩袖肌腱与新设计的聚-L-丙交酯修复装置将改善犬model.Methods的功能和生物力学结果：8个成年，雄性杂种狗（25至30公斤）进行了双侧肩关节手术。一个肩关节仅进行肌腱松解和修复，另一个肩关节进行松解和修复，然后使用修复器械进行加固。在12周时，测量修复部位的肌腱收缩、横截面积、刚度和极限载荷。对加固修复进行了生物相容性组织学评估。此外，8对犬尸体肩关节进行了冈下肌损伤和修复，使用相同的外科手术，并作为零时生物力学对照。八个未配对的，犬尸体肩膀包括作为正常的生物力学controls.Results：在零时间，修复增强显着增加了极限负荷（23%）（p = 0.034），但不是刚度的犬冈下肌腱修复。在12周时，观察到聚-L-丙交酯支架在组织学上具有生物相容性，并且增强的修复表现出明显更少的肌腱回缩（p = 0.008）和显著更大的横截面积（137%），刚度（26%）和极限载荷（35%）比没有加固的修复（分别为p < 0.001、p = 0.002和p = 0.009）。结论：虽然限制但不消除肌腱修复牵拉，增强装置为宿主组织沉积和向内生长提供了肌腱-骨桥和支架，导致12周修复的生物力学功能改善。临床相关性：以与本研究所述类似的方式应用的增强装置可能为接受肩袖修复术的患者提供功能受益。
Background: Despite advances in surgical treatment options, failure rates of rotator cuff repair have continued to range from 20% to 90%. Hence, there is a need for new repair strategies that provide effective mechanical reinforcement of rotator cuff repair as well as stimulate and enhance the intrinsic healing potential of the patient. The purpose of this study was to evaluate the extent to which augmentation of acute repair of rotator cuff tendons with a newly designed poly-L-lactide repair device would improve functional and biomechanical outcomes in a canine model.Methods: Eight adult, male mongrel dogs (25 to 30 kg) underwent bilateral shoulder surgery. One shoulder underwent tendon release and repair only, and the other was subjected to release and repair followed by augmentation with the repair device. At twelve weeks, tendon retraction, cross-sectional area, stiffness, and ultimate load of the repair site were measured. Augmented repairs underwent histologic assessment of biocompatibility. In addition, eight pairs of canine cadaver shoulders underwent infraspinatus injury and repair with and without device augmentation with use of identical surgical procedures and served as time-zero biomechanical controls. Eight unpaired, canine cadaver shoulders were included as normal biomechanical controls.Results: At time zero, repair augmentation significantly increased the ultimate load (23%) (p = 0.034) but not the stiffness of the canine infraspinatus tendon repair. At twelve weeks, the poly-L-lactide scaffold was observed to be histologically biocompatible, and augmented repairs demonstrated significantly less tendon retraction (p = 0.008) and significantly greater cross-sectional area (137%), stiffness (26%), and ultimate load (35%) than did repairs that had not been augmented (p < 0.001, p = 0.002, and p = 0.009, respectively).Conclusions: While limiting but not eliminating tendon repair retraction, the augmentation device provided a tendon-bone bridge and scaffold for host tissue deposition and ingrowth, resulting in improved biomechanical function of the repair at twelve weeks.Clinical Relevance: The augmentation device, applied in a similar manner as described in the present study, might offer a functional benefit to patients undergoing rotator cuff repair.