Advances in biology and mechanics of rotator cuff repair

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• 作者：Olaf Lorbach (1)
  Mike H. Baums (2) (3)
  Tanja Kostuj (4)
  Stephan Pauly (5)
  Markus Scheibel (5)
  Andrew Carr (6)
  Nasim Zargar (6)
  Maristella F. Saccomanno (7)
  Giuseppe Milano (7)
  
  1. Department of Orthopaedic Surgery ; Saarland University ; Homburg ; Germany
  2. Department of Orthopaedic Surgery ; University of G枚ttingen Medical Centre (UMG) ; Georg-August-University ; G枚ttingen ; Germany
  3. Clinic for Orthopaedic Surgery and Orthopaedic Rheumatology ; Aukamm Clinic ; Wiesbaden ; Germany
  4. Institute for Medical Biometry and Epidemiology ; University of Witten/Herdecke ; Witten ; Germany
  5. Center for Muskuloskeletal Surgery ; Charit茅 Universitaetsmedizin ; Berlin ; Germany
  6. Biomedical Research Unit ; Nuffield Department of Orthopaedics ; Rheumatology and Musculoskeletal Sciences ; Botnar Research Institute ; University of Oxford ; Oxford ; UK
  7. Division of Orthopaedic Surgery ; Department of Orthopaedics ; 鈥淎. Gemelli鈥?University Hospital ; Catholic University ; Largo A. Gemelli 8 ; 00168 ; Rome ; RM ; Italy
  
• 关键词：Rotator cuff ; Biology ; Biomechanics ; Growth factors ; Augmentation ; Cell therapy
• 刊名：Knee Surgery, Sports Traumatology, Arthroscopy
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：23
• 期：2
• 页码：530-541
• 全文大小：574 KB
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• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Orthopedics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1433-7347

文摘

High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair. Level of evidence Expert opinion, Level V.