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CDMP-2 injection improves early tendon healing in a rabbit model for surgical repair
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics and Sports Medicine . Linköping University, Faculty of Health Sciences.
2005 (English)In: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, Vol. 15, no 4, 260-264 p.Article in journal (Refereed) Published
Abstract [en]

This study examines the hypothesis that cartilage-derived morphogenic protein-2 (CDMP-2) can improve tendon healing after surgical repair. We have previously found improved tendon healing by applying CDMP-2 in models for conservative treatment with mechanically loaded Achilles tendon defects in rats and rabbits. In this study, the patellar tendon was unloaded by patello- tibial cerclage and cut transversely in 40 rabbits. Two hours post-operative, the rabbits received a dose of 20 μg of CDMP-2 or vehicle injected into the hematoma. Specimens were harvested after 14 and 28 days and evaluated by biomechanical testing, radiography and histology. At 14 days, CDMP-2 caused a 65% increase in force at failure, a 50% increase in ultimate stress and a 57% increase in stiffness, as compared with controls. There was no effect on callus size. At 28 days, no differences between the treatment groups could be demonstrated. No bone or cartilage was found in any tendon or regenerated tissue at any time point. Thus, early tendon repair can be stimulated by CDMP-2 in an unloaded model. These results suggest that CDMP-2 might be of interest for clinical use as a complement to surgical treatment of tendon ruptures.

Place, publisher, year, edition, pages
2005. Vol. 15, no 4, 260-264 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13016DOI: 10.1111/j.1600-0838.2005.00462.xOAI: oai:DiVA.org:liu-13016DiVA: diva2:17674
Available from: 2008-03-13 Created: 2008-03-13 Last updated: 2009-06-08
In thesis
1. Stimulation of tendon repair by platelet concentrate, CDMP-2 and mechanical loading in animal models
Open this publication in new window or tab >>Stimulation of tendon repair by platelet concentrate, CDMP-2 and mechanical loading in animal models
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Growth factor delivery may be useful to accelerate the rate of tendon healing. We studied Platelet Concentrate, which in effect can be regarded as a cocktail of growth factors relevant for tendon healing. In a rat Achilles tendon transection model, one postoperative injection of Platelet Concentrate resulted in increased strength even 3 weeks later.

Mechanical stimulation improves the repair of ruptured tendons. We studied the effects of platelets upon Achilles tendon regenerates in rats 3, 5 and 14 days after transection, either unloaded or mechanically stimulated. At 14 days, physical activity and platelets increased repair independently. Unloading decreased the mechanical properties of the repair tissue to less than half of normal. Moreover, the platelets had no effect without loading.

Thrombin, which we used for platelet activation, improved healing of the rat Achilles tendon by itself. Conversely, continuous inhibition of thrombin by low molecular weight heparin (LMWH) inhibited tendon repair. However, intermittent inhibition, similar to clinical thromboprophylaxis, had no effect on tendon healing.

Cartilage Derived Morphogenetic Protein-2 (CDMP-2) can improve tendon healing in loaded defect models. We now studied unloaded repair in a rabbit patellar tendon model. Two hours postoperative, the rabbits received CDMP-2 injected into the haematoma. The healing tendon became 65 % stronger than controls. We then studied Achilles tendon healing with CDMP-2 injections in sheep, to get a bigger animal model. There was an unexpectedly high variation of repair in these animals, and the study turned out to be underpowered. Spontaneous ruptures in humans have a more variable geometry than in our sheep model, so humans can also be expected to vary a lot in mechanical characteristics of Achilles tendon repair. This accentuates the importance of individualized rehabilitation programs.

In conclusion, both platelet concentrate and CDMP-2 injections might be of interest for clinical use as a complement to surgical or conservative treatment of tendon ruptures. Platelet treatment for tendon ruptures should probably be combined with early physiotherapy.

Place, publisher, year, edition, pages
Institutionen för nervsystem och rörelseorgan, 2007. 34 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1005
Keyword
Achilles tendon, injuries, physiology, Blood platelets, tendon injuries, physiopathology, therapy, wound healing
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-11264 (URN)978-91-85831-88-3 (ISBN)
Public defence
2007-06-07, Aulan, Hälsans Hus, Campus US, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2008-03-13 Created: 2008-03-13 Last updated: 2009-08-22

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Virchenko, OlenaSkoglund, BjörnFahlgren, AnnaAspenberg, Per

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