Key role of biomechanical properties and material selection in rotator cuff repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Xiangquan ,  ZHOU You

Department of Orthopedics, Renhe Hospital Affiliated to China Three Gorges University, the Institute of Sports Medicine of China Three Gorges University, Yichang Clinical Research Center for Sports Injuries and Rehabilitation, Yichang Hubei, 443001, P. R. China;

Corresponding?author：

ZHOU You, Email: zhouyou8010@163.com

Keywords：

Rotator cuff injury; biomaterials; biomechanics; three-dimensional bioprinting

DOI：

10.7507/1002-1892.202506085

Video：

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Objective To summarize the biomechanical research progress of biomaterials in rotator cuff injury repair and to explore how biomaterials can restore the native histological and mechanical properties of the rotator cuff. Methods The relevant literature at home and abroad were widely reviewed to analyze the biomechanical properties of synthetic biomaterials, naturally derived biomaterials, and tissue grafts in the repair of rotator cuff injuries. Results Synthetic biomaterials [such as poly (lactic-co-glycolic acid) and polycaprolactone] can provide initial stable mechanical support due to their adjustable mechanical properties and degradation characteristics, while naturally derived biomaterials (such as collagen and hyaluronic acid) can promote cell adhesion and tissue integration due to their biocompatibility and bioactivity. Tissue grafts exhibit significant clinical utility by providing immediate mechanical stability and promoting tendon-to-bone healing. Three-dimensional bioprinting technology provides new possibilities for personalized repair of rotator cuff injuries by precisely controlling the spatial distribution and mechanical properties of biomaterials. Conclusion Future studies should further optimize the design of bioprinting materials, cell sources, and scaffolds to achieve better mechanical properties and clinical efficacy of biomaterials in the repair of rotator cuff injuries.

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1. Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med, 2012, 31(4): 589-604.
2. Colvin AC, Egorova N, Harrison AK, et al. National trends in rotator cuff repair. J Bone Joint Surg (Am), 2012, 94(3): 227-233.
3. Huegel J, Williams AA, Soslowsky LJ. Rotator cuff biology and biomechanics: a review of normal and pathological conditions. Curr Rheumatol Rep, 2015, 17(1): 476. doi: 10.1007/s11926-014-0476-x.
4. Akhtar A, Richards J, Monga P. The biomechanics of the rotator cuff in health and disease—A narrative review. J Clin Orthop Trauma, 2021, 18: 150-156.
5. Galanopoulos I, Ilias A, Karliaftis K, et al. The impact of re-tear on the clinical outcome after rotator cuff repair using open or arthroscopic techniques-a systematic review. Open Orthop J, 2017, 11: 95-107.
6. Karjalainen TV, Jain NB, Heikkinen J, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev, 2019, 12(12): CD013502. doi: 10.1002/14651858.CD013502.
7. Randelli P, Bak K, Milano G. State of the art in rotator cuff repair. Knee Surg Sports Traumatol Arthrosc, 2015, 23(2): 341-343.
8. Derwin KA, Badylak SF, Steinmann SP, et al. Extracellular matrix scaffold devices for rotator cuff repair. J Shoulder Elbow Surg, 2010, 19(3): 467-476.
9. Longo UG, Carnevale A, Piergentili I, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2021, 22(1): 749. doi: 10.1186/s12891-021-04634-6.
10. 白帥帥, 強輝. 分子生物學方法促進肩袖腱-骨愈合機制研究進展. 臨床醫學進展, 2023, 13(6): 10421-10428.
11. Franceschi F, Ruzzini L, Longo UG, et al. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med, 2007, 35(8): 1254-1260.
12. Klintberg IH, Gunnarsson AC, Svantesson U, et al. Early loading in physiotherapy treatment after full-thickness rotator cuff repair: a prospective randomized pilot-study with a two-year follow-up. Clin Rehabil, 2009, 23(7): 622-638.
13. Zhao S, Su W, Shah V, et al. Biomaterials based strategies for rotator cuff repair. Colloids Surf B Biointerfaces, 2017, 157: 407-416.
14. Romeo A, Easley J, Regan D, et al. Rotator cuff repair using a bioresorbable nanofiber interposition scaffold: a biomechanical and histologic analysis in sheep. J Shoulder Elbow Surg, 2022, 31(2): 402-412.
15. Lei T, Zhang T, Ju W, et al. Biomimetic strategies for tendon/ligament-to-bone interface regeneration. Bioact Mater, 2021, 6(8): 2491-2510.
16. Deprés-Tremblay G, Chevrier A, Snow M, et al. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elbow Surg, 2016, 25(12): 2078-2085.
17. Wang L, Zhu T, Kang Y, et al. Crimped nanofiber scaffold mimicking tendon-to-bone interface for fatty-infiltrated massive rotator cuff repair. Bioact Mater, 2022, 16: 149-161.
18. Kataoka T, Kokubu T, Muto T, et al. Rotator cuff tear healing process with graft augmentation of fascia lata in a rabbit model. J Orthop Surg Res, 2018, 13(1): 200. doi: 10.1186/s13018-018-0900-4.
19. Bianchi E, Ruggeri M, Rossi S, et al. Innovative strategies in tendon tissue engineering. Pharmaceutics, 2021, 13(1): 89. doi: 10.3390/pharmaceutics13010089.
20. 劉萍, 朱威宏, 劉騫. 動物模型在肩袖損傷研究中的應用. 中南大學學報(醫學版), 2021, 46(4): 426-431.
21. Edelstein L, Thomas SJ, Soslowsky LJ. Rotator cuff tears: what have we learned from animal models? J Musculoskelet Neuronal Interact, 2011, 11(2): 150-162.
22. Komi PV. Relevance of in vivo force measurements to human biomechanics. J Biomech, 1990, 23 Suppl 1, 23-34. doi: 10.1016/0021-9290(90)90038-5.
23. Lomas AJ, Ryan CN, Sorushanova A, et al. The past, present and future in scaffold-based tendon treatments. Adv Drug Deliv Rev, 2015, 84: 257-277.
24. Li D, Wang G, Li J, et al. Biomaterials for tissue-engineered treatment of tendinopathy in animal models: A systematic review. Tissue Eng Part B Rev, 2023, 29(4): 387-413.
25. Chevrier A, Hurtig MB, Lavertu M. Chitosan-platelet-rich plasma implants improve rotator cuff repair in a large animal model: Pivotal study. Pharmaceutics, 2021, 13(11): 1955. doi: 10.3390/pharmaceutics13111955.
26. 朱以明, 姜春巖, 王滿宜. 肩關節相關生物力學介紹. 中華創傷骨科雜志, 2005, 7(9): 869-872.
27. Millar NL, Silbernagel KG, Thorborg K, et al. Tendinopathy. Nat Rev Dis Primers, 2021, 7(1): 1. doi: 10.1038/s41572-020-00234-1.
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