Arthroscopic Rotator Cuff Repair Technique Using a Bio-Composite Scaffold for Tissue Augmentation

Cheesman, Quincy T.; Szukics, Patrick; Stark, Michael; Kramer, Sterling; McMillan, Sean

doi:10.1016/j.eats.2021.12.001

Cited by 11 publications

(8 citation statements)

References 5 publications

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“…In a nonbiologic, nonabsorbable material, there is a trade-off between initial strength and long-term overconstraint, as the material remains unchanged and displays nonphysiologic mechanical properties. Although the bioinductive scaffold in this study has been used for augmentation of rotator cuff repair 5 and medial collateral ligament repair in the knee, 17 its use has not been described in augmentation of elbow UCL injuries. In a large-animal model, it has been shown that augmentation of rotator cuff repair using this bioinductive scaffold leads to more robust tissue healing with thickened tendons with regularly oriented connective tissue fibers.…”

Section: Discussionmentioning

confidence: 99%

Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study

Lin,

Brinson,

Atzmon

et al. 2024

Am J Sports Med

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Background: Elbow ulnar collateral ligament (UCL) repair with suture brace augmentation shows good time-zero biomechanical strength and a more rapid return to play compared with UCL reconstruction. However, there are concerns about overconstraint or stress shielding with nonabsorbable suture tape. Recently, a collagen-based bioinductive absorbable structural scaffold has been approved by the Food and Drug Administration for augmentation of soft tissue repair. Purpose/Hypothesis: This study aimed to assess the initial biomechanical performance of UCL repair augmented with this scaffold. We hypothesized that adding the bioinductive absorbable structural scaffold to primary UCL repair would impart additional time-zero restraint to the valgus opening. Study Design: Controlled laboratory study. Methods: Eight cadaveric elbow specimens—from midforearm to midhumerus—were utilized. In the native state, elbows underwent valgus stress testing at 30o, 60o, and 90o of flexion, with a cyclical valgus rotational torque. Changes in valgus rotation from 2- to 5-N·m torque were recorded as valgus gapping. Testing was then performed in 4 states: (1) native intact UCL—with dissection through skin, fascia, and muscle down to an intact UCL complex; (2) UCL-transected—distal transection of the ligament off the sublime tubercle; (3) augmented repair with bioinductive absorbable scaffold; and (4) repair alone without scaffold. The order of testing of repair states was alternated to account for possible plastic deformation during testing. Results: The UCL-transected state showed the greatest increase in valgus gapping of all states at all flexion angles. Repair alone showed similar valgus gapping to that of the UCL-transected state at 30° ( P = .62) and 60° of flexion ( P = .11). Bioinductive absorbable scaffold–augmented repair showed less valgus gapping compared with repair alone at all flexion angles ( P = .021, P = .024, and P = .024 at 30°, 60°, and 90°, respectively). Scaffold-augmented repair showed greater gapping compared with the native state at 30° ( P = .021) and 90° ( P = .039) but not at 60° of flexion ( P = .059). There was no difference when testing augmented repair or repair alone first. Conclusion: UCL repair augmented with a bioinductive, biocomposite absorbable structural scaffold imparts additional biomechanical strength to UCL repair alone, without overconstraint beyond the native state. Further comparative studies are warranted. Clinical Relevance: As augmented primary UCL repair becomes more commonly performed, use of an absorbable bioinductive scaffold may allow for improved time-zero mechanical strength, and thus more rapid rehabilitation, while avoiding long-term overconstraint or stress shielding.

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Section: Discussionmentioning

confidence: 99%

Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study

Lin,

Brinson,

Atzmon

et al. 2024

Am J Sports Med

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“…Although the senior author has initially found it to be most helpful in ACL reconstruction augmentation, augmentation of rotator cuff repair and collateral ligament surgery have been describe in the literature. 1 , 2 …”

Section: Discussionmentioning

confidence: 99%

“…The BioBrace (ConMed, New Haven, CT) is a bioinductive collagen scaffold designed to provide an environment for soft tissue remodeling with time zero biomechanical support and can be used to augment graft reconstructions in the case of concerns for allograft strength, healing, or size. 1 , 2 It is an off-the-shelf implant that comes in ligamentous (5 × 250 mm) and patch form (23 × 30 mm), composed of highly porous type I collagen (20 μm average pore size) and bio-resorbable poly (L-lactide) microfilaments (15 μm diameter), which provides a cited load sharing strength of 141 N at time zero of implantation. 3 This provides a useful mechanical and biological augmentation, especially in procedures requiring allografts or harvested autografts with less than desired size, such as in anterior cruciate ligament (ACL) reconstruction.…”

mentioning

confidence: 99%

Anterior Cruciate Ligament Allograft Reconstruction Augmented With a Reinforced, Bioinductive Collagen Scaffold in the Setting of Multiligamentous Knee Injury

Bi,

Hughes,

Savage-Elliott

et al. 2024

Arthroscopy Techniques

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“…Studies are limited on the clinical efficacy of commercially available synthetic grafts such as Regeneten (Smith & Nephew) and BioBrace (Biorez), which are rapidly becoming popular. 6,19,52 Despite the ongoing development of several products designed to mechanically augment rotator cuff repair with some added bioinductivities to support tendon healing, 7 synthetic grafts to regenerate the BTI have not been designed. The 3D-printed bioactive scaffold proposed in this study exhibits translational potential as an off-the-shelf graft in the form of a microthin membrane that can be easily applied with surgical rotator cuff repairs.…”

Section: Discussionmentioning

confidence: 99%

Bioactive Scaffold With Spatially Embedded Growth Factors Promotes Bone-to-Tendon Interface Healing of Chronic Rotator Cuff Tear in Rabbit Model

Han

Kim

et al. 2023

Am J Sports Med

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Background: Functional restoration of the bone-to-tendon interface (BTI) after rotator cuff repair is a challenge. Therefore, numerous biocompatible biomaterials for promoting BTI healing have been investigated. Purpose: To determine the efficacy of scaffolds with spatiotemporal delivery of growth factors (GFs) to accelerate BTI healing after rotator cuff repair. Study Design: Controlled laboratory study. Methods: An advanced 3-dimensional printing technique was used to fabricate bioactive scaffolds with spatiotemporal delivery of multiple GFs targeting the tendon, fibrocartilage, and bone regions. In total, 50 rabbits were used: 2 nonoperated controls and 48 rabbits with induced chronic rotator cuff tears (RCTs). The animals with RCTs were divided into 3 groups: (A) saline injection, (B) scaffold without GF, and (C) scaffold with GF. To induce chronic models, RCTs were left unrepaired for 6 weeks; then, surgical repairs with or without bioactive scaffolds were performed. For groups B and C, each scaffold was implanted between the bony footprint and the supraspinatus tendon. Four weeks after repair, quantitative real-time polymerase chain reaction and immunofluorescence analyses were performed to evaluate early signs of regenerative healing. Histological, biomechanical, and micro–computed tomography analyses were performed 12 weeks after repair. Results: Group C had the highest mRNA expression of collagen type I alpha 1, collagen type III alpha 1, and aggrecan. Immunofluorescence analysis showed the formation of an aggrecan+/collagen II+ fibrocartilaginous matrix at the BTI when repaired with scaffold with GFs. Histologic analysis revealed greater collagen fiber continuity, denser collagen fibers, and a more mature tendon-to-bone junction in GF-embedded scaffolds than those in the other groups. Group C demonstrated the highest load-to-failure ratio, and modulus mapping showed that the distribution of the micromechanical properties of the BTI repaired with GF-embedded scaffolds was comparable with that of the native BTI. Micro–computed tomography analysis identified the highest bone mineral density and bone volume/total volume ratio in group C. Conclusion: Bioactive scaffolds with spatially embedded GFs have significant potential to promote the BTI healing of chronic RCTs in a rabbit model. Clinical Relevance: The scaffolds with spatiotemporal delivery of GF may serve as an off-the-shelf biomaterial graft to promote the healing of RCTs.

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Arthroscopic Rotator Cuff Repair Technique Using a Bio-Composite Scaffold for Tissue Augmentation

Cited by 11 publications

References 5 publications

Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study

Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study

Anterior Cruciate Ligament Allograft Reconstruction Augmented With a Reinforced, Bioinductive Collagen Scaffold in the Setting of Multiligamentous Knee Injury

Bioactive Scaffold With Spatially Embedded Growth Factors Promotes Bone-to-Tendon Interface Healing of Chronic Rotator Cuff Tear in Rabbit Model

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