The Plug-Type Patch Results in Immediate and Postoperative Advantages in Graft-to-Bone Integration for Bridging Massive Rotator Cuff Tears in a Chronic Rabbit Model

Abstract

Background: Various patches have been used to bridge massive rotator cuff tears (MRCTs) by reconnecting the cuff tendons to the humeral head, but the outcomes continue to be suboptimal. Notably, the graft-bone junction is a vulnerable site for failure, which requires optimization in patch design and techniques to enhance initial and postoperative fixation strength at the graft-bone interface. Hypothesis: The plug-type patch (Plug-Pat) through intratunnel fixation would optimize mechanical characteristics in initial graft-to-bone fixation and subsequently improve postoperative biomechanical and histological properties in graft-to-bone healing when compared with the routine rectangular patch (Rect-Pat). Study Design: Controlled laboratory study. Methods: A total of 60 mature male New Zealand White rabbits underwent acute rotator cuff defects to create chronic models with MRCTs. The fascia lata autograft was then harvested to prepare a Plug-Pat, which was distally rooted in the bone tunnel and proximally sutured to native tendons in a horizontal mattress fashion to reconnect the humeral head and cuff tendons. The control group was repaired with a routine Rect-Pat that was secured onto the bone surface for graft-bone fixation. After surgery, the cuff-graft-bone complexes of rabbits in both groups were harvested immediately (0 weeks) for time-zero initial fixation strength and refreshed contact area assessment, and at 6 or 12 weeks for postoperative biomechanical and histological evaluation. Results: The Plug-Pat significantly enhanced initial fixation strength in comparison with the Rect -Pat (mean ± SD; failure load, 36.79 ± 4.53 N vs 24.15 ± 2.76 N; P < .001) and decreased failure at the graft-bone interface of the construct at 0 weeks, with a significantly increased refreshed bone bed contact area (52.63 ± 2.97 mm2 vs 18.28 ± 1.60 mm2; P < .001) between the graft and bone. At 6 and 12 weeks postoperatively, the Plug-Pat similarly resulted in greater failure load (43.15 ± 4.53 N vs 33.74 ± 2.58 N at 6 weeks; P = .001; 76.65 ± 5.04 N vs 58.17 ± 5.06 N at 12 weeks; P < .001) and stiffness (10.77 ± 2.67 N/mm vs 8.43 ± 0.86 N/mm at 6 weeks; P = .066; 16.98 ± 2.47 N/mm vs 13.21 ± 1.66 N/mm at 12 weeks; P = .011), with less specimen failure at the graft-bone interface than the Rect-Pat. In histological analyses, the Plug-Pat had a higher postoperative graft-bone integration score than the Rect-Pat, showing a more mature intratunnel healing interface with fibrocartilage tidemark formation, improved collagen properties, and more oriented cells when compared with those at the surface healing interface in the Rect-Pat. Conclusion: The Plug-Pat enhanced initial fixation strength and enlarged the refreshed contact area for graft-bone connection at time zero and subsequently improved postoperative biomechanical properties and graft-bone integration at the graft-bone healing interface when compared with the Rect-Pat. Clinical Relevance: The Plug-Pat using intratunnel fixation may be a promising strategy for patch design to optimize its initial and postoperative graft-bone connection for bridging reconstruction of MRCTs.

A composite PET-matrix patch enhances tendon regeneration and tendon-to-bone integration for bridging repair of the chronic massive rotator cuff tears in a rabbit model

“…Biomechanical tests were performed on the healed tendon–bone complex at 4, 8 and 12 weeks after the repair. To ensure that the bone was not crushed during tensile testing, the humerus was immobilized using polyvinyl chloride tubing containing hardened dental powder [ 22 ]. Muscle tissue surrounding the tendon was scraped off using a knife, and then the tendon was wrapped in a layer of gauze to prevent slipping during stretch testing.…”

Bionic Functional Surgical Suture with Hierarchical Micro–Nano Dimensions for Rotator Cuff Repair: Inducing Process‐Matching Mechanobiological and Biological Responses Adapted to the Regeneration

“…The RC regeneration was analyzed by tendon-bone healing, fibrocartilage formation at the footprint, and tendon remodeling at 8 weeks. According to the previous reports, the tendon-bone histological score system (TBSS, Table S1, Supporting Information) [47,48] for tendon-bone healing analysis and the tendon histological score system (THSS, Table S2, Supporting Information) [47,48] for tendon remodeling analysis were assessed by H&E and MT stainings. The few fibroblasts (tenocytes, specialized to tendons) that have flattened nuclei are usually oriented parallel to the tension axis in a normal tendon.…”