Introduction/Aim. Flexor tendon injuries of the hand are common with an incidence of over 3000 per annum in the UK. These injuries can affect hand function significantly. Early treatment with optimal repair is crucial to prevent disability. This study aimed at investigating the re-rupture rate following primary flexor
Autologous cell therapy using stem cells and progenitor cells is considered to be a popular approach in regenerative medicine for the repair and regeneration of tissue and organs. In orthopaedic practice, autologous cell therapy has become a major focus, particularly, as a feasible treatment for tendon injury. Tendons are dense connective tissue that bridge bone to muscle and transmit forces between muscle and bone to maintain mechanical movement. Tendons are poorly vascularised and have very little capacity to self-regenerate. Degeneration of tendon is often caused by injury. The pathogenesis of tendon injury, commonly known as tendinosis, is not an inflammatory condition but is secondary to degenerative changes, including disruption of the collagen matrix, calcification, vascularisation and adipogenesis. The aetiology of tendinosis is considered to be multifactorial and the pathogenesis is still unclear. Intrinsic factors such as a lack of blood and nutrition supply and extrinsic factors such as acute trauma and overuse injury caused by repetitive strain, have been implicated as contributors to the pathogenesis of tendinosis. More recent studies suggest that programmed tendon cell death (tenocyte apoptosis) may play a major role in the development of tendinosis. Such cellular abnormalities may influence the capacity of tendon to maintain its integrity. Traditional treatments such as anti-inflammatory drugs, steroid injections and physiotherapy are aimed at symptom relief and do not address the underlying pathological changes of degeneration. Here, we propose that autologous cell therapy may be an innovative and promising treatment for tendon injury. We will present evidence that suggest that autologous tendon cell therapy may be feasible to repair and regenerate tendon. We will also present data summarising the preclinical evaluation of autologous tendon cell therapy in animal models and the safety and tolerability of autologous tendon cell therapy in humans in studies, which are currently conducted at the Centre for Orthopaedic Research at the University of Western Australia.
Massive rotator cuff repairs have up to 60% failure rate and repair of a chronic repair can have up to 40% failure rate. With this in mind, new methodologies are being to being developed to overcome this problem. The use of tendon augmentation grafts is one of them. Prior attempts have shown equivocal or poorer outcomes to control repairs. Aims and objectives: The specific aim of these expereiments was to test how well ovine tendon cells would take to a specific biological augmentation graft (Ligamimetic), and wheter tissue engineering techniques would enhance this. Tendon cells harvested from ovine tendons will be cultured, exposed to the tendon augmentation graft, and analysed to see how well it takes to the tendon cells. We have conducted a 21 day experiment, sampling at days 7, 14, and 21. The experiment will look in sheep tendon cells:1. Platelet rich plasma: A comparison of the effects of platelet rich plasma to cell adherence, cell proliferation, and collagen production. Mesenchymal stem cell: A comparison of the effects of mesenchymal stem cells to the material on cell adherence, cell proliferation, and collagen production.Introduction
Method
Our aim was to compare the biomechanical strength modified side-to-side repair with modified pulvertaft technique keeping overlap length, anchor points, type of suture, suture throw and amount of suture similar. In our study, we have used turkey tendons. Two investigators performed 34 repairs during one summer month. All mechanical testing was carried out using the tensile load testing machine. Variables measured were maximum load, load to first failure, modulus, load at break, mode of failure, site of failure, tensile strain, and tensile stress. The statistical comparison was carried by Levene's test and T test for means. The mean maximum load tolerated by modified side-to-side repair was 50.3N(S.D13.7) and that by modified pulvertaft 46.96N(S.D: 16.4), overall it was 48.29 N (S.D: 14.57). The tensile stress at maximum load for modified pulvertaft and modified side-to-side repair was 4.2MPa(S.D: 3.1) and 4.7 MPa (S.D: 3.8) respectively {Overall 4.3MPa(S.D: 3.5)}. The tensile stress at yield was 4.01 MPa (S.D: 3.1) and 5.5 MPa (S.D: 3.7) respectively for modified pulvertaft and modified side-to-side repair {overall 4.44 MPa (S.D: 3.45)}. The tensile strain at maximum load respectively for side-to-side and modified pulvertaft repair was 7.87%(S.D: 33.3) and 7.84%(S.D: 34.02) respectively. We found no statistical difference between 2 repairs in terms of strength, load to first failure, and maximum load to failure. The suture cut through was the commonest mode of failure. Our study uniquely compares two techniques under standard conditions, and contrary to existing evidence found no difference.
Currently, the consensus regarding subscapularis
Purpose. The posterolateral or posterior approach for total hip arthroplasty has the advantages of preserving the hip abductor musculature and providing good visualization during femoral preparation and component insertion. Although posterolateral approach is one of the popular approaches in hip arthroplasty, it has been reported high dislocation rate as a drawback. To compensate the drawback the repair of short external rotator of hip is thought to be important. Therefore, we investigated incidence of failed repaired short external rotator muscles, dislocation rate and time of failure between tendon to tendon and tendon to bone repair technique through prospective study more than 1 year follow up. Materials and methods. We performed 213 hip arthroplasties in 202 patients from May 2012 to January 2015. After exclusion of 15 hips due to follow-up loss(9 hips), death(2 hips), greater trochanteric fragment displacement(3 hips) and severe contracted short external rotator(1 hip), we investigated 198 hips in 187 patients. 57 patients were male and 130 patients were female. The mean age of patient was 70.4 (32–98) years. Reattachment short external rotator with posterior capsule to postero-superior aspect of greater trochanter(tendon to bone group, 111 hips) or to the tendon(tendon to tendon group, 87 hips) was performed. Two No.26 metal wire markers were fixed at the greater trochanter tip and short external rotator tendon respectively with a distance less than 1.2cm, and the distance between two wire markers was observed at postoperative 1 day, 2 weeks, 3 months, and annually radiographs in neutral position. When the distance was more than 2.5cm or one of the wire markers was invisible, we defined them the failure of short external rotator repair. The mean follow up period was 28.8 (12–45) months. Results. Failure rate of tendon to bone repair technique(17.1%) was significantly less as compared to that of tendon to
The extracortical single-button (SB) inlay repair is one of the most preferred distal biceps
Normal digital flexion relies on flexor tendon pulleys to transmit linear muscular force to angular digital motion. Despite the critical role these pulleys play, there is a growing trend among surgeons to partially sacrifice or “vent” them during flexor
No animal model currently exists for hip abductor tendon tears. We aimed to 1. Develop a large animal model of delayed abductor
Introduction. Successful
Cadaveric specimens that have been fresh-frozen and then thawed for use have historically been considered to be the gold standard for biomechanical studies and the closest surrogate to living tissue. However, there are notable issues related to specimen rapid decay in the thawed state as well as infectious hazard to those handling the specimens. Cadaveric specimen preparation using a new phenol-based soft-embalmed method has shown considerable promise in preserving tissue in a prolonged fresh-like state while mitigating the infection risk. In this study, we evaluated the ability of soft-embalmed specimens to replace fresh-frozen specimens in the biomechanical study of flexor
Avulsion of the proximal hamstring tendon from the ischial tuberosity is an uncommon but significant injury. Recent literature has highlighted that functional results are superior with surgical repair over non-surgical treatment. Limited data exists regarding the optimal rehabilitation regime in post-operative patients. The aim of this study was to investigate the early interim patient outcomes following repair of proximal hamstring tendon avulsions between a traditionally conservative versus an accelerated rehabilitation regimen. In this prospective randomised controlled trial (RCT) 50 patients underwent proximal hamstring
Previous studies describing drill trajectory for single incision distal biceps
Rupture of the pectoralis major (PM) tendon is a rare yet severe injury. Several techniques have been described for PM fixation including a transosseus technique, when cortical buttons are placed at the superior, middle and inferior PM tendon insertion positions. The concern with this technique is the risk that bicortical drilling poses to the axillary nerve as it courses posteriorly to the humerus. This cadaveric study investigates the proximity of the posterior branch of the axillary nerve to the drill positions for transosseus PM
Rotator cuff repair is performed to treat shoulder pain and disability. Failure of the
Surgical reattachment of torn rotator cuff tendons can lead to satisfactory clinical outcome but failures remain common. Ortho-R product is a freeze-dried formulation of chitosan (CS) that is solubilized in platelet-rich plasma (PRP) to form injectable implants. The purpose of the current pilot study was to determine Ortho-R implant acute residency, test safety of different implant doses, and assess efficacy over standard of care in a sheep model. The infraspinatus tendon (ISP) was detached and immediately repaired in 22 skeletally mature ewes. Repair was done with four suture anchors in a suture bridge configuration (n = 6 controls). Freeze-dried formulations containing 1% w/v chitosan (number average molar mass 35 kDa and degree of deacetylation 83%) with 1% w/v trehalose (as lyoprotectant) and 42.2 mM calcium chloride (as clot activator) were solubilized with autologous leukocyte-rich PRP and injected at the tendon-bone interface and on top of the repaired site (n = 6 with a 1 mL dose and n = 6 with a 2 mL dose). Acute implant residency was assessed histologically at 1 day (n = 2 with a 1 mL dose and n = 2 with a 2 mL dose). Outcome measures included MRI assessment at baseline, 6 weeks and 12 weeks, histopathology at 12 weeks and clinical pathology. MRI images and histological slides were scored by 2 blinded readers (veterinarian and human radiologist, and veterinarian pathologist) and averaged. The Generalized Linear Model task (SAS Enterprise Guide 7.1 and SAS 9.4) was used to compare the different groups with post-hoc analysis to test for pairwise differences. Ortho-R implants were detected near the enthesis, near the top of the anchors holes and at the surface of ISP tendon and muscle at 1 day. Numerous polymorphonuclear cells were recruited to the implant in the case of ISP tendon and muscle. On MRI, all repair sites were hyperintense compared to normal tendon at 6 weeks and only 1 out 18 repair sites was isointense at 12 weeks. The
Aim. The purpose of this study was to develop and test the utility of a hybrid barbed-suture in the core repair of digital flexor tendon injuries. Despite offering advantages over traditional suture methods, concerns over the cost, strength to failure and biocompatibility of barbed sutures have hindered their development. Moreover the recent designs have been very complex. We have attempted to develop and test a simple barbed suture, to assess it's viability in flexor
Operative repair of tendo Achilles ruptures is associated with a lower re-rupture rate. A medial approach is made and the tendon ends debrided. The
Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps
We present a biomechanical cadaveric study investigating the effect of type II Superior Labrum Anterior Posterior (SLAP) lesions on the load-deformation properties of the Long Head of Biceps (LHB) and labral complex. We also report our assessment of whether repair of the type II SLAP lesion restored normal biomechanical properties to the superior labral complex. Using a servo-controlled hydraulic material testing system (Bionix MTS 858, Minneapolis, MA), we compared the load-deformation properties of the LHB tendon with:. the LHB anchor intact;. a type II SLAP lesion present;. following repair with two different suture techniques (mattress versus ‘over-the-top’ sutures). Seven fresh-frozen, cadaveric, human scapulae were tested. We found that the introduction of a type II SLAP lesion significantly increased the toe region of the load deformation curve compared to the labral complex with an intact LHB anchor. The repair techniques restored the stiffness of the intact LHB but failed to reproduce the normal load versus displacement profile of the labral complex with an intact LHB anchor. Of the two suture techniques, the mattress suture best restored the normal biomechanics of the labral complex. We conclude that a type II SLAP lesion significantly alters the biomechanical properties of the LHB