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J Bone Joint Surg Am. 2014 Mar 19;96(6):513-21. doi: 10.2106/JBJS.M.00009.

Augmentation of tendon-to-bone healing.

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Center for Musculoskeletal Care, NYU Hospital for Joint Diseases, 333 East 38th Street, New York, NY 10016.
Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213.
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minamimi-ku, Hiroshima 734-8551, Japan.
Departments of Orthopaedics and Traumatology, and Sports Medicine, Hacettepe University School of Medicine, 06100 Sihhiye, Ankara, Turkey.
Taos Orthopaedic Institute, 1219A Gusdorf Road, Taos, NM 87571.
Sports Medicine and Shoulder Service, Hospital for Special Surgery, 525 East 71st Street, New York, NY 10021. E-mail address for S. A. Rodeo:


Tendon-to-bone healing is vital to the ultimate success of the various surgical procedures performed to repair injured tendons. Achieving tendon-to-bone healing that is functionally and biologically similar to native anatomy can be challenging because of the limited regeneration capacity of the tendon-bone interface. Orthopaedic basic-science research strategies aiming to augment tendon-to-bone healing include the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches. Low-intensity pulsed ultrasound and extracorporeal shockwave treatment may affect tendon-to-bone healing by means of mechanical forces that stimulate biological cascades at the insertion site. Application of various loading methods and immobilization times influence the stress forces acting on the recently repaired tendon-to-bone attachment, which eventually may change the biological dynamics of the interface. Other approaches, such as the use of coated sutures and interference screws, aim to deliver biological factors while achieving mechanical stability by means of various fixators. Controlled Level-I human trials are required to confirm the promising results from in vitro or animal research studies elucidating the mechanisms underlying tendon-to-bone healing and to translate these results into clinical practice.

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