Adhesive materials for tendon-to-bone repair

摘要 超过一半的老年人口患有肩部功能障碍和肩袖疼痛 损伤，通常是一条或多条肩袖肌腱撕裂。肩袖的外科修复是其中之一。 最常见的整形外科手术，在美国每年进行超过250,000次修复 各州。手术修复的目标是在断裂的肌腱和肌腱之间建立牢固而坚韧的连接 骨骼，以恢复肩部功能。不幸的是，健康的依恋系统不是用 目前基于缝合的手术技术，在愈合过程中不能再生，导致高失败率 手术后。这些失败主要是由于用于固定肌腱到骨骼的修复技术； 不是像在健康附着中那样将肌肉负荷分布在广泛的附着足迹区域上， 外科修复将应力集中在少数缝合锚点上。这些应力集中 导致从肌腱上拔出缝合线，推动分发技术的发展 应力远离缝合锚点，并跨越附着体示意图。在这个临床问题的驱使下，我们 实施的模型和概念验证实验表明，机械优化的粘合剂 薄膜可以更好地在肌腱和骨骼之间的界面上分配载荷，并显著增加 肌腱到骨修复术的负荷耐力。在当前的项目中，我们提出了这一先前的理论和证据。 概念致力于开发一种生物相关的粘合剂，用于增强肩袖修复。总体目标 是通过粘合生物材料改善肌腱到骨的外科修复结果。我们会带上 实现这一目标的生物启发方法：粘合剂将模仿海洋生物粘合 生物化学。具体地说，以贻贝为灵感的儿茶酚衍生粘合剂将在体外和体内进行测试 模特们。我们假设，邻苯二酚衍生的粘结剂将增加初始修复强度和韧性 并考虑到改善肌腱到骨骼的愈合。这将在两个目标上进行测试：目标1：开发贻贝- 具有适当机械性能的邻苯二酚衍生粘合剂，用于肌腱到骨骼的修复和修复 评价其体外生物相容性。目的2：确定贻贝来源的儿茶酚的疗效 用于改善体内肌腱与骨的愈合的粘合剂。从长远来看，插入的粘合剂可能是 经修饰后可携带生物活性因子和/或干细胞。除了需要研究的机械增强外， 在目前的提案中，这些因素可能会进一步增强肌腱到肌腱的长期愈合潜力。 骨头附着物。

ABSTRACT More than half of the elderly population suffers from shoulder dysfunction and pain caused by rotator cuff injury, typically a tear of one or more of the rotator cuff tendons. Surgical repair of the rotator cuff is one of the most common orthopedic surgical procedures, with over 250,000 repairs performed each year in the United States. The goal of surgical repair is to create a strong and tough attachment between the ruptured tendon and bone in order to recover shoulder function. Unfortunately, the healthy attachment system is not recreated with current suture-based surgical techniques and is not regenerated during healing, leading to high failure rates post-operatively. These failures are primarily due to the repair techniques used to secure tendon to bone; instead of distributing muscle loads across a wide attachment footprint area, as in the healthy attachment, surgical repairs concentrate stress on a small number of suture anchor points. These stress concentrations lead to pullout of the suture from the tendon, motivating the development of technologies that distribute stresses away from suture anchors and across the attachment footprint. Motivated by this clinical problem, we implemented models and proof-of-concept experiments demonstrating that mechanically-optimized adhesive films can better distribute loads across the interface between tendon and bone and dramatically increase the load tolerance of a tendon-to-bone repair. In the current project, we advance this prior theoretical and proof-of- concept work to develop a biologically relevant adhesive for enhanced rotator cuff repair. The overall objective is to improve tendon-to-bone surgical repair outcomes through adhesive biomaterial approaches. We will take a bioinspired approach to achieve this goal: adhesives will be modeled after marine organism adhesion biochemistry. Specifically, mussel-inspired catechol-derived adhesives will be tested using in vitro and in vivo models. We hypothesize that catechol-derived adhesives will increase the initial repair strength and toughness and allow for improved tendon-to-bone healing. This will be tested across two aims: Aim 1: Develop mussel- inspired catechol-derived adhesives with appropriate mechanical properties for tendon-to-bone repair and evaluate their biocompatibility in vitro. Aim 2: Determine the efficacy of the mussel-inspired catechol-derived adhesive for improved tendon-to-bone healing in vivo. In the long term, the interposed adhesive could be modified to carry bioactive factors and/or stem cells. In addition to the mechanical augmentation to be studied in the current proposal, these factors may further enhance the long-term healing potential of the tendon-to- bone attachment.