Acellular porcine Achilles tendon patch encapsulating tendon-derived stem cells for rotator cuff repair in a rabbit model

Abstract

Currently, the predominant method for repairing rotator cuff involves surgical suture techniques, but the failure rate remains notably high. Failure of the rotator cuff insertion to provide adequate biomechanics during early healing is considered a major cause of failure. Addressing this problem, biological augmentation emerges as a promising strategy for enhancing the biomechanical properties during early stages. Tendon-derived stem cells (TDSCs), which facilitate the differentiation of repair-supportive cells, hold the potential to improve the efficacy of patch application. The study aims to assess the behavior of TDSCs in acellular porcine Achilles tendon (APAT) patches and to explore the capacity of the APAT patch encapsulating TDSCs in promoting both tendon-to-bone healing and biomechanical enhancements in a rabbit rotator cuff repair model. Transmission electron microscopy (TEM) analyses validated the complete cellular clearance of native cells from APAT patches, with uniform distribution of TDSCs. Immunofluorescence staining confirmed successful TDSCs attachment, while population doubling time (PDT) underscored increased TDSCs proliferation on APAT patches. Quantitative polymerase chain reaction (qPCR) demonstrated upregulation of tenocyte and osteocyte related genes in TDSCS cultured within the patches. In the subsequent in vivo experiment, fifty-four rabbits were used to create rotator cuff injury models and randomly assigned to a control group, an APAT patch group, and an APAT patch with TDSCs group. Histological analysis showed that the APAT patch with TDSCs group had significantly enhanced tendon-to-bone healing and a distinctly organized tendon-fibrocartilage-bone structure, as compared to the APAT patch group. In addition, the biomechanical properties of the APAT patch with TDSCs group were significantly improved. In conclusion, APAT patches promote TDSC proliferation and stimulate tenogenic and osteogenic differentiation. APAT patches encapsulating TDSCs have shown considerable potential in promoting tendon-to-bone healing of rotator cuff injuries, indicating that their use in rotator cuff repair surgery is clinically meaningful.