Demineralized Bone Matrix to Augment Tendon-Bone Healing: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Biomaterials Science

Background:

• Rotator cuff and anterior cruciate ligament injuries heal with inferior fibrous tissue, lacking direct enthesis regeneration.
• Demineralized bone matrix (DBM) is a collagen scaffold with growth factors, showing potential for tendon and ligament repair.
• DBM may regenerate direct fibrocartilaginous insertion via endochondral ossification, improving healing quality.

Purpose of the Study:

• To conduct a comprehensive literature review on the use of DBM in tendon repair and anterior cruciate ligament reconstruction (ACLR).
• To evaluate preclinical and clinical evidence for DBM's efficacy in augmenting tendon-bone healing.

Main Methods:

• Systematic review of electronic databases (MEDLINE, EMBASE) for relevant studies.
• Inclusion of peer-reviewed articles in English, with no date restrictions.
• Assessment of methodological quality of included studies.

Main Results:

• Identified 339 articles; 8 preclinical animal studies met inclusion criteria (4 for tendon repair, 4 for ACLR).
• No human clinical studies were found.
• 80% of studies comparing DBM augmentation to controls reported positive histological and biomechanical outcomes.

Conclusions:

• Preclinical data suggest DBM enhances tendon-bone healing in animal models of rotator cuff repair and ACLR.
• DBM demonstrated the ability to recreate a direct fibrocartilaginous enthesis in animal models.
• Further research is required to identify optimal DBM sources (allogenic vs. xenogenic) and forms (cortical bone vs. paste) before clinical trials.