Biological Strategies to Enhance Rotator Cuff Healing.
Umile Giuseppe Longo,
Wasim S. Khan,
Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon
biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy
and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by
aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic
proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair. Growth
factors are delivered to the repair site using tissue-engineered scaffolding, coated sutures, or dissolved in a fibrin sealant.
Platelet-rich plasma is an autologous concentration of platelets and contains an high density of growth factors. There is
some evidence that platelet-rich plasma may improve pain and recovery of function in a short time period, but it does not
improve healing rates in rotator cuff. Thus the routine use of platelet-rich plasma in rotator cuff repair is not recommended.
The addition of mesenchymal stem cells to scaffolds can lead to the production of a better quality healing tissue. Gene
therapy is a gene transfer from a cell into another, in order to over-express the gene required. In this way, cultures of stem
cells can over-express growth factors.
Better understanding of the mechanisms of physiological tendon healing can promote the correct use of these new biological
therapies for a better healing tissue.
Keywords: Biological strategies, gene therapy, growth factors, platelet-rich plasma, rotator cuff healing, stem cells, tendon
healing, tissue engineering.
Rights & PermissionsPrintExport