Fibrous connection to bone after immediate repair of the canine infraspinatus: The most effective bony surface for tendon attachment

Aoki, Mitsuhiro; Oguma, Hiroshi; Fukushima, Sunao; Ishii, Seiichi; Ohtani, Seiji; Murakami, Gen

doi:10.1067/mse.2001.111963

Cited by 52 publications

(32 citation statements)

References 15 publications

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“…22 Our tunnel results are also at odds with a report of rotator cuff healing in a canine model which concluded that healing within a cancellous trough was histologically favorable to healing to the bone surface. 23 However, in that study, all groups exhibited poor healing at 3 weeks and differences between repair groups only became apparent at later times.…”

Section: Discussionmentioning

confidence: 66%

Early healing of flexor tendon insertion site injuries: Tunnel repair is mechanically and histologically inferior to surface repair in a canine model

Silva

Thomopoulos

Kusano

et al. 2006

Journal Orthopaedic Research

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Orthopedic injuries often require surgical reattachment of tendon to bone. Tendon ends can be sutured to bone by direct apposition to the bone surface or by placement within a bone tunnel. Our objective was to compare early healing of a traditional surface versus a novel tunnel method for repair of the flexor digitorum profundus (FDP) tendon insertion site in a canine model. A total of 70 tendon-bone specimens were analyzed 0, 5, 10 or 21 days after injury and repair, using tensile and range of motion mechanical testing, histology and densitometry. Ultimate force (a measure of repair strength) did not differ between surface and tunnel repairs at day 0. Both repair types had reduced strength at 10 and 21 days compared to 0 days, indicative of deterioration of suture grasping strength (tendon softening). At 21 days, tendons repaired in a bone tunnel had 38% lower ultimate force compared to surface repairs (p ¼ 0.017). Histological findings were comparable between repair groups at 5 and 10 days but differed at 21 days, when we saw evidence of maturation of the tendonbone interface in the surface repairs compared to an immature fibrous interface with no evidence of tendon-bone integration in the tunnel repairs. After accounting for bone removed by the tunnel, no difference in bone mineral density or trabecular bone volume existed between surface and tunnel repairs. If the results of our animal study extend to healing of the human FDP insertion, they indicate that FDP tendons should be reattached to the distal phalanx by suture to the cortical surface rather than suture in a bone tunnel. ß

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Section: Discussionmentioning

confidence: 66%

Early healing of flexor tendon insertion site injuries: Tunnel repair is mechanically and histologically inferior to surface repair in a canine model

Silva

Thomopoulos

Kusano

et al. 2006

Journal Orthopaedic Research

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“…In contrast to the organized, distinct development of the four zones of the cartilaginous enthesis, tendonbone healing occurs through the formation of fibrovascular scar tissue and does not reestablish the native tendon-bone insertion site formed during embryological development 1,9,14,[21][22][23] . The work done by Thomopoulos et al 24 stresses the importance of understanding the development and morphogeneses of the tendon-bone enthesis in order to more fully understand the healing process of the insertion site.…”

Section: Tendon Insertion Healingmentioning

confidence: 99%

The enthesis: a review of the tendon-to-bone insertion

Apostolakos¹

2014

MLTJ

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SummaryThe integration of tendon into bone occurs at a specialized interface known as the enthesis. The fibrous tendon to bone enthesis is established through a structurally continuous gradient from uncalcified tendon to calcified bone. The enthesis exhibits gradients in tissue organization classified into four distinct zones with varying cellular compositions, mechanical properties, and functions in order to facilitate joint movement. Damage to tendinous insertions is common in the field of orthopaedic medicine and often involves surgical intervention that requires the attempted recreation of the natural organization of tendon into bone. The difficulty associated with recreating the distinct organization may account for the surgical challenges associated with reconstruction of damaged insertion sites. These procedures are often associated with high failure rates and consequently require revision procedures. Management of tendinous injuries and reconstruction of the insertion site is becoming a popular topic in the field of orthopaedic medicine.

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“…[69][70][71][72][73][74][75][76] (Although the rabbit may be considered by some to be a small animal, it is grouped with the large animals because it is in many ways more similar to the large animals than to the rat with respect to the points of this discussion.) The bony anatomy of these larger animals diverges from human (Fig.…”

Section: Large Animal Modelsmentioning

confidence: 99%

Preclinical Models for Translating Regenerative Medicine Therapies for Rotator Cuff Repair

Derwin

Baker

Iannotti

et al. 2010

Tissue Engineering Part B: Reviews

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Despite improvements in the understanding of rotator cuff pathology and advances in surgical treatment options, repairs of chronic rotator cuff tears often re-tear or fail to heal after surgery. Hence, there is a critical need for new regenerative repair strategies that provide effective mechanical reinforcement of rotator cuff repair as well as stimulate and enhance the patient's intrinsic healing potential. This article will discuss and identify appropriate models for translating regenerative medicine therapies for rotator cuff repair. Animal models are an essential part of the research and development pathway; however, no one animal model reproduces all of the features of the human injury condition. The rat shoulder is considered the most appropriate model to investigate the initial safety, mechanism, and efficacy of biologic treatments aimed to enhance tendon-to-bone repair. Whereas large animal models are considered more appropriate to investigate the surgical methods, safety and efficacy of the mechanical-or combination biologic=mechanical-strategies are ultimately needed for treating human patients. The human cadaver shoulder model, performed using standard-of-care repair techniques, is considered the best for establishing the surgical techniques and mechanical efficacy of various repair strategies at time zero. While preclinical models provide a critical aspect of the translational pathway for engineered tissues, controlled clinical trials and postmarketing surveillance are also needed to define the efficacy, proper indications, and the method of application for each new regenerative medicine strategy.

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Fibrous connection to bone after immediate repair of the canine infraspinatus: The most effective bony surface for tendon attachment

Cited by 52 publications

References 15 publications

Early healing of flexor tendon insertion site injuries: Tunnel repair is mechanically and histologically inferior to surface repair in a canine model

Early healing of flexor tendon insertion site injuries: Tunnel repair is mechanically and histologically inferior to surface repair in a canine model

The enthesis: a review of the tendon-to-bone insertion

Preclinical Models for Translating Regenerative Medicine Therapies for Rotator Cuff Repair

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