The Healing Effect of Bone Morphogenic Protein with Fibrin Glue on an Injury of the Tendon-Bone Junction

Hak Jun Kim; Jung-Ho Park; Hong-Chul Lim; Byung-Soo Kim; Jae-Sun Lee; Sun-Woong Gang; Oju Jeon

doi:10.4055/jkoa.2007.42.1.115

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Kim, Park, Lim, Kim, Lee, Gang, and Jeon: The Healing Effect of Bone Morphogenic Protein with Fibrin Glue on an Injury of the Tendon-Bone Junction

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(1): 115-124.

Published online: 28 February 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.1.115

The Healing Effect of Bone Morphogenic Protein with Fibrin Glue on an Injury of the Tendon-Bone Junction

Hak Jun Kim, M.D., Jung-Ho Park, M.D.^*, Hong-Chul Lim, M.D.^†, Byung-Soo Kim, Ph.D.^‡, Jae-Sun Lee, M.S.^*, Sun-Woong Gang, M.S.^‡, Oju Jeon, M.S.^‡

Department of Orthopeadic Surgery, Seoul Veterans Hospital, Seoul, Korea.

^*Department of Orthopeadic Surgery, Ansan Hospital, Ansan, Korea.

^†Department of Orthopeadic Surgery, Guro Hospital, College of Medicine, Korea University, Seoul, Korea.

^‡Department of Bioengineering, Hanyang University, Seoul, Korea.

Address reprint requests to Hong-Chul Lim, M.D. Department of Orthopaedic Surgery, Guro Hospital, Korea University, 80, Guro-dong, Guro-gu, Seoul 152-050, Korea. Tel: +82.2-818-6680, Fax: +82.2-865-5774, lhc2455@paran.com

Abstract

Purpose

The author hypothesizes that exogenously injected BMP, which is mixed with fibrin glue, can accelerate the healing of a bone-tendon junction injury and increase its holding strength during the early regeneration period.

Materials and Methods

A direct injury model of the bone-tendon junction was made using the Achilles tendon-calcaneus bone of 54 rabbits: and the transected Achilles tendon was repaired to its original insertion site using the Krackow method. In Group 1, no additional manipulation was performed. In Group 2, only fibrin glue was injected into the junction between the Achilles tendon and the calcaneus in order to exclude the effect of the fibrin glue. In Group 3, BMP-2 incorporated into the fibrin glue was injected into the junction. The results were evaluated by histological analysis and biomechanical tests at 2, 4, and 8 weeks after surgery. The Kruskal-Wallis test was used for a statistical evaluation.

Results

Histological analysis revealed the early appearance of fibrocartilage at 2 weeks in Group 3: the area of the fibrocartilage expanded with time. The biomechanical tests showed significant differences in the maximum stress between Groups 1 and 3, and between Groups 2 and 3, at 2, 4, and 8 weeks. 74.4% of the normal maximum stress was recovered at 8 weeks in Group 3.

Conclusion

The combined use of BMP-2 and the fibrin glue can accelerate the healing of an injury of the bone-tendon junction.

Keywords: Achilles tendon, Bone-tendon junction injury, Bone Morphogenic Protein, Fibrin glue

Figures and Tables

Fig. 1

Microscopic photographs of the specimen stained with H&E at 2 weeks after surgery (×100). (A) Not injected group (group I); Granulation tissues are filled in the gap of the tendon-bone junction. (B) FG injected group (group II); Granulation tissue and a small amount of fibrocartilages are filled in the tendon-bone junction. (C) BMP-2+FG injected group (group III); Granulation tissue and thick fibrocartilages (black arrow) are filled in the bone tendon junction.

Fig. 2

Microscopic photographs of the specimen stained with Masson-Trichrome at 2 weeks after surgery (×100). (A) Non-injected group (group I); The newly formed granulation tissues are not aligned in any direction and not organized. (B) FG injected group (group II); The newly formed granulation tissues are loosely aligned to the fibrocartilages. (C) BMP-2+FG injected group (group III); The newly formed granulation tissues are aligned at right angles to the fibrocartilages.

Fig. 3

Microscopic photographs of the specimen stained with H&E at 4 weeks after surgery (×100). (A) Not injected group (group I); The amount of granulation tissues is reduced and the fibrous tissues loosely directed. (B) FG injected group (group II); There is a larger amounts of fibrocartilages (black arrow) in the tendon-bone junction. (C) BMP-2+FG injected group (group III); The thickness of the fibrocartilages has increased and there is newly formed granulation tissues combined with fibrocatilages.

Fig. 4

Microscopic photographs of the specimen stained with Masson-Trichrome at 4 weeks after surgery (×100). (A) Non-injected group (group I); Newly formed fibrous tissues (black arrow) have direction but are loosely aligned. (B) FG injected group (group II); The amount of newly formed fibrous tissues is higher and some fibrous tissues joins the fibrocatilages (black arrow). (C) BMP-2+FG injected group (group III); The newly formed fibrous tissue are combine perpendicularly with the fibrous cartilage (black arrow).

Fig. 5

Microscopic images of the specimen stained with H&E at 8 weeks after surgery (×100). (A) Non-injected group (group I); Fibrocartilage tissues (black arrow) appear in the junction of the tendon and newly formed fibrous tissues fill the tendon-to bone junction. (B) FG injected group (group II); Newly formed fibrous tissue combine with the fibrocartilages and are aligned perpendicularly. (C) BMP-2+FG injected group (group III); Newly formed fibrous tissues are joined tightly to the fibrocartilage. New bone formation from the fibrocartilages can be seen at the junction and fibrocartilages stick to the bone as a result of new bone formation (black arrow).

Fig. 6

Microscopic images of the specimen stained with Masson-Trichrome at 4 weeks after surgery (×100). (A) Non-injected group (group I); Newly formed fibrous tissues shows good alignment and continuation. (B) FG injected group (group II); Newly formed fibrous tissues are combined tightly to the fibrous cartilages. (C) BMP-2+FG injected group (group III); Newly formed fibrous tissues are combined tightly to the fibrous cartilages perpendicularly.

Fig. 7

Stress-strain graph of the fibrin glue with BMP-2 8 weeks after surgery showing a very similar pattern to the normal stress-strain graph, but not to the graph of the non-injected group.

Table 1

Biomechanical Properties of the Bone-tendon Junction Treated without or with the Fibrin Glue Only and the Fibrin Glue Mixed with Bone Morphogenetic Protein-2

^*Control, not injected; ^†FG only, fibrin glue only injected; ^‡FG+BMP-2, fibrin glue combined bone morphogenetic protein-2 injected.

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