An Analytical Model for Rotator Cuff Repairs

Background: Currently, natural and synthetic scaffolds are being explored as augmentation devices for rotator cuff repair. When used in this manner, these devices are believed to offer some degree of load sharing; however, no studies have quantified this effect. Furthermore, the manner in which loads on an augmented rotator cuff repair are distributed among the various components of the repair is not known, nor is the relative biomechanical importance of each component. The objectives of this study are to (1) develop quasi-static analytical models of simplified rotator cuff repairs, (2) validate the models, and (3) predict the degree of load sharing provided by an augmentation scaffold. Methods: The individual components of the repair constructs were modeled as non-linear springs, and the model equations were formulated based on the physics of springs in series and parallel. The model was validated and used to predict the degree of load sharing provided by a scaffold. Parametric sensitivity analysis was used to identify which of the component(s)/parameter(s) most influenced the mechanical behavior of the augmented repair models. Findings: The validated models predict that load will be distributed ~70-80% to the tendon repair and ~20-30% to the augmentation component. The sensitivity analysis suggests that the greatest improvements in the force carrying capacity of a tendon repair may be achieved by improving the properties of the bone-suture-tendon interface. Future studies will perform parametric simulation to illustrate the manner in which changes to the individual components of the repair, representing different surgical techniques and scaffold devices, may influence the biomechanics of the repair construct

Preclinical Models for Translating Regenerative Medicine Therapies for Rotator Cuff Repair

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

Development of a Refined Tenocyte Differentiation Culture Technique for Tendon Tissue Engineering

We have established that human tenocytes can differentiate in the absence of exogenous fetal bovine serum (FBS) but in the presence of insulin-like growth factor-1 (IGF-1) and transforming growth factor-β3 (TGF-β3). The extent of tenocyte differentiation was assessed by examining cell survival, collagen synthesis, cell morphology and expression of tenocyte differentiation markers such as scleraxis (Scx), tenomodulin (Tnmd), collagen type I (Col-I) and decorin (Dcn). Our results indicate that 50 ng/ml IGF-1 and 10 ng/ml TGF-β3 (in the absence of FBS) were capable of maintaining in vitro human tenocyte survival in 14-day cultures. The extent of collagen synthesis and messenger ribonucleic acid expression of Scx, Tnmd, Col-I and Dcn were significantly upregulated in response to IGF-1 and TGF-β3. These findings have shown for the first time that human tenocytes can be maintained in long-term culture, in serum-free conditions, making this approach a suitable one for the purpose of tendon tissue engineering