Novel engineered tendon-fibrocartilage-bone composite with cyclic tension for rotator cuff repair

Journal of Tissue Engineering and Regenerative MedicineVolume 12, Issue 7 p. 1690-1701 RESEARCH ARTICLE Novel engineered tendon–fibrocartilage–bone composite with cyclic tension for rotator cuff repair Qian Liu, Qian Liu Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA The Second Xiangya Hospital, Central South University, Changsha, P.R. ChinaSearch for more papers by this authorTaku Hatta, Taku Hatta Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorJun Qi, Jun Qi Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorHaoyu Liu, Haoyu Liu Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorAndrew R. Thoreson, Andrew R. Thoreson Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorPeter C. Amadio, Peter C. Amadio Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorSteven L. Moran, Steven L. Moran Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorScott P. Steinmann, Scott P. Steinmann Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorAnne Gingery, Anne Gingery Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorChunfeng Zhao, Corresponding Author Chunfeng Zhao zhaoc@mayo.edu orcid.org/0000-0002-8737-4587 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA Correspondence Chunfeng Zhao, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Email: zhaoc@mayo.eduSearch for more papers by this author Qian Liu, Qian Liu Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA The Second Xiangya Hospital, Central South University, Changsha, P.R. ChinaSearch for more papers by this authorTaku Hatta, Taku Hatta Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorJun Qi, Jun Qi Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorHaoyu Liu, Haoyu Liu Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorAndrew R. Thoreson, Andrew R. Thoreson Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorPeter C. Amadio, Peter C. Amadio Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorSteven L. Moran, Steven L. Moran Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorScott P. Steinmann, Scott P. Steinmann Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorAnne Gingery, Anne Gingery Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USASearch for more papers by this authorChunfeng Zhao, Corresponding Author Chunfeng Zhao zhaoc@mayo.edu orcid.org/0000-0002-8737-4587 Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA Correspondence Chunfeng Zhao, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Email: zhaoc@mayo.eduSearch for more papers by this author First published: 15 May 2018 https://doi.org/10.1002/term.2696Citations: 17Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Surgical repair of rotator cuff tears presents a significant clinical challenge with high failure rates and inferior functional outcomes. Graft augmentation improves repair outcomes; however, currently available grafting materials have limitations. Although cell-seeded decellularized tendon slices may facilitate cell infiltration, promote tendon incorporation, and preserve original mechanical strength, the unique fibrocartilage zone is yet to be successfully reestablished. In this study, we investigated the biological and mechanical properties of an engineered tendon–fibrocartilage–bone composite (TFBC) with cyclic tension (3% strain; 0.2 Hz). Decellularized TFBCs seeded with bone marrow-derived mesenchymal stem cell (BMSCs) sheets and subjected to mechanical stimulation for up to 7 days were characterised by histology, immunohistochemistry, scanning electron microscopy, mechanical testing, and transcriptional regulation. The decellularized TFBC maintained native enthesis structure and properties. Mechanically stimulated TFBC–BMSC constructs displayed increased cell migration after 7 days of culture compared with static groups. The seeded cell sheet not only integrated well with tendon scaffold but also distributed homogeneously and aligned to the direction of stretch under dynamic culture. Developmental genes were regulated including scleraxis, which was significantly upregulated with mechanical stimulation. The Young's modulus of the cell-seeded constructs was significantly higher compared with the noncell-seeded controls. In conclusion, the results of this study reveal that the TFBC–BMSC composite provides an ideal multilayer construct for cell seeding and growth, with mechanical preconditioning further enhances cell penetration and differentiation. The BMSC cell sheet revitalised TFBC in conjunction with mechanical stimulation could serve as a novel and primed biological patch to improve rotator cuff repair. CONFLICT OF INTEREST No competing financial interests exist. Citing Literature Volume12, Issue7July 2018Pages 1690-1701 RelatedInformation