Biological Augmentation Using Electrospun Constructs with Dual Growth Factor Release for Rotator Cuff Repair

Surgical reattachment of tendon to bone is the standard therapy for rotator cuff tear (RCT), but its effectiveness is compromised by retear rates of up to 94%, primarily due to challenges in achieving successful tendon-bone enthesis regeneration under natural conditions. Biological augmentation using biomaterials has emerged as a promising approach to address this challenge. In this study, a bilayer construct incorporates polydopamine (PDA)-mediated bone morphogenetic protein 2 (BMP2) and BMP12 in separate poly(lactic-co-glycolic acid) (PLGA) fiber layers to promote osteoblast and tenocyte growth, respectively, and intermediate fibrocartilage formation, aiming to enhance the regenerative potential of tendon-bone interfaces. The lower layer, consisting of PLGA fibers with BMP2 immobilization through PDA adsorption, significantly accelerated osteoblast growth. Concurrently, the upper BMP12@PLGA-PDA fiber mat facilitated fibrocartilage formation and tendon tissue regeneration, evidenced by significantly elevated tenocyte viability and tenogenic differentiation markers. Therapeutic efficacy assessed through in vivo RCT models demonstrated that the dual-BMP construct augmentation significantly promoted the healing of tendon-bone interfaces, confirmed by biomechanical testing, cartilage immunohistochemistry analysis, and collagen I/II immunohistochemistry analysis. Overall, this combinational strategy, which combines augmentation patches with the controlled release of dual growth factors, shows great promise in improving the overall success rates of rotator cuff repairs.