EFFECT OF DIFFERENT SURGERY TECHNIQUES ON BONE-TENDON HEALING OF ROTATOR CUFF INSERTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TAO Xu , TANG Kanglai , CHEN Lei , ZHOU Jianbo , CAO Honghui , CHANG Tingjie , LI Hui , XU Jianzhong.

Department of Orthopedics, the Orthopedic Surgery Center of Chinese PLA, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P.R.China;

Corresponding author：

Keywords：

Rotator cuff injury; Tendon-bone healing; Cancellous bone; Cortical bone; Rabbit

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Objective?To analyze the effect of different surgery techniques on the tendon-bone healing of rotator cuff insertion.?Methods?Forty-two adult Japanese rabbits, weighing 2.0-2.5 kg and male or female, were selected. Thirty-six rabbits were given a sharply left-lateral tenotomy of the supraspinatus tendon with subsequent re-attachment of the tendon. According to the depth of re-attachment, 36 rabbits were equally randomized into the cancellous-fixation group (a cancellous bed was prepared with a dental burr) and the cortical-fixation group (the same treatment was performed except the preparation of the bone bed). Six rabbits served as the controls without treatment (control group). At 4 and 8 weeks after operation, the general observation, HE staining, and the biomechanical test were performed.?Results?At 4 weeks after operation, the supraspinatus-humerus specimens morphologically showed atrophy and vague between tendon and new bone in the cancellous-fixation group and the cortical-fixation group; at 8 weeks, no obvious difference was observed between 2 groups and the control group. The histological results of the cortical-fixation group at 4 weeks revealed the interface between tendon and new bone became smooth. The interface became transitional at 8 weeks, and the shape of bone tissue was nearly normal. The interface obtained from the cancellous-fixation group at 4 weeks became sclerotic, and collagen fibers formed in disorder. With ingrowth of new bone and re-establishment of collagen-fiber continuity at 8 weeks, thickness of interface became thin, and bone tissue was remodeling. The ultimate load were significantly higher in the cortical-fixation group than in the cancellous-fixation group at both 4 and 8 weeks, and the results gained at 8 weeks is significantly higher than that at 4 weeks in each group (P lt; 0.05). Except rupture strength at 4 weeks between 2 groups and all tensile strength (P gt; 0.05), there were significant differences in the results of others (P lt; 0.05).?Conclusion?In this model, the tendon-bone healing process and the biomechanical properties of cortical-fixation is superior to those of cancellous-fixation.

Citation： TAO Xu,TANG Kanglai,CHEN Lei,ZHOU Jianbo,CAO Honghui,CHANG Tingjie,LI Hui,XU Jianzhong.. EFFECT OF DIFFERENT SURGERY TECHNIQUES ON BONE-TENDON HEALING OF ROTATOR CUFF INSERTION. Chinese Journal of Reparative and Reconstructive Surgery, 2011, 25(4): 385-388. doi: Copy

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2.	Meyer D, Fucentese S, Koller B, et al. Association of osteopenia of the humeral head with fullthickness rotator cuff tears. J Shoulder Elbow Surg, 2004, 13(3): 333-337.
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7.	Gamradt SC, Gallo RA, Adler RS, et al. Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg, 2010, 19(1): 73-80.
8.	Lorbach O, Bachelier F, Vees J, et al. Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med, 2008, 36(8): 1504-1510.
9.	Soda Y, Sumen Y, Murakami Y, et al. Attachment of autogenous tendon graft to cortical bone is better than to cancellous bone: a mechanical and histological study of MCL reconstruction in rabbits. Acta Orthop Scand, 2003, 74(3): 322-326.
10.	St Pierre P, Olson E, Elliott J, et al. Tendon-healing to cortical bone compared with healing to a cancellous trough. A biomechanical and histological evaluation in goats. J Bone Joint Surg (Am), 1995, 77(12): 1858-1866.
11.	Wong MW, Qin L, Lee KM, et al. Articular cartilage increases transition zone regeneration in bone-tendon junction healing. Clin Orthop Relat Res, 2009, 467(4): 1092-1100.
12.	Wong MW, Qin L, Lee KM, et al. Healing of bone-tendon junction in a bone trough: a goat partial patellectomy model. Clin Orthop Relat Res, 2003, (413): 291-302.
13.	Derwin KA, Baker AR, Iannotti JP, et al. Preclinical models for translating regenerative medicine therapies for rotator cuff repair. Tissue Eng Part B Rev, 2010, 16(1): 21-30.

1. Tang KL, Habermeryer P, Li QH, et al. Etiology, classification and clinical evaluation of partial-thickness tears of rotator cuff. Chin J Traumatol, 2003, 6(5): 309-317.
2. Meyer D, Fucentese S, Koller B, et al. Association of osteopenia of the humeral head with fullthickness rotator cuff tears. J Shoulder Elbow Surg, 2004, 13(3): 333-337.
3. Yamada M, Briot J, Pedrono A, et al. Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg, 2007, 16(5): 596-602.
4. Barber FA, Herbert MA, Richards DP. Sutures and suture anchors: update 2003. Arthroscopy, 2003, 19(9): 985-990.
5. Barber FA, Herbert MA, Coons DA, et al. Sutures and suture anchors—update 2006. Arthroscopy, 2006, 22(10): 1063. e1-9.
6. Uhthoff HK, Seki M, Backman DS, et al. Tensile strength of the supraspinatus after reimplantation into a bony trough: an experimental study in rabbits. J Shoulder Elbow Surg, 2002, 11(5): 504-509.
7. Gamradt SC, Gallo RA, Adler RS, et al. Vascularity of the supraspinatus tendon three months after repair: characterization using contrast-enhanced ultrasound. J Shoulder Elbow Surg, 2010, 19(1): 73-80.
8. Lorbach O, Bachelier F, Vees J, et al. Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair. Am J Sports Med, 2008, 36(8): 1504-1510.
9. Soda Y, Sumen Y, Murakami Y, et al. Attachment of autogenous tendon graft to cortical bone is better than to cancellous bone: a mechanical and histological study of MCL reconstruction in rabbits. Acta Orthop Scand, 2003, 74(3): 322-326.
10. St Pierre P, Olson E, Elliott J, et al. Tendon-healing to cortical bone compared with healing to a cancellous trough. A biomechanical and histological evaluation in goats. J Bone Joint Surg (Am), 1995, 77(12): 1858-1866.
11. Wong MW, Qin L, Lee KM, et al. Articular cartilage increases transition zone regeneration in bone-tendon junction healing. Clin Orthop Relat Res, 2009, 467(4): 1092-1100.
12. Wong MW, Qin L, Lee KM, et al. Healing of bone-tendon junction in a bone trough: a goat partial patellectomy model. Clin Orthop Relat Res, 2003, (413): 291-302.
13. Derwin KA, Baker AR, Iannotti JP, et al. Preclinical models for translating regenerative medicine therapies for rotator cuff repair. Tissue Eng Part B Rev, 2010, 16(1): 21-30.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF DIFFERENT SURGERY TECHNIQUES ON BONE-TENDON HEALING OF ROTATOR CUFF INSERTION

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