Intrasynovial autograft for reconstruction of chronic large rotator cuff tears in a rabbit model: biomechanical, computed tomography, and histological results.

BACKGROUND: Rotator cuff (RC) tears are a common cause of shoulder dysfunction and pain, posing significant challenges for orthopedic surgeons. Grafts have been proposed as a solution to augment or bridge torn tendons, but optimal clinical outcomes are not always achieved due to poor graft integration, suboptimal mechanical properties, and immunological reactions. The aim of this study was to investigate the biomechanical, CT and histological results of RC reconstruction using an intrasynovial tendon autograft, in a chronic large tear subscapularis rabbit model. METHODS: Twenty-six adult male Zealand white rabbits were used in this study. Large defects in the subscapularis tendons were produced bilaterally in 20 rabbits. After 6 weeks, secondary procedures were performed to the right shoulder of the rabbits, which were reconstructed with an intrasynovial interposition autograft (graft group). The left shoulder did not undergo any further treatment (defect group). The specimens were randomly divided into two equal time groups and underwent biomechanical testing, CT analysis, and histological evaluation at 6, and 12 weeks after reconstruction. In addition, 6 rabbits that were not operated, were used as a control group. RESULTS: At 12 weeks post-repair, the graft group exhibited a significant increase in ultimate failure load compared to the defect group (p < 0.05). Furthermore, the 12-week graft group demonstrated comparable stiffness to that of the control group. CT analysis indicated no significant progression of intramuscular fat accumulation in both graft groups, in contrast to the 12-week defect group when compared to the control group. Finally, histological evaluation revealed a gradual integration of the graft with the host tissue at 12 weeks. CONCLUSION: Our study suggests that intrasynovial flexor tendon autografts hold promise as an effective interposition graft for the reconstruction of chronic large RC tears, as they improve the biomechanical and biological properties of the repaired tendon. Nonetheless, further investigations in preclinical large animal models are warranted to validate and extrapolate these findings to human studies.

Repair of chronic and large rotator cuff tears using extra-synovial autografts: An experimental study in rabbits.

Purpose: To investigate whether and how extra-synovial autografts can enhance the reconstruction of chronic and large rotator cuff tears in a rabbit subscapularis model. Methods: Twenty rabbits were used to create a large subscapularis tear bilaterally. Six weeks later, the right shoulder of each rabbit was operated to repair the tear with an extra-synovial autograft, whereas the left shoulder did not undergo any surgery. At 6 and 12 weeks after the second procedure, the specimens underwent biomechanical and histological evaluation. Six more rabbits were used only as a normal reference. Results: Biomechanical evaluation demonstrated that the ultimate load to failure of the Graft group (184.1 ± 35.7 N) was significantly higher (p = 0.04) than that of the Defect group (144.5 ± 32.2 N) at 12 weeks after repair, rising to 76% of the normal subscapularis tendon tensile strength. Histological analysis revealed an enhanced healing environment with neoangiogenesis and decreased inflammatory response at the repair site. Moreover, the tendon maturing score of the Graft group increased substantially from 6 (15.8 ± 0.9) to 12 (23.1 ± 0.6) weeks after repair (p = 0.01). Conclusion: In vivo data support the efficacy of extra-synovial autograft interposition in repairing chronic and large rotator cuff tears in a rabbit subscapularis model. The autografts were capable of enhancing the biomechanical properties of the repaired tendons, as evidenced by increased tensile strength, and forming new connective tissue simulating a fibrocartilage zone, as revealed by histological evaluation. Level of Evidence: N/A.

From Three-Dimensional (3D)- to 6D-Printing Technology in Orthopedics: Science Fiction or Scientific Reality?

Over the past three decades, additive manufacturing has changed from an innovative technology to an increasingly accessible tool in all aspects of different medical practices, including orthopedics. Although 3D-printing technology offers a relatively inexpensive, rapid and less risky route of manufacturing, it is still quite limited for the fabrication of more complex objects. Over the last few years, stable 3D-printed objects have been converted to smart objects or implants using novel 4D-printing systems. Four-dimensional printing is an advanced process that creates the final object by adding smart materials. Human bones are curved along their axes, a morphological characteristic that augments the mechanical strain caused by external forces. Instead of the three axes used in 4D printing, 5D-printing technology uses five axes, creating curved and more complex objects. Nowadays, 6D-printing technology marries the concepts of 4D- and 5D-printing technology to produce objects that change shape over time in response to external stimuli. In future research, it is obvious that printing technology will include a combination of multi-dimensional printing technology and smart materials. Multi-dimensional additive manufacturing technology will drive the printing dimension to higher levels of structural freedom and printing efficacy, offering promising properties for various orthopedic applications.

Thermomechanical Fatigue Testing on Fe-Mn-Si Shape Memory Alloys in Prestress Conditions.

Active materials have gained increasing momentum during the last decades due to their ability to act as sensors and actuators without the need for an external controlling system or an electronic signal. Shape memory alloys (SMAs), which are a subcategory of active materials, are slowly being introduced in the civil engineering sector in applications that refer to prestressing and strengthening of various structural elements. Low-cost iron-based SMAs are a good alternative to the Ni-Ti SMAs for such uses since the cost of large-scale civil engineering applications would otherwise be prohibitive. The scope of this study is the investigation of the thermomechanical response of the Fe-17Mn-5Si-10Cr-4Ni-1(V,C) ferrous SMA. In particular, this study focuses on the application of prestress, and on the alloy's behavior under fatigue loadings. In addition, the effect of loading frequency on the recovery stress of the material is thoroughly investigated. Four dog-bone specimens were prepared and tested in low-cycle fatigue. All the experiments aimed at the simulation of prestress. The recovery stress was monitored after pre-straining and heating applied under strain-control conditions. The experimental results are promising in terms of the is situ prestress feasibility since the measured recovery stress values are satisfactory high.

Three-Dimensional-Printed Scaffolds for Meniscus Tissue Engineering: Opportunity for the Future in the Orthopaedic World.

The meniscus is a critical component of a healthy knee joint. It is a complex and vital fibrocartilaginous tissue that maintains appropriate biomechanics. Injuries of the meniscus, particularly in the inner region, rarely heal and usually progress into structural breakdown, followed by meniscus deterioration and initiation of osteoarthritis. Conventional therapies range from conservative treatment, to partial meniscectomy and even meniscus transplantation. All the above have high long-term failure rates, with recurrence of symptoms. This communication presents a brief account of in vitro and in vivo studies and describes recent developments in the field of 3D-printed scaffolds for meniscus tissue engineering. Current research in meniscal tissue engineering tries to combine polymeric biomaterials, cell-based therapy, growth factors, and 3D-printed scaffolds to promote the healing of meniscal defects. Today, 3D-printing technology represents a big opportunity in the orthopaedic world to create more specific implants, enabling the rapid production of meniscal scaffolds and changing the way that orthopaedic surgeons plan procedures. In the future, 3D-printed meniscal scaffolds are likely to be available and will also be suitable substitutes in clinical applications, in an attempt to imitate the complexity of the native meniscus.

Finite Element Method for the Evaluation of the Human Spine: A Literature Overview.

The finite element method (FEM) represents a computer simulation method, originally used in civil engineering, which dates back to the early 1940s. Applications of FEM have also been used in numerous medical areas and in orthopedic surgery. Computing technology has improved over the years and as a result, more complex problems, such as those involving the spine, can be analyzed. The spine is a complex anatomical structure that maintains the erect posture and supports considerable loads. Applications of FEM in the spine have contributed to the understanding of bone biomechanics, both in healthy and abnormal conditions, such as scoliosis, fractures (trauma), degenerative disc disease and osteoporosis. However, since FEM is only a digital simulation of the real condition, it will never exactly simulate in vivo results. In particular, when it concerns biomechanics, there are many features that are difficult to represent in a FEM. More FEM studies and spine research are required in order to examine interpersonal spine stiffness, young spine biomechanics and model accuracy. In the future, patient-specific models will be used for better patient evaluations as well as for better pre- and inter-operative planning.

The Role of Scaffolds in Tendon Tissue Engineering.

Tendons are unique forms of connective tissue aiming to transmit the mechanical force of muscle contraction to the bones. Tendon injury may be due to direct trauma or might be secondary to overuse injury and age-related degeneration, leading to inflammation, weakening and subsequent rupture. Current traditional treatment strategies focus on pain relief, reduction of the inflammation and functional restoration. Tendon repair surgery can be performed in people with tendon injuries to restore the tendon's function, with re-rupture being the main potential complication. Novel therapeutic approaches that address the underlying pathology of the disease is warranted. Scaffolds represent a promising solution to the challenges associated with tendon tissue engineering. The ideal scaffold for tendon tissue engineering needs to exhibit physiologically relevant mechanical properties and to facilitate functional graft integration by promoting the regeneration of the native tissue.

Numerical Simulation of the Posterior Malleolus Fracture with the Finite Element Method.

The high demand for biodegradable implants in bone fracture fixations has dramatically increased the use of polymers for biomedical applications as well. However, the replacement of stainless steel and titanium screws by biodegradable materials represents one of the most critical aspects of biomechanics. In this study, the mechanical behavior of polycaprolactone (PCL) in tension and compression is examined. Driven by the advanced technology of computational mechanics, the fixation of the posterior malleolus fracture has been designed and analyzed. The core idea depicts the static analysis of screws made of PCL fixed in the ankle joint. The focus of the study is on this bio-absorbable, polymer-based material performance under constant compression. Parametric analysis is employed for the optimization of the PCL scaffold. Future studies will focus on the experimental verification of the numerical analysis results.