The Biomechanical Role of Scaffolds in Augmented Rotator Cuff Tendon Repairs
VETERANS AFFAIRS MEDICAL CENTER PORTLAND OR
Pagination or Media Count:
Background Scaffolds continue to be developed and used for rotator cuff repair augmentation however, the appropriate scaffold material properties andor surgical application techniques for achieving optimal biomechanical performance remains unknown. The objectives of the study were to simulate a previously validated spring-network model for clinically relevant scenarios to predict 1 the manner in which changes to components of the repair influence the biomechanical performance of the repair and 2 the percent load carried by the scaffold augmentation component. Materials and methods The models were parametrically varied to simulate clinically relevant scenarios, namely, changes in tendon quality, altered surgical techniques, and different scaffold designs. The biomechanical performance of the repair constructs and the percent load carried by the scaffold component were evaluated for each of the simulated scenarios. Results The model predicts that the biomechanical performance of a rotator cuff repair can be modestly increased by augmenting the repair with a scaffold that has tendon-like properties. However, engineering a scaffold with supraphysiologic stiffness may not translate into yet stiffer or stronger repairs. Importantly, the mechanical properties of a repair construct appear to be most influenced by the properties of the tendon-to-bone repair. The model suggests that in the clinical setting of a weak tendon-to-bone repair, scaffold augmentation may significantly off-load the repair and largely mitigate the poor construct properties. Conclusions The model suggests that future efforts in the field of rotator cuff repair augmentation may be directed toward strategies that strengthen the tendon-to-bone repair andor toward engineering scaffolds with tendon-like mechanical properties.
- Anatomy and Physiology
- Medicine and Medical Research