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Title: Biological augmentation of the tendon-bone enthesis using demineralised bone matrix and mesenchymal stem cells
Author: Shahbazi, Shirin
ISNI:       0000 0004 7661 114X
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2018
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Rotator cuff (RC) injuries are among the most common upper limb injuries, causing impaired function and pain for patients, as well as resulting in a significant financial burden for health care providers. Chronic RC tears are associated with tendon retraction from the bone surface making their surgical repairs challenging. In order to enhance the outcome of these surgeries, different grafts have been investigated however, these do not restore the biological and functional properties of the native enthesis. This study aims to investigate the use of demineralised bone matrix (DBM) with cells as an augmentation strategy for enhancing regeneration of the tendon-bone enthesis. Sources of allogeneic and xenogenic DBM as potential graft materials for RC repair were selected based on their mechanical strength. The effect of DBM and extracts of DBM on differentiation of stem cells and trans-differentiation of tenocytes and osteoblasts was investigated. This study showed that DBM was able to induce differentiation of MSCs and trans-differentiation of tenocytes and osteoblasts into chondrocytes. Using both allogeneic and xenogenic grafts together with stem cells isolated at the time of surgery in an ovine in-vivo model of patellar tendon avulsion allogenic DBM was able to recapitulate the natural enthesis and led to near normal function 12 weeks after surgery. The repair process with xenogenic grafts was slower and there were differences in both the functional recovery and in the morphology of the enthesis when xenogenic grafts were use. It was concluded that DBM has sufficient mechanical and biological properties, which in combination with MSC augmentation can enhance healing of the tendon-bone enthesis.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available