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Tenocyte-seeded scaffolds show potential to regenerate torn rotator cuff tendons
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Researchers at the University Hospital of Munich found that absorbable collagen-based scaffolds seeded with autologous tenocytes can regenerate rotator cuff tendon tissue. This approach may lead to improved biomechanical outcomes in shoulders with rotator cuff tears, according to researchers who presented results at the EFORT Congress.
“We saw a superior biomechanical outcome with scaffolds seeded with these tenocytes in comparison to defect and scaffold alone,” Björn Roßbach, MD, said during the presentation.
“The biomechanical results are close to those of healthy tendons, but the scaffolds seeded with the autologous tenocytes perhaps need a longer time until the complete healing process takes place into the surrounding tissue and maybe an observation period of 6 or 12 months is necessary to find comparable values,” he said.
Images: Roßbach B
Roßbach and colleagues won the Silver Free Paper Award at the Congress for presenting the second best free paper.
Tenocyte scaffolds
“With our technique, in the future it may be possible to repair massive/irreparable rotator cuff ruptures, and degenerated tendon could be enforced to reduce risks of re-rupture,” Peter E. Müller, MD, deputy clinical director at University Hospital of Munich, Germany, told Orthopaedics Today Europe. “For the repair of rotator cuffs with scaffolds, the use of differentiated tenocytes is mandatory.”
The researchers noted that in the literature allografts, autografts, xenografts and synthetic biomaterials did not show long-term success in rotator cuff tear treatment due to significant complications. Among the complications are poor vascularization, biomechanical insufficiency and loss of tendon elasticity from new ossification. Roßbach, Müller and colleagues conducted this study because they believed that absorbable collagen-based scaffolds seeded with autologous tenocytes may offer better results.
Initial study
Roßbach and colleagues tested the tenocyte-loaded scaffolds in three groups of sheep. They created a critical-size rotator cuff defect in the tendon-bone junction of the infraspinatus tendon in each animal and used the uninvolved contralateral shoulders as controls. They did a tissue biopsy of the patella tendon of each animal’s right hind leg, performed enzymatic tissue digestion with type I collagenase, cultivation of the specimens and then, in the second culture passage they identified the growth of 10 million autologous tenocytes.
The defects were left untreated in group I, group B received a collagen-based scaffold without tenocytes and group III received a scaffold seeded with 10 million autologous tenocytes. Researchers drilled two holes in the greater tuberosity of the sheep to fix the scaffold to the bone with two transosseous sutures and to the tendon using single stitches on all sides.
At 12 weeks, the investigators checked the biomechanical status of the infraspinatus tendons in the sheep.
Roßbach and colleagues found new tissue generation only in group III. However, they observed hypertrophic tissue formation in groups I and II. The tensile strength was less in the latter two groups at about 2,000 N and greater in group III at about 2,500 N. The latter measurement did not differ significantly from native healthy tendons, according to Roßbach.
Group III also showed the best tendon elongation results and breaking stress results, which were similar to those of healthy native tendons.
Within the biomechanical testing, 71% of failures were due to intratendinous rupture and 29% were due to tendon-to-bone failure, independent of group affiliation, Roßbach said. – by Renee Blisard Buddle
- Reference:
- Roßbach B. Paper #13-3065. Presented at: EFORT Congress; June 5-8, 2013; Istanbul.
- For more information:
- Peter Müller, MD, and Björn Roßbach, MD, can be reached at the Department of Orthopaedic Surgery, University Hospital of Munich, Campus Grosshadern, Machioninstr. 15, 81377, Munich, Germany; email: bjoern_peter.rossbach@med.uni-muenchen.de; email: peter.mueller@med.uni-muenchen.de.
Disclosures: Müller and Roßbach have no relevant financial disclosures.