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Results for “Absorbable Implants”

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PubMed2006

Arthroscopic fixation of bursal-sided rotator cuff tears.

Subacromial decompression and debridement of partial-thickness bursal-sided rotator cuff tears are often reported with a high rate of unsatisfactory outcomes. We describe an arthroscopic procedure to repair partial-thickness bursal-sided rotator cuff tears without converting to a full-thickness tear in patients with a normal articular-sided rotator cuff and an A0B2 or A0B3 pattern of tear (minimum thickness of 25% to 75%). The articular side of the rotator cuff experiences greater tension than the bursal side of the cuff. As such, by leaving the articular footprint intact, we accomplish 3 goals: the intact articular fibers act as an internal splint to protect the bursal-sided repair, a wide and anatomic footprint is recreated, and we are able to minimize any length-tension mismatch because the tissue is not excessively lateralized with repair. After bursectomy and acromioplasty, the frayed edges of the bursal flap are gently debrided and the tuberosity is excoriated to bleeding bone. One or two bioabsorbable anchors are placed, and both sutures are placed through the full thickness of the rotator cuff (one anterior and one posterior) by use of a percutaneous suture lasso in this manner: (1) the lasso is passed through the full thickness of the cuff, and the nitinol wire is shuttled out of a single cannula along with the more medial of the suture limbs; (2) the nitinol wire is then pulled back out of the percutaneous portal along with the suture limb, with the suture being passed through the full thickness of the cuff; and (3) the procedure is repeated for the posterior limb of the suture after a lasso is again passed through the full thickness of the rotator cuff in a more posterior position. This subset of patients is treated with an aggressive rehabilitation protocol because the intact articular rotator cuff fibers act as an internal splint to protect the bursal repair.

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PubMed2006

Graft laceration and pullout strength of soft-tissue anterior cruciate ligament reconstruction: in vitro study comparing titanium, poly-d,l-lactide, and poly-d,l-lactide-tricalcium phosphate screws.

PURPOSE: The aim of part 1 of this study was to compare the structural properties of tibia-graft-interference screw constructs of soft-tissue graft fixation via the anterior cruciate ligament (ACL) by use of different interference screws. In part 2 the influence of graft laceration as a result of 1 single interference screw insertion on the mechanical properties of the graft was evaluated. METHODS: In part 1 of the study, in a bovine knee model, soft-tissue graft fixation with titanium, biodegradable poly-D,L-lactide (PLDLA), and PLDLA-tricalcium phosphate (TCP) interference screws was performed, and the structural properties were determined by use of a materials testing machine at a rate of 12.5 mm/s. In part 2 the bone was cut after 1 single insertion of titanium, PLDLA, or PLDLA-TCP interference screws, and the mechanical properties of the graft were determined. RESULTS: Soft-tissue graft fixation with a biodegradable PLDLA interference screw showed a statistically significantly higher maximum load when compared with PLDLA-TCP and titanium interference screws. PLDLA-TCP screw fixation revealed a significantly higher ultimate load than titanium screw fixation. The mechanical properties of the grafts after 1 single insertion of PLDLA-TCP interference screws showed a statistically significantly higher stiffness, yield load, and maximum load when compared with the PLDLA and titanium interference screw groups. CONCLUSIONS: The results of this study suggest that the use of a titanium screw to fix a soft-tissue graft in cruciate ligament reconstruction surgery may cause damage to the graft. Soft-tissue ACL reconstruction fixed with a PLDLA interference screw resulted in a significantly higher pullout strength than ACL reconstructions fixed with a PLDLA-TCP or titanium interference screw. CLINICAL RELEVANCE: In contrast to fixation with a biodegradable interference screw, fixation with a titanium interference screw may damage the integrity of a soft-tissue graft in cruciate ligament reconstruction and should therefore be avoided.

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PubMed2006

Hybrid femoral fixation of soft-tissue grafts in anterior cruciate ligament reconstruction using the EndoButton CL and bioabsorbable interference screws: a biomechanical study.

PURPOSE: The purpose of this study was to evaluate the effect of hybrid femoral fixation with bioabsorbable interference screws (BioRCI; Smith & Nephew Endoscopy, Andover, MA) and EndoButton CL (Smith & Nephew Endoscopy) fixation. METHODS: Biomechanical testing of 3 different fixation techniques was performed by use of porcine hind-limb distal femurs and mature bovine extremity common extensor tendons. Two independent testing sessions were examined. The first testing session (group A) compared femoral fixation via the EndoButton CL device (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The second testing session (group B) compared femoral fixation via BioRCI screws alone (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The femur-graft complex was cyclically loaded between 50 and 250 N at 1 Hz for 1,000 cycles. After cycling, the amount of graft slippage was determined by measuring the change in grip-to-grip distance. The complex was then loaded to failure at 1 mm/s, and the ultimate tensile strength, stiffness, and mode of failure were determined. RESULTS: In group A the addition of an interference screw to the EndoButton CL fixation increased the ultimate tensile strength (1,364.7 +/- 102.4 N for EndoButton CL alone v 1,449.3 +/- 94.4 N for combined technique, P = .035) and stiffness (195.5 +/- 12.1 N/mm for EndoButton CL alone v 307.3 +/- 54.9 N/mm for combined technique, P = .004) and decreased the amount of graft slippage (2.6 +/- 0.5 mm for EndoButton CL alone v 2.0 +/- 0.3 mm for combined technique, P = .017). In group B the addition of the EndoButton CL device to interference screw fixation significantly increased the ultimate tensile strength (643.5 +/- 148.4 N for BioRCI screws alone v 1,290.3 +/- 254.4 N for combined technique, P = .004) but had no effect on stiffness (315.7 +/- 38.9 N/mm for BioRCI screws alone v 341.5 +/- 64.0 N/mm for combined technique, P = .267) or graft slippage (2.7 +/- 1.0 mm for BioRCI screws alone v 2.0 +/- 0.6 mm for combined technique, P = .087). CONCLUSIONS: Our study shows that hybrid femoral fixation of double-looped gracilis-semitendinosus grafts via the EndoButton CL device and a bioabsorbable interference screw is stronger than interference or EndoButton CL fixation alone with respect to ultimate tensile strength, stiffness, and slippage. The addition of an interference screw to suspensory fixation via the EndoButton CL device increased the ultimate tensile strength from 1,360 N to 1,450 N, improved reconstruction stiffness from 200 N/mm to 300 N/mm, and decreased the amount of graft slippage resulting from cyclic loading from 2.6 mm to 2.0 mm. CLINICAL RELEVANCE: The hybrid fixation of the EndoButton CL device and an interference screw is a stronger and stiffer construct than either device alone and allows for aperture fixation, which may translate into better clinical results.

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PubMed2004

Extratracheal biodegradable splint to treat life-threatening tracheomalacia.

A 9-month-old girl presented with life-threatening acute respiratory failure 1 week after the surgical correction of a double aortic arch, which was due to a severe bulging of the pars membranacea into the lumen of the trachea that produced a complete obstruction of the lower trachea. Under cardiopulmonary bypass, a Y-shaped posterior biodegradable splint was placed behind the trachea and sutured to the posterior trachea, and a simultaneous right aortic arch aortopexy was performed. Thereafter, the child recovered normal respiratory function. Follow-up bronchoscopy showed a posterior dip at the splint level and an asymptomatic persistent posterior compression of the right main bronchus.

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PubMed2004

A simple solution for management of the postpneumonectomy empyema cavity.

Postpneumonectomy bronchopleural fistula with empyema is a difficult problem. Once the fistula is healed, successful closure of the pleural space is associated with varying degrees of success, as well as the potential for major reconstructive surgery. My colleagues and I describe a simple approach for the definitive management of the open pleural space involving split-thickness skin grafts to marsupialize the pleural cavity.

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PubMed2004

Umbilical cord blood derived endothelial progenitor cells for tissue engineering of vascular grafts.

BACKGROUND: A substantial limitation regarding present pediatric cardiac surgery is the lack of appropriate materials for the repair of congenital defects. To address this shortcoming, tissue engineering is a scientific field that aims at in vitro fabrication of living autologous grafts with the capacity of growth, repair, and regeneration. Here we focused on tissue engineered vascular grafts using human umbilical cord blood derived endothelial progenitor cells (EPCs), as a noninvasive cell source for pediatric applications. METHODS: EPCs were isolated from 20 ml fresh human umbilical cord blood by Ficoll gradient centrifugation and cultured in endothelial basal medium containing growth factors. After proliferation and differentiation cells were analyzed by immunohistochemistry and seeded onto three-dimensional (3D) biodegradable vascular scaffolds (porosity > 95%, n = 22). Twenty-four hours after seeding the vascular grafts were positioned into a pulse-duplicator-in vitro system and grown for 48 hours under biomimetic conditions. A second group was grown 6 days statically and an additional 6 days biomimetically. Controls were cultured statically. Analysis of the grafts included immunohistochemistry, histology, and scanning electron microscopy. RESULTS: Preseeding differentiated EPCs indicated constant endothelial phenotypes including acetylated low-density lipoprotein, cluster of differentiation 31, von Willebrand factor, and endothelial nitric oxide synthetase. Seeded EPCs established favorable cell-to-polymer attachment and proliferation into the 3D tubular scaffolds. Both conditioned and static cellular constructs demonstrated positive staining for cluster of differentiation 31, von Willebrand factor, and expression of endothelial nitric oxide synthase. CONCLUSIONS: Human umbilical cord derived EPCs indicated exceptional growth characteristics used for tissue engineering of vascular grafts. These cells demonstrated a constant endothelial phenotype and related functional features. Based on these results EPCs seem to be a promising autologous cell source with regard to cardiovascular tissue engineering, particularly for the repair of congenital defects.

Absorbable Implants↗

PubMed2005

Invited commentary.

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Absorbable Implants↗

PubMed2006

Invited commentary.

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Absorbable Implants↗

PubMed2006

Development of a novel temporary epicardial pacing wire with biodegradable film.

PURPOSE: A temporary epicardial pacing wire (TEPW) has been routinely placed in patients undergoing cardiac surgery. However, its fixation or removal occasionally causes troublesome complications. The aim of this study is to develop a novel TEPW using biodegradable film to fix the electrode to the epicardium without needle stabbing. DESCRIPTION: A biodegradable film was prepared with poly(L-lactide-co-epsilon-caprolactone). The film has a honeycomb-patterned structure that serves as a temporary adhesive for the myocardial surface, and the electrode was incorporated within the film. The novel TEPW was placed on the ventricular epicardium of dogs (group A, n = 5). As a control, conventional TEPW was inserted (group B, n = 6). The pacing threshold, R wave amplitude, impedance, and slew rate were measured at postoperative days 0, 1, 3, 5, 7, and 14, and complications after removal were checked. EVALUATION: All measurements in both groups were identified and differences were not observed. In addition, the novel TEPWs could be easily removed without related complications. CONCLUSIONS: This novel TEPW is safe and feasible for postoperative management of cardiac surgeries.

Absorbable Implants↗

PubMed2006

Invited commentary.

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Absorbable Implants↗

PubMed2004

Chondrogenic differentiation of human mesenchymal stem cells cultured in a cobweb-like biodegradable scaffold.

Human mesenchymal stem cells (MSCs) were cultured in vitro in a cobweb-like biodegradable polymer scaffold: a poly(dl-lactic-co-glycolic acid)-collagen hybrid mesh in serum-free DMEM containing TGF-beta3 for 1-10 weeks. The cells adhered to the hybrid mesh, distributed evenly, and proliferated to fill the spaces in the scaffold. The ability of the cells to express gene encoding type I collagen decreased, whereas its ability to express type II collagen and aggrecan increased. Histological examination by HE staining indicated that the cells showed fibroblast morphology at the early stage and became round after culture for 4 weeks. The cartilaginous matrices were positively stained by safranin O and toluidine blue. Immunostaining with anti-type II collagen and anti-cartilage proteoglycan showed that type II collagen and cartilage proteoglycan were detected around the cells. In addition, a homogeneous distribution of cartilaginous extracellular matrices was detected around the cells. These results suggest the chondrogenic differentiation of the mesenchymal stem cells in the hybrid mesh. The PLGA-collagen hybrid mesh enabled the aggregation of mesenchymal stem cells and provided a promotive microenvironment for the chondrogenic differentiation of the MSCs.

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PubMed2006

Evaluation of human bone marrow stromal cell growth on biodegradable polymer/bioglass composites.

Bone tissue engineering using human bone marrow mesenchymal stem cells (HBMCs) and biocompatible materials provides an attractive approach to regenerate bone tissue to meet the major clinical need. The aim of this study was to examine the effects of novel porous biodegradable composite materials consisting of a bioactive phase (45S5 Bioglass, 0, 5, and 40 wt%) incorporated within a biodegradable poly(dl-lactic acid) matrix, on HBMCs growth. Cell adhesion, spreading, and viability was examined using Cell Tracker Green/Ethidium Homodimer-1. Bone formation was assessed using scaffolds seeded with stro-1 positive HBMCs in nude mice. In vitro biochemistry indicated that with minimal scaffold pre-treatment osteoblast activity falls with increasing Bioglass content. However, 24h scaffold pre-treatment with serum resulted in a significant increase in alkaline phosphatase specific activity in 5 wt% Bioglass composites relative to the 0 and 40 wt% Bioglass groups. In vivo studies indicate significant new bone formation throughout all the scaffolds, as evidenced by immunohistochemistry.

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PubMedDate not supplied

Hydroxyapatite/poly(epsilon-caprolactone) composite coatings on hydroxyapatite porous bone scaffold for drug delivery.

Hydroxyapatite (HA) porous scaffold was coated with HA and polycaprolactone (PCL) composites, and antibiotic drug tetracycline hydrochloride was entrapped within the coating layer. The HA scaffold obtained by a polymeric reticulate method, possessed high porosity ( approximately 87%) and controlled pore size (150-200 microm). Such a well-developed porous structure facilitated usage in a drug delivery system due to its high surface area and blood circulation efficiency. The PCL polymer, as a coating component, was used to improve the brittleness and low strength of the HA scaffold, as well to effectively entrap the drug. To improve the osteoconductivity and bioactivity of the coating layer, HA powder was hybridized with PCL solution to make the HA-PCL composite coating. With alteration in the coating concentration and HA/PCL ratio, the morphology, mechanical properties, and biodegradation behavior were investigated. Increasing the concentration rendered the stems thicker and some pores to be clogged; as well increasing the HA/PCL ratio made the coating surface be rough due to the large amount of HA particles. However, for all concentrations and compositions, uniform coatings were formed, i.e., with the HA particles being dispersed homogeneously in the PCL sheet. With the composite coating, the mechanical properties, such as compressive strength and elastic modulus were improved by several orders of magnitude. These improvements were more significant with thicker coatings, while little difference was observed with the HA/PCL ratio. The in vitro biodegradation of the composite coatings in the phosphate buffered saline solution increased linearly with incubation time and the rate differed with the coating concentration and the HA/PCL ratio; the higher concentration and HA amount caused the increased biodegradation. At short period (<2 h), about 20-30% drug was released especially due to free drug at the coating surface. However, the release rate was sustained for prolonged periods and was highly dependent on the degree of coating dissolution, suggesting the possibility of a controlled drug release in the porous scaffold with HA+PCL coating.

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PubMedDate not supplied

Development and characterisation of silver-doped bioactive glass-coated sutures for tissue engineering and wound healing applications.

A novel silver-doped bioactive glass powder (AgBG) was used to coat resorbable Vicryl (polyglactin 910) and non-resorbable Mersilk surgical sutures, thereby imparting bioactive, antimicrobial and bactericidal properties to the sutures. Stable and homogeneous coatings on the surface of the sutures were achieved using an optimised aqueous slurry-dipping technique. Dynamic mechanical analysis (DMA) was used to investigate the viscoelastic parameters of storage modulus and tandelta and thermal transitions of the as-received and composite (coated) sutures. The results generally showed that the bioactive glass coating did not affect the dynamic mechanical and thermal properties of the sutures. The in vitro bioactivity of the sutures was tested by immersion in simulated body fluid (SBF). After only 3 days of immersion in SBF, bonelike hydroxyapatite formed on the coated suture surfaces, indicating their enhanced bioactive behaviour. Resorbable sutures with bioactive coatings as fabricated here, in conjunction with 3-D textile technology, may provide attractive materials for producing 3-D scaffolds with controlled porosities for tissue engineering applications. The bactericidal properties imparted by the Ag-containing glass coating open also new opportunities for use of the composite sutures in wound healing and body wall repair.

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PubMed2004

Importance of integrin beta1-mediated cell adhesion on biodegradable polymers under serum depletion in mesenchymal stem cells and chondrocytes.

To evaluate the predominant mechanism of chondrogenic cell [mesenchymal stem cells (MSCs) and chondrocytes] adhesion under serum free conditions, we measured the surface roughness and wettability of poly(lactic acid:polyglycolic acid=75:25) (PLGA), poly(lactic acid) (PLA), and poly(-epsilon-caprolactone) (PCL)-coated glass plates. Also to evaluate the biological reactions involved in cell-polymer interactions, integrin beta1, one of the cell adhesion molecules, was blocked with monoclonal antibody. In cell attachment test, MSCs and chondrocytes adhesion to synthetic polymers in 1h were very low and ranged from 2.8% to 8.0%. In present study, the correlation between attachment rate and surface roughness, contact angle, or integrin beta1 blocking on PLGA, PLA and PCL-coated plates could not be proved. However, we found that L-arginine-coated PLA highly increased the attachment rates of MSCs (30.2%) and of chondrocytes (26%), whereas integrin beta1 blocking significantly decreased these attachment rates to 5.6% and 7.4%, respectively, suggesting that increased cell adhesion to L-arginine-coated plates is mediated by integrin beta1. In this study, we showed that polymer characteristics such as roughness and wettability did not play an important role in cell adhesion under serum free conditions, because there was no significant difference according to polymer characteristics, whereas biological interactions mediated by integrin beta1 were critical during the early period of cell adhesion. The results suggest that L-arginine could be useful for facilitating early cell adhesion to synthetic polymers in cartilage tissue engineering.

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PubMedDate not supplied

Multi-channeled biodegradable polymer/CultiSpher composite nerve guides.

Innovative methods to fabricate porous, biodegradable conduits were developed to produce nerve guides with multiple longitudinally aligned channels. The geometry of the nerve guide's channels was designed to be appropriate for harboring neurite extension. Both the coated mandrel and mandrel adhesion techniques permit flexibility in the number of channels, channel organization, and channel diameters. In this study, the composite nerve guides were comprised of poly(caprolactone) (PCL) and porous collagen-based beads (CultiSphers). The incorporation of the collagenous beads results in enhanced cortical neuron adhesion, viability, and neurite extension as compared to PCL alone. Additionally, Schwann cell studies indicated that the PCL/CultiSpher composite is a suitable substrate for cell adhesion. Mechanical properties of the PCL/CultiSpher material and in vitro degradation rates indicate the potential usefulness of this novel composite for use in the fabrication of nerve guides.

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PubMedDate not supplied

Degradation behaviour of self-reinforced 80L/20G PLGA devices in vitro.

In vitro degradation of self-reinforced PLGA 80L/20G material and bioabsorbable stents was studied in artificial urine and phosphate buffer solution (PBS) to define if the media have an effect on the degradation rate in urological applications. After six weeks, the Mv of the samples immersed in PBS was 40% (16.7 kDa) from the initial value and 57% (24.0 kDa) for the samples immersed in artificial urine. The strength loss of samples that were immersed in PBS was slower when compared with samples in artificial urine. The bending strength of samples immersed 15 weeks in artificial urine was 43% (21.7 MPa) of the bending strength of samples immersed in PBS (50.9 MPa), and the shear strength was 13% (artificial urine 3.7 MPa, PBS 28.8 MPa), respectively. The maximum compression force in PBS was slightly over at the initial level after 2 weeks of immersion. It decreased to half (102.2N) of the initial value (204.1N) in 8 weeks, and after 12 weeks it was 25% (50.8 N) of the initial value. The compression force in artificial urine was 35% (66.8 N) of the initial value (193.9 N) after 8 weeks. In 12 weeks it had lowered to 26 N in artificial urine, which was 14% of the initial value. The degradation rate of self-reinforced L-lactic and glycolic acid stents in vitro tests in artificial urine was coinciding with our clinical test. Based on these results, it is possible to make a sufficiently accurate in vitro model for the degradation rate of bioabsorbable polymers for urological applications.

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PubMed2004

Differentiation, growth and activity of rat bone marrow stromal cells on resorbable poly(L/DL-lactide) membranes.

Nonporous and porous membranes produced from poly(L/DL-lactide) 80/20% were characterized using profilometry, contact-angle measurements, infra-red spectroscopy, X-ray photoemission spectroscopy and scanning electron microscopy, and used to culture bone marrow stromal cells isolated from the rat femora. The cells were cultured for 5, 10, 15 and 20 days. Cell growth and activity was estimated from the amounts of DNA, alkaline phosphatase activity and total protein amount present in the cell lysate and cell differentiation was assessed histochemically. Cell morphology was estimated from scanning electron microscopy. The cells fully expressed osteoblastic phenotype, revealed spindle-shaped, ellipsoidal morphology, developed podia, produced an abundant fibrillar extracellular matrix and mineral noduli. The number of cells on the membranes increased with time of culturing and was higher for the porous membranes than the nonporous membranes. Osteoblastic differentiation was most significant between 5 and 10 days of culture. The total amounts of DNA, alkaline phosphatase and proteins increased with time of culturing. The surface characteristics of the porous membranes were superior to the nonporous membranes.

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