Tendon Phenotype Should Dictate Tissue Engineering Modality in Tendon Repair: A Review - Michael Gott - Discovery Medicine
Subscribe to PDF Edition Personal Subscription Institutional xsport massapequa Subscription Renew Subscription Subscriber Self-Service Obtain a New Password Log Out Subscriber Log In Johns Hopkins CME About About the Author
Specialty: Orthopedics Institution: Department of Orthopedic Surgery, xsport massapequa North Shore University Hospital-LIJ Address: 300 Community Drive, Manhasset, New York, 11030, United States Author: John A. Schwartz
Specialty: Orthopedics Institution: Laboratory xsport massapequa of Orthopaedic Research, Feinstein Institute xsport massapequa for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Anthony Catanzano
Specialty: Orthopedics Institution: Laboratory of Orthopaedic Research, Feinstein Institute for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Pasquale Razzano
Specialty: Orthopedics Institution: Laboratory of Orthopaedic Research, Feinstein Institute for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Daniel A. Grande
Abstract: Advancements in the technical aspects of tendon xsport massapequa repair have significantly improved the treatment of tendon injuries. Arthroscopic techniques, suture material, and improved rehabilitation have all been contributing factors. Biological augmentation and tissue engineering appear to have the potential to improve clinical outcomes as well. After review of the physiology of tendon repair, three critical components of tissue engineering can be discerned: the cellular component, the carrier vehicle xsport massapequa (matrix or scaffold), and the bioactive component (growth factors, platelet rich plasma). These three components xsport massapequa are discussed with regard to each of three tendon types: Intra-synovial (flexor tendon), xsport massapequa extra-synovial (Achilles tendon), and extra-synovial tendon under compression (rotator cuff). Scaffolds, biologically enhanced scaffolds, growth factors, platelet rich plasma, gene therapy, mesenchymal stem cells, and local environment factors in combination or alone may contribute to tendon healing. In the future it may be beneficial to differentiate these modes of healing augmentation with regard to tendon subtype.
Tendon injuries are encountered routinely in orthopedic practice. Treatment xsport massapequa of these injuries has improved tremendously over the last two decades (Tang, 2005; Yamaguchi et al., 2003; Beredijiklian, 2003). Even so, the cost of tendon injuries to our society in terms of human suffering and financial xsport massapequa burden continues to be significant. Management of tendon injury has been documented as far back as the 2 nd century A.D., yet treatment protocols for many of these injuries are still actively debated (Burkhead and Habermeyer, 1996). While the advancements in basic and clinical research often lead to new therapies and treatment adjuncts, these same advancements can initiate even more controversy in the appropriateness and applicability of these new technologies. Despite the strides made in understanding tendon physiology, many of the mechanisms behind its response to injury remain unknown. Unlike bone, which has the ability to restore normal tissue after injury, tendon heals with scar that is never identical to the uninjured tissue. The goal of clinical practice is to capitalize on that scarring while attempting to limit adhesion formation in order to optimize post-injury function. Current tissue engineering techniques seek to accelerate and/or modulate and/or improve the speed and quality of the healing tendon tissue.
Although intrasynovial tendons, extrasynovial tendons, and extrasynovial tendons under compression all possess a similar biochemical composition, injuries xsport massapequa to these tendons are generally managed differently because of the unique xsport massapequa anatomy, physiology, function, biomechanics, healing, and post-operative rehabilitation that pertain to each. Each tendon type presents its own unique set of challenges.
All tendons share basic structural components. Key differences exist, which aid each in its specific function. xsport massapequa Collagen is the single most abundant structural component of tendon. Whereas water makes up 70% of its total mass, collagen constitutes 60-85% of tendon dry weight (type I - 95%, type III and IV - 5%) (O’Brien, 1997; Piez et al., 1969; Jimenez et al., 1978). Its molecular architecture provides tendon xsport massapequa with its high tensile strength. The intrasynovial flexor tendons xsport massapequa and the extrasynovial tendons xsport massapequa like the Achilles and quadriceps tendon are similar in their collagen profile. Rotator cuff tendon xsport massapequa , however, is slightly different xsport massapequa in that it demonstrates the presence of some type II collagen, and interdigitation of some of its fibers (Clark and Harryman, xsport massapequa 1992). The ground substance of tendon is composed largely of proteoglycans. Proteoglycans make up 1% of the dry weight of tendon, and
Subscribe to PDF Edition Personal Subscription Institutional xsport massapequa Subscription Renew Subscription Subscriber Self-Service Obtain a New Password Log Out Subscriber Log In Johns Hopkins CME About About the Author
Specialty: Orthopedics Institution: Department of Orthopedic Surgery, xsport massapequa North Shore University Hospital-LIJ Address: 300 Community Drive, Manhasset, New York, 11030, United States Author: John A. Schwartz
Specialty: Orthopedics Institution: Laboratory xsport massapequa of Orthopaedic Research, Feinstein Institute xsport massapequa for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Anthony Catanzano
Specialty: Orthopedics Institution: Laboratory of Orthopaedic Research, Feinstein Institute for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Pasquale Razzano
Specialty: Orthopedics Institution: Laboratory of Orthopaedic Research, Feinstein Institute for Medical Research Address: 350 Community Drive, Manhasset, New York, 11030, United States Author: Daniel A. Grande
Abstract: Advancements in the technical aspects of tendon xsport massapequa repair have significantly improved the treatment of tendon injuries. Arthroscopic techniques, suture material, and improved rehabilitation have all been contributing factors. Biological augmentation and tissue engineering appear to have the potential to improve clinical outcomes as well. After review of the physiology of tendon repair, three critical components of tissue engineering can be discerned: the cellular component, the carrier vehicle xsport massapequa (matrix or scaffold), and the bioactive component (growth factors, platelet rich plasma). These three components xsport massapequa are discussed with regard to each of three tendon types: Intra-synovial (flexor tendon), xsport massapequa extra-synovial (Achilles tendon), and extra-synovial tendon under compression (rotator cuff). Scaffolds, biologically enhanced scaffolds, growth factors, platelet rich plasma, gene therapy, mesenchymal stem cells, and local environment factors in combination or alone may contribute to tendon healing. In the future it may be beneficial to differentiate these modes of healing augmentation with regard to tendon subtype.
Tendon injuries are encountered routinely in orthopedic practice. Treatment xsport massapequa of these injuries has improved tremendously over the last two decades (Tang, 2005; Yamaguchi et al., 2003; Beredijiklian, 2003). Even so, the cost of tendon injuries to our society in terms of human suffering and financial xsport massapequa burden continues to be significant. Management of tendon injury has been documented as far back as the 2 nd century A.D., yet treatment protocols for many of these injuries are still actively debated (Burkhead and Habermeyer, 1996). While the advancements in basic and clinical research often lead to new therapies and treatment adjuncts, these same advancements can initiate even more controversy in the appropriateness and applicability of these new technologies. Despite the strides made in understanding tendon physiology, many of the mechanisms behind its response to injury remain unknown. Unlike bone, which has the ability to restore normal tissue after injury, tendon heals with scar that is never identical to the uninjured tissue. The goal of clinical practice is to capitalize on that scarring while attempting to limit adhesion formation in order to optimize post-injury function. Current tissue engineering techniques seek to accelerate and/or modulate and/or improve the speed and quality of the healing tendon tissue.
Although intrasynovial tendons, extrasynovial tendons, and extrasynovial tendons under compression all possess a similar biochemical composition, injuries xsport massapequa to these tendons are generally managed differently because of the unique xsport massapequa anatomy, physiology, function, biomechanics, healing, and post-operative rehabilitation that pertain to each. Each tendon type presents its own unique set of challenges.
All tendons share basic structural components. Key differences exist, which aid each in its specific function. xsport massapequa Collagen is the single most abundant structural component of tendon. Whereas water makes up 70% of its total mass, collagen constitutes 60-85% of tendon dry weight (type I - 95%, type III and IV - 5%) (O’Brien, 1997; Piez et al., 1969; Jimenez et al., 1978). Its molecular architecture provides tendon xsport massapequa with its high tensile strength. The intrasynovial flexor tendons xsport massapequa and the extrasynovial tendons xsport massapequa like the Achilles and quadriceps tendon are similar in their collagen profile. Rotator cuff tendon xsport massapequa , however, is slightly different xsport massapequa in that it demonstrates the presence of some type II collagen, and interdigitation of some of its fibers (Clark and Harryman, xsport massapequa 1992). The ground substance of tendon is composed largely of proteoglycans. Proteoglycans make up 1% of the dry weight of tendon, and
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