Basic ScienceImproved time-zero biomechanical properties using poly-L-lactic acid graft augmentation in a cadaveric rotator cuff repair model
Section snippets
Experimental design
We used 8 pairs (N = 16) of human cadaveric shoulders (mean age, 51 ± 12 years) in this study (Anatomy Gifts Registry, Hanover, MD). On each shoulder, 3 rotator cuff tendon strips were created corresponding to (1) the anterior half of the supraspinatus, (2) the posterior half of the supraspinatus, and (3) the superior half of the infraspinatus. Tendon strips were released from the proximal humerus and repaired through a transosseous technique. Corresponding tendon strips from paired shoulders
Repair construct mechanical properties
Figure 2 shows a pair of representative load-displacement curves for non-augmented and augmented repair constructs in the anterior supraspinatus region of the rotator cuff. These curves show that in the load-to-failure test, repair constructs were stiffest in the initial phase of loading and became less stiff with progressive loading. The manner in which the biomechanical outcomes (initial stiffness, yield load, and ultimate load) were obtained is shown on these representative curves.
Of the 48
Discussion
The objectives of this study were to determine the extent to which the X-Repair device is capable of improving the mechanical properties (stiffness, yield load, and ultimate load) of a rotator cuff repair in vitro and the extent to which regional differences in the rotator cuff tendons influence these capabilities. The mechanical characteristics of this graft material led us to hypothesize that tendon repairs augmented with the X-Repair device would have significantly increased initial
Conclusion
Our data showed that application of the X-Repair PLLA graft device significantly increases the yield load and ultimate load of a primary rotator cuff repair across all of the supraspinatus tendon and the upper half of the infraspinatus tendon but does not affect initial repair stiffness. The increased ultimate load achieved through graft application is significantly greater in the anterior half of the supraspinatus and upper half of the infraspinatus than that achieved in the posterior
Disclaimer
This work was supported by Synthasome (San Diego, CA) and National Institutes of Health grants T32 AR 050959-01 and R44 AR051260. None of the authors, their family members, or affiliated research institutions have received financial payments or other benefits for the work related to this research.
References (43)
- et al.
Electromyographic analysis of deltoid and rotator cuff function under varying loads and speeds
J Bone Joint Surg Am
(2000) - et al.
Homotypic variation of canine flexor tendons: implications for the design of experimental studies in animal models
J Biomech
(2004) - et al.
Ultimate tensile failure loads of a human dermal allograft rotator cuff augmentation
Arthroscopy
(2008) - et al.
Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study
J Shoulder Elbow Surg
(2006) - et al.
Cyclic loading of anchor-based rotator cuff repairs: confirmation of the tension overload phenomenon and comparison of suture anchor fixation with transosseous fixation
Arthroscopy
(1997) - et al.
Mode of failure for rotator cuff repair with suture anchors identified at revision surgery
J Shoulder Elbow Surg
(2003) - et al.
Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears
J Shoulder Elbow Surg
(2003) - et al.
Mechanical properties of the posterior rotator cuff
Clin Biomech (Bristol, Avon)
(2000) - et al.
Comparison of muscle sizes and moment arms of two rotator cuff muscles measured by ultrasonography and magnetic resonance imaging
Eur J Ultrasound
(2000) - et al.
LactoSorb plates for rotator cuff repair
Arthroscopy
(2002)
A biomechanical and radiographic analysis of standard and intracortical suture anchors for arthroscopic rotator cuff repair
Arthroscopy
The effect of fibrin clot on healing rat supraspinatus tendon defects
J Shoulder Elbow Surg
Relevance of pathology and basic research to the surgeon treating rotator cuff disease
J Orthop Sci
Rotator cuff repair: an analysis of utility scores and cost-effectiveness
J Shoulder Elbow Surg
Technical pearls on how to maximize healing of the rotator cuff
Instr Course Lect
Determinants of outcome in the treatment of rotator cuff disease
Clin Orthop Relat Res
A noncontact, nondestructive method for quantifying intratissue deformations and strains
J Biomech Eng
Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?
J Bone Joint Surg Am
Surgical repair of chronic rotator cuff tears. A prospective long-term study
J Bone Joint Surg Am
Rotator cuff repair augmentation in a canine model with use of a woven poly-L-lactide device
J Bone Joint Surg Am
Repair site integrity after arthroscopic transosseous-equivalent suture-bridge rotator cuff repair
Am J Sports Med
Cited by (63)
Graft Augmentation of Rotator Cuff Repair Improves Load to Failure But Does Not Affect Stiffness or Gap Formation: A Meta-analysis of Biomechanical Studies
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryEngineering multi-tissue units for regenerative Medicine: Bone-tendon-muscle units of the rotator cuff
2021, BiomaterialsCitation Excerpt :Likewise, synthetic scaffolds that traditionally exhibit lower bioactivity than their biological counterparts can be biologically augmented. These include coating synthetic scaffolds with collagen [276] or fabrication of woven or fibrous scaffolds to mimic ECM morphology [113,266,290–293]. Such efforts aim to better approximate tendon-like mechanical responses such as the initial nonlinear or toe region of stress-strain curves during tensile loading [113] as well as to control cell behavior including engineering of tenocyte alignment [266,291].
Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair
2017, Journal of Shoulder and Elbow SurgeryCitation Excerpt :No scaffold, however, was able to match the native tissue. Previous studies using intact scaffolds found maximum failure forces of 796 ± 34 N for X-Repair,49 998 ± 148 N for LARS ligament,42 and 780 ± 200 N for Poly-Tape (also known as Leeds-Keio).56 Whereas the absolute values are different, the relative differences are similar to what we report.
Suture spanning augmentation of single-row rotator cuff repair: a biomechanical analysis
2017, Journal of Shoulder and Elbow SurgeryOutcomes After Combined Remnant Preservation and Bone Marrow Stimulation for Acute Rotator Cuff Tears
2023, Orthopaedic Journal of Sports Medicine