Tendon tissue engineering: progress, challenges, and translation to the clinic.

The tissue engineering field has made great strides in understanding how different aspects of tissue engineered constructs (TECs) and the culture process affect final tendon repair. However, there remain significant challenges in developing strategies that will lead to a clinically effective and commercially successful product. In an effort to increase repair quality, a better understanding of normal development, and how it differs from adult tendon healing, may provide strategies to improve tissue engineering. As tendon tissue engineering continues to improve, the field needs to employ more clinically relevant models of tendon injury such as degenerative tendons. We need to translate successes to larger animal models to begin exploring the clinical implications of our treatments. By advancing the models used to validate our TECs, we can help convince our toughest customer, the surgeon, that our products will be clinically efficacious. As we address these challenges in musculoskeletal tissue engineering, the field still needs to address the commercialization of products developed in the laboratory. TEC commercialization faces numerous challenges because each injury and patient is unique. This review aims to provide tissue engineers with a summary of important issues related to engineering tendon repairs and potential strategies for producing clinically successful products.

The effects of orientation, temperature, and displacement magnitude changes on the sonometrics system accuracy.

The accuracy and reliability of a sonomicrometry system (Sonometrics Corporation, Ontario, Canada) was evaluated for its potential use in measuring 3-D in vivo joint kinematics. Distances between different sets of piezoelectric crystals were measured through a salt solution using ultrasound technology. We evaluated crystal-to-crystal distance under simulated in vivo conditions of changing crystal orientation and displacement magnitude. Crystal-to-crystal distance was also evaluated under changing solution temperature, since the crystals may be used at different temperatures. The 2 mm round and peg crystals were accurate to within 0.5mm for 0 through 180 degrees rotations, but the 2mm round suture loop crystals were only reliable at 0 degrees rotation. The speed of sound through a salt solution (and hence the distance between crystals) versus temperature was fit using a second order polynomial, C=1421.1+3.9808T-3.09x10(-2)T2, with an R2 value of 0.9998. The translational error was less than 0.072 mm for crystal displacements of 0.012, 0.2, 1.0, and 5.0 mm. The system was also accurate under dynamic conditions with translational errors that were less than 0.045 mm under 0.65 Hz motion. These results suggest that the Sonometrics crystals possess attributes (translational accuracy and rotational independence) that could provide the basis for a system capable of measuring joint kinematics.

Evaluation of an electromagnetic position tracking device for measuring in vivo, dynamic joint kinematics.

An electromagnetic position tracking device was evaluated to determine its static and dynamic accuracy and reliability for applications related to measuring in vivo joint kinematics. The device detected the position and orientation of small coiled sensors, maintained in an electromagnetic field. System output was measured against known translations or rotations throughout the measurement volume. Average translational errors during static testing were 0.1 +/- 0.04, 0.2 +/- 0.17, and 0.8 +/- 0.81 mm (mean+/-SD) for sensors 50, 300, and 550 mm away from the field generator, respectively. Average rotational errors were 0.4 +/- 0.31 degrees, 0.4 +/- 0.21 degrees, and 0.9 +/- 0.85 degrees (mean +/- SD) for sensors located at the same distances. Since we intended to use this system in an animal walking on a treadmill, we incrementally moved the sensors under various treadmill conditions. The effects of treadmill operation on translational accuracy were found to be negligible. The effects of dynamic motions on sensor-to-sensor distance were also assessed for future data collection in the animal. Sensor-to-sensor distance showed standard deviations of 2.6 mm and a range of 13 mm for the highest frequency tested (0.23 Hz). We conclude that this system is useful for static or slow dynamic motions, but is of limited use for obtaining gait kinematics at higher speeds.

Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension.

This study had two purposes: first, to determine how femoral attachment location affects the load sharing between the two bundles of a Y-type posterior cruciate ligament reconstruction, and second, to determine how the bundles, separately and in combination, control posterior tibial translation throughout the full range of knee flexion. One and two-bundle reconstructions were performed in 12 cadaveric knees. The one-bundle reconstructions were attached within the femoral posterior cruciate ligament footprint at one of three locations, high and shallow (S1), mid and shallow (S2), or mid and deep (D). The two-bundle reconstructions comprised an S1 bundle with either an S2 or a D bundle. Posterior translation and bundle tension were measured as the knee was flexed from full extension to 1,200 of flexion while a posterior force of either 50 or 100 N was applied to the proximal tibia. The shallow one-bundle reconstruction restored posterior translation to within 2 mm of that of the intact knee over the entire range of knee flexion. The deep reconstruction did not control abnormal posterior translation above 45 degrees. The tension in the shallow bundles increased with knee flexion, and the deep bundle tension remained nearly constant throughout knee flexion. Both two-bundle reconstructions controlled posterior translation, but with different load-sharing characteristics. The S1-S2 configuration resisted posterior tibial translation as both bundles became taut in flexion. In contrast, the S1-D configuration resisted posterior translation in a reciprocal fashion with the D bundle tension being the greatest in extension and the S1 bundle tension being the greatest tension in flexion.