Abstract
ObjectivesOur main objective was to biologically improve rotator cuff healing in an elderly rat model using mesenchymal stem cells (MSCs) in combination with a collagen membrane and compared against other current techniques.MethodsA chronic rotator cuff tear injury model was developed by unilaterally detaching the supraspinatus (SP) tendons of Sprague-Dawley rats. At 1 month postinjury, the tears were repaired using one of the following techniques: (a) classical surgery using sutures (n = 12), (b) type I collagen membranes (n = 15), and (c) type I collagen membranes + 1 × 106 allogeneic MSCs (n = 14). Lesion restoration was evaluated at 1, 2, and 3 months postinjury based on biomechanical criteria. Continuous variables were described using mean and standard deviation (SD). To analyse the effect of the different surgical treatments in the repaired tendons’ biomechanical capabilities (maximum load, stiffness, and deformity), a two-way ANOVA model was used, introducing an interaction between such factor and time (1, 2, and 3 months postinjury).ResultsWith regard to maximum load, we observed an almost significant interaction between treatment and time (F = 2.62, df = 4, p = 0.053). When we analysed how this biomechanical capability changed with time for each treatment, we observed that repair with OrthADAPT and MSCs was associated with a significant increase in maximum load (p = 0.04) between months 1 and 3. On the other hand, when we compared the different treatments among themselves at different time points, we observed that the repair with OrthADAPT and MSCs has associated with a significant higher maximum load, when compared with the use of suture, but only at 3 months (p = 0.014). With regard to stiffness and deformity, no significant interaction was observed (F = 1.68, df = 4, p = 0.18; F = 0.40, df = 4, p = 0.81; respectively).ConclusionsThe implantation of MSCs along with a collagen I scaffold into surgically created tendon defects is safe and effective. MSCs improved the tendon’s maximum load over time, indicating that MSCs could help facilitate the dynamic process of tendon repair.
Highlights
The rotator cuff is formed by a group of muscles and tendons that stabilise the glenohumeral joint and enable the normal movement of the shoulder
When we analysed how this biomechanical capability changed with time for each treatment, we observed that repair with OrthADAPT and mesenchymal stem cells (MSCs) was associated with a significant increase in maximum load (p = 0.04), between months 1 and 3 (Table 2)
On the other hand, when we compared the different treatments among themselves at different time points, we observed that the repair with OrthADAPT and MSCs has associated with a significant higher maximum load, when compared with the use of suture, but only at 3 months (p = 0.014) (Table 3)
Summary
The rotator cuff is formed by a group of muscles and tendons that stabilise the glenohumeral joint and enable the normal movement of the shoulder. Clinical failure in degenerative lesions has been linked to preoperative factors such as age [3], reduced acromiohumeral distance [4], tear size [5,6,7,8], chronically inferior tissue quality and tendon retraction and to surgical factors such as high repair tension [9] All of these factors have a marked effect on biological healing and remodelling, which eventually influence the clinical outcome. There is a need for new approaches that improve the healing process through mechanical re-enforcement and enhance natural healing, especially at the insertion site In this context, different therapies in the field of tendon regeneration, such as the local injection of mesenchymal stem cells (MSCs) and growth factors or tissue engineering using bioactive biological membranes, have been tested in different animal models [10,11,12,13,14,15,16]. We compared three different strategies: a surgical procedure based on a modified Masson-Allen stitch using a suture, a surgical procedure using a commercially available biocomposite scaffold consisting of type I collagen that is available for human use and a surgical procedure using the type I collagen scaffold in combination with allogeneic MSCs
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