Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.772549
Title: Augmentation strategies in rotator cuff repair
Author: Rashid, Mustafa
ISNI:       0000 0004 7960 0358
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2018
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Abstract:
Rotator cuff repair surgery is commonly performed for symptomatic tears failing to resolve with conservative measures. This thesis investigated the healing rate following rotator cuff repair, and the influence of age and tear size. Patient tissue responses to 2 commercially available biological patches used in cuff repair were subsequently investigated. Finally, safety and efficacy of 2 novel biodegradable polymeric scaffolds to repair an ovine tendon defect, was investigated. The overall rate of healing following rotator cuff repair was 58% at 1 year. Healing was influenced by age and tear size, however age was the predominant prognostic factor. A predictive model for healing was generated, demonstrating likelihood of healing as low as 17%. Patient supraspinatus tendon biopsies demonstrated an adverse response to dermal allograft and xenograft patches currently used in cuff repair augmentation, whereby significant extracellular matrix disruption was observed. One patient receiving the xenograft experienced a significant adverse immune response, characterised by extensive infiltration of pro-inflammatory cells. A novel biodegradable polydioxanone / polycaprolactone patch was investigated in an ovine tendon injury model. At 3 months, this patch induced tendon healing, without adverse systemic or tissue responses. Significant fibroblast infiltration and neovascularisation was observed within the scaffold. A biodegradable polydioxanone multifilament suture was also developed. This novel suture demonstrated bioactivity, inducing tendon healing without adverse systemic or tissue responses. Fibroblast infiltration and neovascularisation was observed when compared to monofilament polydioxanone control suture. Healing following cuff repair remains a challenge. Current biological patches used to augment repair are not supported by clinical efficacy trials, and demonstrated a deleterious effect on the native tendon. Novel synthetic implants tailored for tendon repair successfully induced tendon healing in an ovine model. Future work will explore the safety and clinical efficacy of these implants for rotator cuff repair augmentation in humans.
Supervisor: Carr, Andrew ; Dakin, Stephanie ; Snelling, Sarah Sponsor: Royal College of Surgeons (England) ; National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.772549  DOI: Not available
Keywords: Surgery
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