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Suh DS, Lee JK, Yoo JC, Woo SH, Kim GR, Kim JW, Choi NY, Kim Y, Song HS. Atelocollagen Enhances the Healing of Rotator Cuff Tendon in Rabbit Model. Am J Sports Med 2017; 45:2019-2027. [PMID: 28586622 DOI: 10.1177/0363546517703336] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Failure of rotator cuff healing is a common complication despite the rapid development of surgical repair techniques for the torn rotator cuff. PURPOSE To verify the effect of atelocollagen on tendon-to-bone healing in the rabbit supraspinatus tendon compared with conventional cuff repair. STUDY DESIGN Controlled laboratory study. METHODS A tear of the supraspinatus tendon was created and repaired in 46 New Zealand White rabbits. They were then randomly allocated into 2 groups (23 rabbits per group; 15 for histological and 8 for biomechanical test). In the experimental group, patch-type atelocollagen was implanted between bone and tendon during repair; in the control group, the torn tendon was repaired without atelocollagen. Each opposite shoulder served as a sham (tendon was exposed only). Histological evaluation was performed at 4, 8, and 12 weeks. Biomechanical tensile strength was tested 12 weeks after surgery. RESULTS Histological evaluation scores of the experimental group (4.0 ± 1.0) were significantly superior to those of the control group (7.7 ± 2.7) at 12 weeks ( P = .005). The load to failure was significantly higher in the experimental group (51.4 ± 3.9 N) than in the control group (36.4 ± 5.9 N) ( P = .001). CONCLUSION Histological and biomechanical studies demonstrated better results in the experimental group using atelocollagen in a rabbit model of the supraspinatus tendon tear. CLINICAL RELEVANCE Atelocollagen patch could be used in the cuff repair site to enhance healing.
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Affiliation(s)
- Dong-Sam Suh
- RMS Research Institute, Seoul, Republic of Korea
| | - Jun-Keun Lee
- RMS Research Institute, Seoul, Republic of Korea
| | - Ji-Chul Yoo
- RMS Research Institute, Seoul, Republic of Korea
| | - Sang-Hun Woo
- RMS Research Institute, Seoul, Republic of Korea
| | - Ga-Ram Kim
- RMS Research Institute, Seoul, Republic of Korea
| | - Ju-Won Kim
- RMS Research Institute, Seoul, Republic of Korea
| | - Nam-Yong Choi
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yongdeok Kim
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Seok Song
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Miranda I, Sánchez-Alepuz E, Lucas F, Carratalá V, González-Jofre C. Use of platelet-rich plasma in the treatment of rotator cuff pathology. What has been scientifically proven? Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Giotis D, Aryaei A, Vasilakakos T, Paschos NK. Effectiveness of Biologic Factors in Shoulder Disorders. Open Orthop J 2017; 11:163-182. [PMID: 28400884 PMCID: PMC5366381 DOI: 10.2174/1874325001711010163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 12/17/2022] Open
Abstract
Background: Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field. Methods: This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies. Results: Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies. Conclusion: The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.
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Affiliation(s)
- Dimitrios Giotis
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Ashkan Aryaei
- Department of Biomedical Engineering, University of California, Davis, USA
| | - Theofanis Vasilakakos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
| | - Nikolaos K Paschos
- Department of Trauma & Orthopaedic Surgery, University of Ioannina, Ioannina, Greece; Department of Biomedical Engineering, University of California, Davis, USA
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Deprés-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elbow Surg 2016; 25:2078-2085. [PMID: 27554609 DOI: 10.1016/j.jse.2016.06.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed.
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Affiliation(s)
| | - Anik Chevrier
- Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada
| | - Martyn Snow
- Department of Arthroscopy, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Mark B Hurtig
- Department of Clinical Studies, University of Guelph, Guelph, ON, Canada
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, The Hospital for Special Surgery, New York, NY, USA
| | - Michael D Buschmann
- Biomedical Engineering Institute, Polytechnique Montréal, Montreal, QC, Canada; Chemical Engineering Department, Polytechnique Montréal, Montreal, QC, Canada.
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Jiménez-Martín A, Santos-Yubero F, Najarro-Cid F, Navarro-Martínez S, Zurera-Carmona M, Pérez-Hidalgo S. Use of grafts in rotator cuff re-rupture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Use of grafts in rotator cuff re-rupture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:286-95. [PMID: 27453346 DOI: 10.1016/j.recot.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/12/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Rotator cuff re-ruptures appear in 38-65% of cases. In order to reduce this rate, many studies have been performed using different types of biomaterial for purely mechanical aims (re-inforce the suture) and/or biological agents (growth factor transporterts). The aim of this study is to review 22 cases treated with xenografts and analyse various current alternatives. MATERIALS AND METHODS A descriptive and retrospective study was conducted using the variables of age, sex, laterality, time of surgery, involvement in MRI, number of anchors, and final mobility results on the Constant and the University of California Los Angeles (UCLA) validated scales. RESULTS The study included 22 patients, with a mean age of 51.7±4.6 years. A mean of 2 anchors were used and 13 patients were treated with a porcine intestinal submucosa implant, 6 with equine pericardium, and 3 with porcine dermis. Final results were: 37.6±13 points for the Constant test, and 16.9±3.9 points on the UCLA scale. The follow up was 36±10.2 months. CONCLUSIONS In our experience, xenografts could provide good functional results and they would be a surgical alternative to tendon transfers in cases of massive tears. Further studies should be conducted with other biomaterials.
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Weber SC. Platelet-rich Plasma in the Management of Arthroscopic Rotator Cuff Repair: Update 2016. Tech Orthop 2016. [DOI: 10.1097/bto.0000000000000178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee KW, Lee JS, Kim YS, Shim YB, Jang JW, Lee KI. Effective healing of chronic rotator cuff injury using recombinant bone morphogenetic protein-2 coated dermal patch in vivo. J Biomed Mater Res B Appl Biomater 2016; 105:1840-1846. [PMID: 27228085 DOI: 10.1002/jbm.b.33716] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/18/2016] [Accepted: 05/09/2016] [Indexed: 11/06/2022]
Abstract
Biologic augmentation for rotator cuff repair is a challenging treatment in patients with chronic large, massive, and irreparable rotator cuff injuries. Particularly, the use of an extracellular matrix (ECM) patch such as dermal tissue offered improved biomechanical properties in previous studies. Cytokines induce cell chemotaxis, proliferation, matrix synthesis, and cell differentiation. Moreover, osteoinductive growth factors such as bone morphogenetic protein-2 (BMP-2) affect the formation of new bone and fibrocartilage in lesions. However, the effects of using a dermal patch in combination with BMP-2 have not been evaluated to date, although many researchers have recognized the importance thereof. In this study, rhBMP-2-coated dermal patch (1 cm × 2 cm) isolated from human cadaveric donor was inserted in a rabbit model of chronic rotator cuff injury for in vivo evaluation. Bone mineral density and biomechanical strength were tested and histological and histomorphometric analyses were performed. The results showed that insertion of an rhBMP-2-coated acellular dermal patch not only significantly ameliorated new bone formation, it also improved biomechanical properties such as ultimate tensile strength. Thus, the use of this combination may improve the chronic rotator cuff injury-healing rate and clinical outcomes after rotator cuff repair. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1840-1846, 2017.
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Affiliation(s)
- Kwang-Won Lee
- Department of Orthopedic Surgery, Eulji University Hospital, Daejeon, Republic of Korea
| | - Jung-Soo Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Sik Kim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Young-Bock Shim
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Ju-Woong Jang
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
| | - Kwang-Il Lee
- Institute of Biomaterial and Medical Engineering, Cellumed Co., Ltd, Seoul, Republic of Korea
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Sayegh ET, Sandy JD, Virk MS, Romeo AA, Wysocki RW, Galante JO, Trella KJ, Plaas A, Wang VM. Recent Scientific Advances Towards the Development of Tendon Healing Strategies. ACTA ACUST UNITED AC 2015; 4:128-143. [PMID: 26753125 DOI: 10.2174/2211542004666150713190231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There exists a range of surgical and non-surgical approaches to the treatment of both acute and chronic tendon injuries. Despite surgical advances in the management of acute tears and increasing treatment options for tendinopathies, strategies frequently are unsuccessful, due to impaired mechanical properties of the treated tendon and/or a deficiency in progenitor cell activities. Hence, there is an urgent need for effective therapeutic strategies to augment intrinsic and/or surgical repair. Such approaches can benefit both tendinopathies and tendon tears which, due to their severity, appear to be irreversible or irreparable. Biologic therapies include the utilization of scaffolds as well as gene, growth factor, and cell delivery. These treatment modalities aim to provide mechanical durability or augment the biologic healing potential of the repaired tissue. Here, we review the emerging concepts and scientific evidence which provide a rationale for tissue engineering and regeneration strategies as well as discuss the clinical translation of recent innovations.
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Affiliation(s)
- Eli T Sayegh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - John D Sandy
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612
| | - Mandeep S Virk
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Anthony A Romeo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Robert W Wysocki
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Jorge O Galante
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Katie J Trella
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Anna Plaas
- Department of Rheumatology/Internal Medicine, Rush University Medical Center, Chicago, IL 60612
| | - Vincent M Wang
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
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Kaux JF, Drion P, Croisier JL, Crielaard JM. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med 2015. [PMID: 26195890 PMCID: PMC4498322 DOI: 10.46582/jsrm.1101003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. MATERIALS AND METHOD Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. RESULTS Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. CONCLUSIONS The majority of pre-clinical studies show that PRP stimulates the tendon's healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed.
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Affiliation(s)
- Jean-François Kaux
- Physical Medicine and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Pierre Drion
- ULg-GIGA-R, Experimental Surgery, University of Liège, Belgium
| | - Jean-Louis Croisier
- Physiotherapy Service, Department of Motility Sciences, University of Liège, Liège, Belgium
| | - Jean-Michel Crielaard
- Physical Medicine and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
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Valencia Mora M, Ruiz Ibán MA, Díaz Heredia J, Barco Laakso R, Cuéllar R, García Arranz M. Stem cell therapy in the management of shoulder rotator cuff disorders. World J Stem Cells 2015; 7:691-9. [PMID: 26029341 PMCID: PMC4444610 DOI: 10.4252/wjsc.v7.i4.691] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 01/26/2015] [Accepted: 02/04/2015] [Indexed: 02/07/2023] Open
Abstract
Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy.
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Affiliation(s)
- Maria Valencia Mora
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Miguel A Ruiz Ibán
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Jorge Díaz Heredia
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Raul Barco Laakso
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Ricardo Cuéllar
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Mariano García Arranz
- Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
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Williams PN, Moran G, Bradley JP, S ElAttrache N, Dines JS. Platelet-rich plasma and other cellular strategies in orthopedic surgery. Curr Rev Musculoskelet Med 2015; 8:32-39. [PMID: 25576070 DOI: 10.1007/s12178-014-9246-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The use of biologics in the treatment of musculoskeletal disease has become increasingly more common as research studies continue to provide further elucidation of their mechanisms in healing. Platelet-rich plasma, patches, growth factors, and stem cells are among the many biologics under active investigation and have varying levels of success in augmenting surgical or nonoperative interventions. However, the limitations of these treatments exist, and clear guidelines for their indications and application have yet to be established. Well-designed clinical trials will help determine the appropriate future use of biologics to ensure consistent outcomes.
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Affiliation(s)
- Phillip N Williams
- Division of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA.
| | - George Moran
- Division of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
| | - James P Bradley
- Center for Sports Medicine, University of Pittsburgh Medical Center, 3200 Water Street, South Side, Pittsburgh, PA, 15203, USA
| | - Neal S ElAttrache
- Kerlan Jobe Orthopaedic Clinic, 6801 Park Terrace, Suite 1400, Los Angeles, CA, 90045, USA
| | - Joshua S Dines
- Division of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, 535 E 70th Street, New York, NY, 10021, USA
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Chung SW, Kim JY, Yoon JP, Lyu SH, Rhee SM, Oh SB. Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity. Am J Sports Med 2015; 43:588-96. [PMID: 25535097 DOI: 10.1177/0363546514561004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The healing failure rate is high for partial-thickness or small full-thickness rotator cuff tears. PURPOSE To retrospectively evaluate and compare outcomes after arthroscopic repair of high-grade partial-thickness and small full-thickness rotator cuff tears and factors affecting rotator cuff healing. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Included in the study were 55 consecutive patients (mean age, 57.9 ± 7.2 years) who underwent arthroscopic repair for high-grade partial-thickness (n = 34) and small full-thickness (n = 21) rotator cuff tears. The study patients also underwent magnetic resonance imaging (MRI) preoperatively and computed tomography arthrography (CTA) at least 6 months postoperatively, and their functional outcomes were evaluated preoperatively and at the last follow-up (>24 months). All partial-thickness tears were repaired after being converted to full-thickness tears; thus, the repair process was almost the same as for small full-thickness tears. The tendinosis of the torn tendon was graded from the MRI images using a 4-point scale, and the reliabilities were assessed. The outcomes between high-grade partial-thickness tears that were converted to small full-thickness tears and initially small full-thickness tears were compared, and factors affecting outcomes were evaluated. RESULTS The inter- and intraobserver reliabilities of the tendinosis grade were good (intraclass correlation coefficient, 0.706 and 0.777, respectively). Failure to heal as determined by CTA was observed in 12 patients with a high-grade partial-thickness tear (35.3%; complete failure in 4 and partial failure in 8) and in 3 patients with a small full-thickness tear (14.3%; complete failure in 1 and partial failure in 2). The patients with high-grade partial-thickness rotator cuff tears showed a higher tendinosis grade than did those with small full-thickness tears (P = .014), and the severity of the tendinosis was related to the failure to heal (P = .037). Tears with a higher tendinosis grade showed a 7.64-times higher failure rate (95% CI, 1.43-36.04) than did those with a lower tendinosis grade (P = .013). All functional outcome scores improved after surgery (all P < .001); however, there was no difference between groups. CONCLUSION The high-grade partial-thickness rotator cuff tears showed more severe tendinosis compared with the small full-thickness tears in this study. Contrary to previous impressions that tear size or fatty infiltration is the factor that most influences healing, tendinosis severity assessed by preoperative MRI was the only factor associated with failure to heal, given the numbers available for analysis, in patients with partial-thickness and small full-thickness rotator cuff tears. Surgeons should pay more attention to tendon quality during repair surgery or rehabilitation in smaller rotator cuff tears, especially in high-grade partial-thickness tears with severe tendinosis.
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Affiliation(s)
- Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Yoon Kim
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyung-Pook National University College of Medicine, Daegu, Korea
| | - Seong Hwa Lyu
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sung Min Rhee
- Department of Orthopedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Se Bong Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea
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Warth RJ, Dornan GJ, James EW, Horan MP, Millett PJ. Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression. Arthroscopy 2015; 31:306-20. [PMID: 25450417 DOI: 10.1016/j.arthro.2014.09.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 09/08/2014] [Accepted: 09/09/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review, meta-analysis, and meta-regression of all Level I and Level II studies comparing the clinical or structural outcomes, or both, after rotator cuff repair with and without platelet-rich product (PRP) supplementation. METHODS A literature search of the PubMed and EMBASE databases was performed to identify all Level I or II studies comparing the clinical or structural outcomes, or both, after arthroscopic repair of full-thickness rotator cuff tears with (PRP+ group) and without (PRP- group) PRP supplementation. Data included outcome scores (American Shoulder and Elbow Surgeons [ASES], University of California Los Angeles [UCLA], Constant, Simple Shoulder Test [SST] and visual analog scale [VAS] scores) and retears diagnosed with imaging studies. Meta-analyses compared preoperative, postoperative, and gain in outcome scores and relative risk ratios for retears. Meta-regression compared the effect of PRP treatment on outcome scores and retear rates according to 6 covariates. Minimum effect sizes that were detectable with 80% power were also calculated for each study. RESULTS Eleven studies were included in this review and a maximum of 8 studies were used for meta-analyses according to data availability. There were no statistically significant differences between the PRP+ and PRP- groups for overall outcome scores or retear rates (P > .05). Overall gain in the Constant score was decreased when liquid PRP was injected over the tendon surface compared with PRP application at the tendon-bone interface (-6.88 points v +0.78 points, respectively; P = .046); however, this difference did not reach the previously reported minimum clinically important difference (MCID) for Constant scores. When the initial tear size was greater than 3 cm in anterior-posterior length, the PRP+ group exhibited decreased retear rates after double-row repairs when compared with the PRP- group (25.9% v 57.1%, respectively; P = .046). Sensitivity power analyses revealed that most included studies were only powered to detect large differences in outcome scores between groups. CONCLUSIONS There were no statistically significant differences in overall gain in outcome scores or retear rates between treatment groups. Gain in Constant scores was significantly increased when PRPs were applied at the tendon-bone interface when compared with application over the top of the repaired tendon. Retear rates were significantly decreased when PRPs were used for the treatment of tears greater than 3 cm in anterior-posterior length using a double-row technique. Most of the included studies were only powered to detect large differences in outcome scores between treatment groups. In addition, an increased risk for selection, performance, and attrition biases was found. LEVEL OF EVIDENCE Level II, meta-analysis of Level I and Level II studies.
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Affiliation(s)
- Ryan J Warth
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Evan W James
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Marilee P Horan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A..
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Barrionuevo DV, Laposy CB, Abegão KGB, Nogueira RMB, Nai GA, Bracale BN, Delfim IG. Comparison of experimentally-induced wounds in rabbits treated with different sources of platelet-rich plasma. Lab Anim 2015; 49:209-14. [PMID: 25586936 DOI: 10.1177/0023677214567747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the years, autologous platelet-rich plasma (PRP) has been used to great advantage in the healing of acute and chronic wounds. However, it is impossible to use in some situations so alternative PRPs need to be considered, such as homologous or heterologous PRPs. In order to evaluate the effects of PRP in the form of autologous, heterologous and homologous gels on in vivo cutaneous wound healing, 18 animals divided into three groups of six, were used for the study, with another six animals used as PRP donors. For the heterologous group an adult, mixed breed dog was used to obtain the PRP. The wounds were induced using an 8 mm punch. The left side was treated with NaCl 0.9%® (A) and a PRP gel was applied (GA = autologous; GHE = heterologous and GHO = homologous) on the right side (B). The wounds were evaluated for a period of 17 days. On the 17th day biopsies were taken for histopathological assessment of the wounds. The percentage of contraction was evident in side B (treated), which was confirmed in the microscopic analysis of the histological sections. Thus, it was concluded that PRP, regardless of the source, improves and accelerates the healing process, demonstrating its therapeutic potential on cutaneous lesions and its use in patients with impaired wound healing.
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Affiliation(s)
- D V Barrionuevo
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - C B Laposy
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - K G B Abegão
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - R M B Nogueira
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - G A Nai
- Oeste Paulista University, Postgraduate Program in Animal Sciences, Presidente Prudente, São Paulo, Brazil
| | - B N Bracale
- Oeste Paulista University, Veterinary Medicine, Presidente Prudente, São Paulo, Brazil
| | - I G Delfim
- Oeste Paulista University, Veterinary Medicine, Presidente Prudente, São Paulo, Brazil
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Abstract
Tendinopathy is a debilitating musculoskeletal
condition which can cause significant pain and lead to complete rupture
of the tendon, which often requires surgical repair. Due in part
to the large spectrum of tendon pathologies, these disorders continue
to be a clinical challenge. Animal models are often used in this
field of research as they offer an attractive framework to examine
the cascade of processes that occur throughout both tendon pathology and
repair. This review discusses the structural, mechanical, and biological
changes that occur throughout tendon pathology in animal models,
as well as strategies for the improvement of tendon healing. Cite this article: Bone Joint Res 2014;3:193–202.
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Affiliation(s)
- M W Hast
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - A Zuskov
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
| | - L J Soslowsky
- University of Pennsylvania, McKay Orthopaedic Research Laboratory, 424 Stemmler Hall 36th Street and Hamilton Walk, Philadelphia, 19104-6081, USA
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