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Tendon collagen crosslinking offers potential to improve suture pullout in rotator cuff repair: an ex vivo sheep study

机译：肌腱胶原交联具有改善肩袖修复缝合线的潜力：一项离体绵羊研究

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The suture-tendon interface is often the weakest link in tendon to bone repair of massive rotator cuff tears. Genipin is a low-toxicity collagen crosslinker derived from the gardenia fruit that has been shown to augment collagen tissue strength and mechanically arrest tendon-tear progression.\udThe purpose of the current study was to evaluate whether genipin crosslinking can sufficiently augment the suture-tendon interface to improve suture pullout strength using simple single-loop sutures and the modified Mason-Allen technique. The study also aimed to assess whether time of genipin treatment is a relevant factor in efficacy.\udIn an ex vivo (cadaveric) sheep rotator cuff tendon model, a total of 142 suture pullout tests were performed on 32 infraspinatus tendons. Each tendon was prepared with three single-loop stitches. Two groups were pretreated by incubation in genipin solution for either 4 hours or 24 hours. Two corresponding control groups were incubated in phosphate buffered saline for the same periods. The same test protocol was applied to tendons using modified Mason-Allen technique stitch patterns. Each suture was loaded to failure on a universal materials testing machine. Suture pullout force, stiffness, and work to failure were calculated from force-displacement data, and then compared among the groups.\udMedian single-loop pullout force on tendons incubated for 24 hours in genipin yielded an approximately 30% increase in maximum pullout force for single-loop stitches with a median of 73 N (range, 56-114 N) compared with 56 N (range, 40-69 N; difference of medians = 17 N; p = 0.028), with corresponding increases in the required work to failure but not stiffness. Genipin treatment for 4 hours showed no added benefit for suture-pullout behavior (46 N, [range, 35-95 N] versus 45 N, [range, 28-63 N]; difference of medians, 1 N; p = 1). No tested genipin crosslinking conditions indicated benefit for tendons grasped using the modified Mason-Allen technique after 4 hours (162 N, [range, 143-193 N] versus 140 N, [range, 129-151 N]; difference of medians, 22 N; p = 0.114) or after 24 hours of crosslinking (172 N, [range, 42-183 N] versus 164 N [range, 151-180 N]; difference of medians, 8 N; p = 0.886).\udExogenous collagen crosslinking in genipin can markedly improve resistance to pullout at the tendon-suture interface for simple stitch patterns while the modified Mason-Allen stitch showed no benefit in an ex vivo animal model.\udTendon strength augmentation by genipin pretreatment offers the potential to improve suture retention properties. Future studies are warranted for the development of clinically viable intraoperative delivery strategies and in vivo testing for safety and efficacy.
机译：缝线-肌腱界面通常是肌腱与大型肩袖撕裂的骨修复的最薄弱环节。 Genipin是衍生自the子果实的低毒性胶原交联剂，已显示出可以增强胶原组织强度和机械阻止肌腱撕裂进展的作用。\ ud本研究的目的是评估genipin交联能否充分增强缝合肌腱使用简单的单环缝线和改良的Mason-Allen技术来提高缝线的抗拔强度。该研究还旨在评估Genipin治疗的时间是否是疗效的相关因素。\ ud在离体（尸体）绵羊肩袖肌腱模型中，对32根鼻下肌腱进行了总共142个缝合线拔出测试。每个肌腱都准备了三个单环针。两组通过在Genipin溶液中孵育4小时或24小时进行预处理。将两个相应的对照组在磷酸盐缓冲液中孵育相同的时间。使用改良的Mason-Allen技术的针迹图案将相同的测试方案应用于肌腱。每个缝线在通用材料测试机上加载失败。从力-位移数据计算出缝合线的拉出力，刚度和断裂功，然后在各组之间进行比较。\ ud在Genipin中孵育24小时的肌腱的单环中值拉出使最大拉出力增加了大约30％中位数为73 N（范围为56-114 N）的单圈针迹，而中位数为56 N（范围为40-69 N；中位数之差= 17 N； p = 0.028），所需工作量相应增加失败，但没有僵硬。 Genipin治疗4小时显示对缝线抽出行为没有额外的益处（46 N，[范围，35-95 N]与45 N，[范围，28-63 N]；中位差，1 N； p = 1） 。没有经过测试的Genipin交联条件表明使用改良的Mason-Allen技术可在4小时后抓紧肌腱（162 N，[范围，143-193 N]对140 N，[范围，129-151 N]；中位数差异22） N； p = 0.114）或交联24小时后（172 N，[范围：42-183 N]与164 N [范围，151-180 N]；中位数之差，8 N； p = 0.886）。 genipin中的胶原蛋白交联可显着提高简单针迹图案在腱-缝合线界面处的抗拔出性，而改良的Mason-Allen针迹在离体动物模型中则无益处。保留特性。有必要进行进一步的研究，以开发临床上可行的术中分娩策略以及体内安全性和有效性测试。

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