The effects of bone marrow or periosteum on tendon-to-bone tunnel healing in a rabbit model

Abstract

The purpose of this study was to investigate whether a grafting technique using either periosteum or bone marrow as an adjunct, would reconstitute more favorable tendon anchorage morphology with improved tensile strength in a bone tunnel model. We hypothesized that autogenous bone marrow aspirate can enhance the tendon-bone attachment as well as a freshly harvested periosteum, because both tissues contain pluripotent cells. Thirty-six skeletally mature New Zealand white rabbits were utilized. For the tendon graft healing in a bone tunnel model, the extensor digitorum longus tendon was detached from its femoral insertion and transplanted through a bone tunnel into the proximal tibia. Three groups were compared. For the group P (periosteum), a periosteum-wrapped tendon was fixed into the tunnel through the proximal tibial metaphysis. For the group BM (bone marrow), instead of periosteum augmentation, fresh bone marrow was injected into the tendon graft that would sit inside the tunnel. For the group C (control), the limb underwent a similar operation with neither the periosteum enveloping nor bone marrow injecting the tendon. At 6 and 12 weeks after surgery, two rabbits were used for light and electron microscopic examinations, and ten rabbits were used for biomechanical tests in each group. The interface tissue between bone and tendon was thicker and less organized in group C compared to groups P and BM at 6 weeks. Ultra-structurally, the interface tissue was loosely organized in group C, compared to others. Bone ingrowth into tendon was more obvious in groups P and BM, compared to group C. The proliferation of cartilage islands was observed within bone tunnels of both groups P and BM; but a well-defined fibrocartilage zone was noted only in group BM at the interface at week 12. Biomechanical findings: (1) at 6 weeks, the average failure load of group P was significantly higher than the others (P < 0.01). At same time point, in terms of stiffness, while group P was significantly higher than the other groups (P < 0.01), group BM was also significantly higher than that of group C (P < 0.05); (2) at 12 weeks, in terms of failure loads, there was a statistical significant difference only between groups BM and C (P < 0.05). At the same time point, stiffness values were not statistically different among the three groups. Based on the histological and biomechanical findings, the present study demonstrated that periosteum had a positive effect when compared to bone marrow and control groups on the tendon-to-bone healing at an early time point (6 weeks), and bone marrow was also effective at 12 weeks time point compared to the control group in an extra-articular bone tunnel in rabbits. The presence of pluripotent cells in both the bone marrow and the periosteum may be the possible mechanism for enhanced healing. Periosteum had a positive effect at an early time point (6 weeks). Bone marrow was more effective at 12 weeks. Therefore, it is possible that a combination of wrapping periosteum and injecting bone marrow to the te...

Enhancement of tendon&ndash;bone healing via the combination of biodegradable collagen-loaded nanofibrous membranes and a three-dimensional printed bone-anchoring bolt

“…3,21,22 Reports indicated that enveloping the tendon graft with periosteum may improve osseous ingrowth and healing at the tendon-bone interface because periosteum has a unique population of mesenchymal stem cells to form various connective tissues and induce new bone formation. 8,9,23,24 Although enveloping the grafts with periosteum appears to be a promising approach, clinical evidence supporting its use in humans to augment tendon-bone healing is still lacking, and donor site morbidity is an inevi- the tendon graft to promote tendon-bone healing. 18,26 In the current study, we selected collagen and PLGA to build up a nanofibrous membrane and act as a biomimetic periosteum to enhance tissue invasion and cell attachments in the tendonbone tunnel interface.…”

“…3,4 Orthopedic basic science research strategies aiming to augment tendon-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, and enveloping the grafts with periosteum or osteoconductive materials. [5][6][7][8][9] In addition, numerous studies have clinically demonstrated the promotion of tendon-bone anchoring by fixation with a biodegradable interference screw or press-fit bone plug. 10,11 In recent decades, polymeric biomaterials for clinical applications have received increasing attention owing to their additional potential advantages.…”

A new strategy to enhance artificial ligament graft osseointegration in the bone tunnel using hydroxypropylcellulose

“…This differs from the intra-articular tendon-bone healing required for ACL reconstruction. However, this model of graft implantation has been wellestablished in several tendon-bone healing studies [33,34], and it is feasible for preliminary research of a new graft coating. Second, the thickness of the HPC coating was difficult to control, which may have influenced the effect of HPC coating on the graft-bone healing in the bone tunnel.…”

Glucosamine-chondroitin sulphate accelerates tendon-to-bone healing in rabbits

“…[11,12] Using growth factors with coverage of tendon with the periosteum as a shield have been also used to improve healing. [13,14] In contrast to platelet rich plasma, a topical hemostatic agent (Ankaferd Blood Stopper ® ; Ankaferd Ilac Kozmetik AS, Istanbul, Turkey) was shown to negatively affect tendon healing. [15] Despite all these tested methods, there is no consensus on any technique which enables and expedites perfect bone-tendon healing.…”