TY - JOUR

T1 - Possibilities and limitations of electrospun chitosan-coated polycaprolactone grafts for rotator cuff tear repair

AU - Willbold, Elmar

AU - Wellmann, Mathias

AU - Welke, Bastian

AU - Angrisani, Nina

AU - Gniesmer, Sarah

AU - Kampmann, Andreas

AU - Hoffmann, Andrea

AU - de Cassan, Dominik

AU - Menzel, Henning

AU - Hoheisel, Anna Lena

AU - Glasmacher, Birgit

AU - Reifenrath, Janin

N1 - Funding Information: This work was supported by the Deutsche Forschungsgemeinschaft (DFG) within the framework of FOR 2180 "Forschergruppe Gradierte Implantate ‐ Sehnen‐ und Knochen‐Verbindungen". We thank Eike Jakubowitz from OrthoGo (Institut für Orthopädische Bewegungsdiagnostik) for help with professional photographic equipment, Christopher Müller for excellent graphic art work, and Michael Schwarze for help with statistical analysis. We also thank Mykola Fedchenko for pathological expertise and Marco Gustav, Maike Haupt, Maike Hermann, Hilke Catherina Janßen, Mattias Reebmann, Marie‐Luise Schröder, Diana Strauch, Patrick Wolf, and Stefanie Rausch (all from Hannover Medical School) for excellent technical support. We thank Andreas Spenst (Hannover Medical School) for excellent processing of the biomechanical data and Alexander Becker and Michael Bode (both from Leibniz University Hannover) for valuable scientific discussions. Funding Information: This work was supported by the Deutsche Forschungsgemeinschaft (DFG) within the framework of FOR 2180 "Forschergruppe Gradierte Implantate - Sehnen- und Knochen-Verbindungen". We thank Eike Jakubowitz from OrthoGo (Institut f?r Orthop?dische Bewegungsdiagnostik) for help with professional photographic equipment, Christopher M?ller for excellent graphic art work, and Michael Schwarze for help with statistical analysis. We also thank Mykola Fedchenko for pathological expertise and Marco Gustav, Maike Haupt, Maike Hermann, Hilke Catherina Jan?en, Mattias Reebmann, Marie-Luise Schr?der, Diana Strauch, Patrick Wolf, and Stefanie Rausch (all from Hannover Medical School) for excellent technical support. We thank Andreas Spenst (Hannover Medical School) for excellent processing of the biomechanical data and Alexander Becker and Michael Bode (both from Leibniz University Hannover) for valuable scientific discussions.

PY - 2020/1/29

Y1 - 2020/1/29

N2 - Acute and chronic rotator cuff tears remain challenging for therapy. A wide range of therapeutic approaches were developed but re-tears and postoperative complications occur regularly. Especially in elderly people, the natural regeneration processes are decelerated, and graft materials are often necessary to stabilize the tendon-to-bone attachment and to improve the healing process. We here investigated in a small animal model a newly developed electrospun polycaprolactone fiber implant coated with a chitosan-polycaprolactone graft copolymer and compared these implants biomechanically and histologically with either a commercially available porous polyurethane implant (Biomerix 3D Scaffold) or suture-fixed tendons. Fifty-one rats were divided into three groups of 17 animals each. In the first surgery, the left infraspinatus tendons of all rats were detached, and the animals recovered for 4 weeks. In the second surgery, the tendons were fixed with suture material only (suture-fixed group; n = 17), whereas in the two experimental groups, the tendons were fixed with suture material and the polyurethane implant (Biomerix scaffold group; n = 17) or the modified electrospun polycaprolactone fiber implant (CS-g-PCL scaffold group; n=17), respectively. The unaffected right infraspinatus tendons were used as native controls. After a recovery of 8 weeks, all animals were clinically inconspicuous. In 12 animals of each group, repaired entheses were biomechanically tested for force at failure, stiffness, and modulus of elasticity, and in five animals, repaired entheses were analyzed histologically. Biomechanically, all parameters did not differ statistically significant between both implant groups, and the entheses failed typically at the surgical site. However, with respect to the force at failure, the median values of the two implant groups were smaller than the median value of the suture-fixed group. Histologically, the modified polycaprolactone fiber implant showed no acute inflammation processes, a good infiltration with cells, ingrowth of blood vessels and tendinous tissue, and a normal fibrous ensheathment. Further improvement of the implant material could be achieved by additional implementation of drug delivery systems. Therewith, the used CS-g-PCL fiber mat is a promising basic material to reach the goal of a clinically usable graft for rotator cuff tear repair.

AB - Acute and chronic rotator cuff tears remain challenging for therapy. A wide range of therapeutic approaches were developed but re-tears and postoperative complications occur regularly. Especially in elderly people, the natural regeneration processes are decelerated, and graft materials are often necessary to stabilize the tendon-to-bone attachment and to improve the healing process. We here investigated in a small animal model a newly developed electrospun polycaprolactone fiber implant coated with a chitosan-polycaprolactone graft copolymer and compared these implants biomechanically and histologically with either a commercially available porous polyurethane implant (Biomerix 3D Scaffold) or suture-fixed tendons. Fifty-one rats were divided into three groups of 17 animals each. In the first surgery, the left infraspinatus tendons of all rats were detached, and the animals recovered for 4 weeks. In the second surgery, the tendons were fixed with suture material only (suture-fixed group; n = 17), whereas in the two experimental groups, the tendons were fixed with suture material and the polyurethane implant (Biomerix scaffold group; n = 17) or the modified electrospun polycaprolactone fiber implant (CS-g-PCL scaffold group; n=17), respectively. The unaffected right infraspinatus tendons were used as native controls. After a recovery of 8 weeks, all animals were clinically inconspicuous. In 12 animals of each group, repaired entheses were biomechanically tested for force at failure, stiffness, and modulus of elasticity, and in five animals, repaired entheses were analyzed histologically. Biomechanically, all parameters did not differ statistically significant between both implant groups, and the entheses failed typically at the surgical site. However, with respect to the force at failure, the median values of the two implant groups were smaller than the median value of the suture-fixed group. Histologically, the modified polycaprolactone fiber implant showed no acute inflammation processes, a good infiltration with cells, ingrowth of blood vessels and tendinous tissue, and a normal fibrous ensheathment. Further improvement of the implant material could be achieved by additional implementation of drug delivery systems. Therewith, the used CS-g-PCL fiber mat is a promising basic material to reach the goal of a clinically usable graft for rotator cuff tear repair.

KW - biomechanics

KW - chitosan

KW - histology

KW - polycaprolactone fiber implant

KW - rat

KW - rotator cuff

KW - tendon

UR - http://www.scopus.com/inward/record.url?scp=85074842689&partnerID=8YFLogxK

U2 - 10.1002/term.2985

DO - 10.1002/term.2985

M3 - Article

C2 - 31670896

AN - SCOPUS:85074842689

VL - 14

SP - 186

EP - 197

JO - Journal of Tissue Engineering and Regenerative Medicine

JF - Journal of Tissue Engineering and Regenerative Medicine

SN - 1932-6254

IS - 1

ER -