Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors*

Rodeo, Scott A.; Potter, Hollis G.; Kawamura, Syosuke; Turner, A. Simon; Kim, Hyon Jeong; Atkinson, Brent L.

doi:10.2106/00004623-200711000-00021

Cited by 181 publications

(76 citation statements)

References 17 publications

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“…However, following ligament reconstruction or tendon repair, the structure and composition of the graft attachment site are replaced by disorganized scar. The global hypothesis of our laboratory's ongoing work is that, while initial healing depends on biological signals such as cytokines 12,[18][19][20][21] , mechanical load is of paramount importance for subsequent remodeling of the healing attachment site.…”

Section: Discussionmentioning

confidence: 99%

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

Packer

Bedi

Fox

et al. 2014

Journal of Bone and Joint Surgery

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Section: Discussionmentioning

confidence: 99%

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

Packer

Bedi

Fox

et al. 2014

Journal of Bone and Joint Surgery

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“…Although the surgery is performed routinely, prior studies have reported a relatively high rate of failure of tendon healing after repair [3,11,12,14]. Previous basic science work has shown that the native supraspinatus tendon-bone insertion site is not recreated after a rotator cuff repair [4,13,24]. Instead, the tendon heals to the bone with fibrovascular interface scar tissue, which has inferior biomechanical properties compared with native tissue.…”

Section: Introductionmentioning

confidence: 99%

rhPDGF-BB Promotes Early Healing in a Rat Rotator Cuff Repair Model

Kovacevic

Gulotta

Liang

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Tendon-bone healing after rotator cuff repair occurs by fibrovascular scar tissue formation, which is weaker than a normal tendon-bone insertion site. Growth factors play a role in tissue formation and have the potential to augment soft tissue healing in the perioperative period. Questions/purposes Our study aim was to determine if rhPDGF-BB delivery on a collagen scaffold can improve tendon-to-bone healing after supraspinatus tendon repair compared with no growth factor in rats as measured by (1) gross observations; (2) histologic analysis; and (3) biomechanical testing. Methods Ninety-five male Sprague-Dawley rats underwent acute repair of the supraspinatus tendon. Rats were randomized into one of five groups: control (ie, repair only), scaffold only, and three different platelet-derived growth factor (PDGF) doses on the collagen scaffold. Animals were euthanized 5 days after surgery to assess cellular proliferation and angiogenesis. The remaining animals were analyzed at 4 weeks to assess repair site integrity by gross visualization, fibrocartilage formation with safranin-O staining, and collagen fiber organization with picrosirius red staining, and to determine the biomechanical properties (ie, load-to-failure testing) of the supraspinatus tendon-bone construct. Results The repaired supraspinatus tendon was in continuity with the bone in all animals. At 5 days, rhPDGF-BB delivery on a scaffold demonstrated a dose-dependent response in cellular proliferation and angiogenesis compared with the control and scaffold groups. At 28 days, with the numbers available, rhPDGF-BB had no effect on increasing fibrocartilage formation or improving collagen fiber maturity at the tendon-bone insertion site compared with controls. The control group had higher tensile loads to failure and stiffness (35.5 ± 8.8 N and 20.3 ± 4.5 N/mm) than all the groups receiving the scaffold, including the PDGF groups (scaffold: 27 ± 6.4 N, p = 0.021 and 13 ± 5.7 N/mm, p = 0.01; 30 lg/mL PDGF: 26.5 ± 7.5 N, p = 0.014 and 13.3 ± 3.2 N/mm, p = 0.01; 100 lg/mL PDGF: 25.7 ± 6

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“…However, when the loads were normalized for tissue volume, they observed no differences between treated and untreated shoulders. The data suggest, while the bovine cortical bone extract may have accelerated the healing process, it did not change the quality of the repair [48].…”

Section: Growth Factor Additionmentioning

confidence: 84%

“…Osteoinductive proteins have been examined for their role in rotator cuff healing. In a sheep infraspinatus tear model, growth factors from bovine cortical bone extract (BMP-2 to BMP-7, TGF-b1 to TGF-b3, and FGF) were implanted into a healing rotator cuff with a Type I collagen sponge [48]. The investigators found increased bone volume, soft tissue volume, and failure loads in the augmented group when compared to nonaugmented control.…”

Section: Growth Factor Additionmentioning

confidence: 99%

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

Cheung

Silverio

Sperling

2010

Clinical Orthopaedics &Amp; Related Research

148

103

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Background Degenerative rotator cuff tears are increasing with the aging population, and healing is not uniform after surgery. Rotator cuffs may show improved healing when biologic factors are added during surgery. Questions/purposes We asked: (1) What cellular processes are involved in normal bone-to-tendon healing? (2) What approaches are being developed in tendon augmentation? (3) What approaches are being developed with the addition of growth factors? Methods We reviewed research in relating to biologic augmentation and cellular processes involved in rotator cuff repair, focusing on animal models of rotator cuff repair and nonrandomized human trials. Results Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is distinct from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells, although current research does not conclusively confirm which if any of these scaffolds enhance repair owing in part to intermanufacturer variations and the limited human research. Growth factors and platelet-rich-plasma are established in other fields of research and may enhance repair but have not been rigorously tested. Conclusions There is potential application of biologic augmentation to improve healing after rotator cuff repair. However, research in this field is still inconclusive and has not been sufficiently demonstrated to merit regular clinical use. Future human trials can elucidate the use of biologic augmentation in rotator cuff repairs.

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Biologic Augmentation of Rotator Cuff Tendon-Healing with Use of a Mixture of Osteoinductive Growth Factors*

Cited by 181 publications

References 17 publications

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

Effect of Immediate and Delayed High-Strain Loading on Tendon-to-Bone Healing After Anterior Cruciate Ligament Reconstruction

rhPDGF-BB Promotes Early Healing in a Rat Rotator Cuff Repair Model

Strategies in Biologic Augmentation of Rotator Cuff Repair: A Review

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