Rodeo, J Bone Joint Surg Am 2007 - Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors

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Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors

Rodeo, Atkinson, et al.·J Bone Joint Surg Am·2007·233 citations·Basic science

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Background

Clinical studies have demonstrated a high rate of incomplete healing of rotator cuff tendon repair. Since healing of such a repair is dependent on bone ingrowth into the repaired tendon, we hypothesized that osteoinductive growth factors would improve rotator cuff tendon-healing.

Methods

72 skeletally mature sheep underwent detachment of the infraspinatus tendon followed by immediate repair.
The animals received one of 3 treatments at the tendon-bone interface: (1) an osteoinductive bone protein extract on a Type-I collagen sponge carrier, (2) the collagen sponge carrier alone, and (3) no implant.
The animals were killed at 6 and 12 weeks, and the repaired rotator cuff was evaluated with use of magnetic resonance imaging, plain radiographs, histologic analysis, and biomechanical testing.

Results

A gap consistently formed between the end of the repaired tendon and bone in this model, with reparative scar tissue and new bone spanning the gap.
Magnetic resonance imaging showed that the volume of newly formed bone (p < 0.05) and soft tissue (p < 0.05) in the tendon-bone gap were greater in the growth factor-treated animals compared with the collagen sponge control group at both time-points.
Histologic analysis showed a fibrovascular tissue in the interface between tendon and bone, with a more robust fibrocartilage zone between the bone and the tendon in the growth factor-treated animals.
The repairs that were treated with the osteoinductive growth factors had significantly greater failure loads at 6 weeks and 12 weeks (p < 0.05); however, when the data were normalized by tissue volume, there were no differences between the groups, suggesting that the treatment with growth factor results in the formation of poor-quality scar tissue rather than true tissue regeneration.
The repairs that were treated with the collagen sponge carrier alone had significantly greater stiffness than the growth factor-treated group at 12 weeks (p = 0.005).

Conclusions

This model tests the effects of growth factors on scar tissue formation in a gap between tendon and bone. The administration of osteoinductive growth factors resulted in greater formation of new bone, fibrocartilage, and soft tissue, with a concomitant increase in tendon attachment strength but less stiffness than repairs treated with the collagen sponge carrier alone.

Copyright remains with the authors and publisher.

Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors

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Paprosky, Lawrence, et al.J Arthroplasty19941,213 citationsRetrospective cohort

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Adolescent Idiopathic Scoliosis: A New Classification to Determine Extent of Spinal Arthrodesis.

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Problems in the Management of Type III (Severe) Open Fractures: A New Classification of Type III Open Fractures.

Gustilo, Williams, et al.J Trauma19842,361 citationsRetrospective cohort

Neer Award 2005: The Grammont Reverse Shoulder Prosthesis: Results in Cuff Tear Arthritis, Fracture Sequelae, and Revision Arthroplasty.

Boileau, Hovorka, et al.J Shoulder Elbow Surg20061,115 citationsProspective cohort

A System for the Surgical Staging of Musculoskeletal Sarcoma.

Enneking, Goodman, et al.Clin Orthop Relat Res19802,112 citationsRetrospective cohort

Fracture Fixation in the Operative Management of Hip Fractures (FAITH): An International, Multicentre, Randomised Controlled Trial.

Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) InvestigatorsLancet2017310 citationsRCT

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Goutallier, Voisin, et al.Clin Orthop Relat Res19942,669 citationsProspective cohort

Dislocations after Total Hip-Replacement Arthroplasties.

Lewinnek, Zimmerman, et al.J Bone Joint Surg Am19782,549 citationsRetrospective cohort

Morphologic Study of the Glenoid in Primary Glenohumeral Osteoarthritis.

Walch, Khoury, et al.J Arthroplasty19991,142 citationsRetrospective cohort

The Three Column Spine and Its Significance in the Classification of Acute Thoracolumbar Spinal Injuries.

DenisSpine (Phila Pa 1976)19832,566 citationsRetrospective cohort

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Frankle, Vasey, et al.J Bone Joint Surg Am2005773 citationsRetrospective cohort

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A New Classification of Thoracolumbar Injuries: The Importance of Injury Morphology, the Integrity of the Posterior Ligamentous Complex, and Neurologic Status.

Vaccaro, Oner, et al.Spine (Phila Pa 1976)2005866 citationsConsensus statement

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FLOW Investigators, Guyatt, et al.N Engl J Med2015347 citationsRCT

Curve Progression in Idiopathic Scoliosis.

Weinstein, PonsetiJ Bone Joint Surg Am1983641 citationsRetrospective cohort

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Burkhart, De BeerArthroscopy20001,884 citationsCase series

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Baumgaertner, Keggi, et al.J Bone Joint Surg Am19951,441 citationsRetrospective cohort

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Berndt, HartyJ Bone Joint Surg Am1959945 citationsBiomechanical study

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Weinstein, SPORT Investigators, et al.N Engl J Med20081,207 citationsRCT

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Yamaguchi, Middleton, et al.J Shoulder Elbow Surg2001498 citationsRetrospective cohort

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O'Driscoll, Morrey, et al.J Bone Joint Surg Am1991997 citationsCase series

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O'Sullivan, Zee, et al.Lancet20021,587 citationsRCT

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Arnoczky, WarrenAm J Sports Med19821,227 citationsAnatomic study

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MirelsClin Orthop Relat Res19891,222 citationsRetrospective cohort

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Fehlings, Rampersaud, et al.PLoS One20121,200 citationsProspective cohort

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Neer, Fukuda, et al.J Bone Joint Surg Am1983774 citationsCase series

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NeerJ Bone Joint Surg Am1974598 citationsCase series

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Neer, FosterJ Bone Joint Surg Am1980934 citationsCase series

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Glassman, Schwab, et al.Spine (Phila Pa 1976)20051,878 citationsRetrospective cohort

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Harms, MelcherSpine (Phila Pa 1976)20011,528 citationsCase series

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PipkinJ Bone Joint Surg Am1957445 citationsCase series

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Anderson, Park, et al.J Bone Joint Surg Am1975416 citationsCase series

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Herring, Browne, et al.J Bone Joint Surg Am2004143 citationsProspective cohort

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KiblerAm J Sports Med19981,240 citationsReview article

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Watson, BalletJ Hand Surg Am19841,138 citationsRetrospective cohort

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Valle, PaproskyJ Bone Joint Surg Am2003199 citationsRetrospective cohort

The Tibial Plateau Fracture. The Toronto Experience 1968--1975.

Schatzker, Bruce, et al.Clin Orthop Relat Res19791,029 citationsRetrospective cohort

Surgical Dislocation of the Adult Hip a Technique with Full Access to the Femoral Head and Acetabulum without the Risk of Avascular Necrosis.

Ganz, Berlemann, et al.J Bone Joint Surg Br20011,367 citationsCase series

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Hertel, Leunig, et al.J Shoulder Elbow Surg2004837 citationsProspective cohort

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Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors

Rodeo, Atkinson, et al.·J Bone Joint Surg Am·2007·233 citations·Basic science

|

Background

Clinical studies have demonstrated a high rate of incomplete healing of rotator cuff tendon repair. Since healing of such a repair is dependent on bone ingrowth into the repaired tendon, we hypothesized that osteoinductive growth factors would improve rotator cuff tendon-healing.

Methods

72 skeletally mature sheep underwent detachment of the infraspinatus tendon followed by immediate repair.
The animals received one of 3 treatments at the tendon-bone interface: (1) an osteoinductive bone protein extract on a Type-I collagen sponge carrier, (2) the collagen sponge carrier alone, and (3) no implant.
The animals were killed at 6 and 12 weeks, and the repaired rotator cuff was evaluated with use of magnetic resonance imaging, plain radiographs, histologic analysis, and biomechanical testing.

Results

A gap consistently formed between the end of the repaired tendon and bone in this model, with reparative scar tissue and new bone spanning the gap.
Magnetic resonance imaging showed that the volume of newly formed bone (p < 0.05) and soft tissue (p < 0.05) in the tendon-bone gap were greater in the growth factor-treated animals compared with the collagen sponge control group at both time-points.
Histologic analysis showed a fibrovascular tissue in the interface between tendon and bone, with a more robust fibrocartilage zone between the bone and the tendon in the growth factor-treated animals.
The repairs that were treated with the osteoinductive growth factors had significantly greater failure loads at 6 weeks and 12 weeks (p < 0.05); however, when the data were normalized by tissue volume, there were no differences between the groups, suggesting that the treatment with growth factor results in the formation of poor-quality scar tissue rather than true tissue regeneration.
The repairs that were treated with the collagen sponge carrier alone had significantly greater stiffness than the growth factor-treated group at 12 weeks (p = 0.005).

Conclusions

This model tests the effects of growth factors on scar tissue formation in a gap between tendon and bone. The administration of osteoinductive growth factors resulted in greater formation of new bone, fibrocartilage, and soft tissue, with a concomitant increase in tendon attachment strength but less stiffness than repairs treated with the collagen sponge carrier alone.

Copyright remains with the authors and publisher.

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