Rotator cuff tendon to bone insertion site healing

肩袖肌腱至骨插入部位愈合

• 批准号: 7383941
• 负责人: LOUIS J SOSLOWSKY
• 金额: $ 34.63万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-01 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7383941
• 关键词: Age; Animal Model; Articular Range of Motion; Back; Bone Regeneration; Clinical; Clinical Research; Collagen; Collagen Fiber; Collagen Type III; Data; Doctor of Medicine; Environment; Exercise; Extracellular Matrix; Failure; Fiber; Future; Gene Expression; Hand; Healed; Human; Immobilization; Incidence; Injury; Lead; Mechanics; Modeling; Motion; Operative Surgical Procedures; Passive Range of Motion function; Patients; Post Technic; Postoperative Period; Property; Protocols documentation; Range of motion exercise; Rehabilitation therapy; Relative (related person); Reporting; Research; Research Personnel; Role; Rotator Cuff; Shoulder; Site; Surgeon; Techniques; Tendon structure; Time; Week; aggrecan; base; biglycan; bone; bone healing; day; decorin; healing; improved; insight; programs; repaired; response; size; trend

The ability of rotator cuff tendons to heal back to bone following injury is limited, and failure of surgically repaired rotator cuff tears in humans has been reported in 20-70% of cases. Many factors outside of the surgeon's control contribute to the limited healing potential including patient age, tear size, and time from injury to repair. However, two important factors that are within the surgeon's control are surgical repair technique and post-operative rehabilitation protocol. While much research has been done on surgical repair technique, surprisingly, very little data in regard to post-operative rehabilitation protocols following tendon to bone repairs in the shoulder are available to guide clinicians. As a result, the current clinical trend to passively mobilize the shoulder shortly after repair, which is fraught with a high incidence of failure currently, has relied on data from tendon to tendon healing in the hand. However, data from our animal model and that of others indicates that the response of tendon to activity may be different when healing to bone rather than to tendon. We recently developed an animal model in which healing of the rotator cuff tendon to bone insertion site could be carefully evaluated as a function of post-operative activity level. Immobilization was found to result in better healing than either cage activity or exercise and the longer the period of immobilization, the better the insertion site properties. Based on these results, we now hypothesize that remobilization after a sufficient period of immobilization will lead to improved insertion site mechanical and structural properties compared to immobilization alone. A period of immobilization will be necessary to 'protect' the insertion site and to allow for appropriate extracellular matrix (EGM) expression (e.g., type and III collagen, aggrecan, decorin and biglycan) such that the insertion site can re-form. Thus, the positive effect of remobilization requires a minimum period of immobilization. The specific aims are: 1) Following repair, immobilize shoulders either continuously, or with passive motion, and compare insertion site mechanics, collagen fiber orientation and ECM gene expression at 2, 6, 10, 14, 18 and 22 weeks post-repair, 2) Following repair, immobilize shoulders for 2, 6 and 10weeks, then remobilize for 4, 8 and 12 weeks and compare insertion site mechanics, fiber orientation, and ECM gene expression to immobilization only at matching post-repair time points as well as over time, and, since immobilization has been shown to reduce range of motion, 3) Compare passive range of motion (ROM) prior to repair, immediately after immobilization has been discontinued, and after 3 ofays, 1, 2 and 6 weeks of remobilization.

肩袖肌腱在受伤后愈合回骨的能力是有限的，并且无法恢复 据报道，20-70% 的病例经手术修复了人类肩袖撕裂。外界诸多因素 外科医生的控制能力导致愈合潜力有限，包括患者年龄、撕裂大小和时间 从受伤到修复。然而，外科医生可以控制的两个重要因素是手术修复 技术和术后康复方案。虽然在手术修复方面已经做了很多研究 令人惊讶的是，关于肌腱术后康复方案的数据很少 肩部的骨修复可以指导临床医生。因此，目前的临床趋势 修复后不久被动活动肩部，目前失败率很高， 依赖于手部肌腱愈合的数据。然而，来自我们动物模型的数据以及 其他人的研究表明，在骨愈合时，肌腱对活动的反应可能与骨愈合时不同。 到肌腱。我们最近开发了一种动物模型，其中肩袖肌腱与骨骼的愈合 可以根据术后活动水平仔细评估插入部位。固定是 研究发现，与笼内活动或运动相比，愈合效果更好，并且持续时间更长 固定化程度越高，插入位点特性越好。根据这些结果，我们现在假设 经过足够长的固定时间后重新活动将改善插入部位的机械和性能 与单独固定相比的结构特性。需要一段时间的固定 “保护”插入位点并允许适当的细胞外基质（EGM）表达（例如，类型 和 III 型胶原蛋白、聚集蛋白聚糖、核心蛋白聚糖和双糖链蛋白聚糖），使得插入位点可以重新形成。因此，积极的 重新动员的效果需要最短的固定时间。具体目标是： 1）以下 修复、连续或被动运动固定肩部，并比较插入部位 修复后 2、6、10、14、18 和 22 周的力学、胶原纤维取向和 ECM 基因表达， 2) 修复后，固定肩部 2、6 和 10 周，然后重新活动 4、8 和 12 周， 仅将插入位点力学、纤维取向和 ECM 基因表达与固定进行比较 匹配修复后时间点以及随着时间的推移，并且，由于固定已被证明可以减少 运动范围，3) 比较修复前、固定后的被动运动范围 (ROM) 已停药，并经过 3 周、1、2 和 6 周的再动员。