Effect of Mechanical Stimulation Combined With Platelet-Rich Plasma on Healing of the Rotator Cuff in a Murine Model

Abstract

Background: Mechanical stimulation and platelet-rich plasma (PRP) have been shown to be beneficial for healing of the bone-tendon interface (BTI), but few studies have explored the efficacy of a combination of these applications. We investigated the effect of mechanical stimulation combined with PRP on rotator cuff repair in mice. Hypothesis: Mechanical stimulation combined with PRP can enhance BTI healing in a murine model of rotator cuff repair. Study Design: Controlled laboratory study. Methods: A total of 160 C57BL/6 mice were used. Overall, 40 mice were used to prepare PRP, while 120 mice underwent acute supraspinatus tendon (SST) repair. The animals were randomly assigned to 4 groups: control group, mechanical stimulation group, PRP group, and mechanical stimulation combined with PRP group (combination group). At 4 and 8 weeks postoperatively, animals were sacrificed, the eyeballs were removed to collect blood, and the SST–humeral complexes were collected. Histological, biomechanical, immunological, and bone morphometric tests were performed. Results: Histologically, at 4 and 8 weeks after surgery, the area of the fibrocartilage layer at the BTI in the combination group was larger than in the other groups. The content and distribution of proteoglycans in this layer in the combination group were significantly greater than in the other groups. At 8 weeks postoperatively, trabecular number, and trabecular bone thickness of the subchondral bone area of interest at the BTI of the combination group were greater than those of the other groups, bone volume fraction of the combination group was greater than the control group. On biomechanical testing at 4 and 8 weeks after surgery, the failure load and ultimate strength of the SST–humeral complex in the combination group were higher than in the other groups. Enzyme-linked immunosorbent assay results showed that, at 4 weeks postoperatively, the serum concentrations of transforming growth factor beta 1 and platelet-derived growth factor (PDGF) in the combination group were significantly higher than in the other groups; at 8 weeks, the PDGF-AB concentration in the combination group was higher than in the control and mechanical stimulation groups. Conclusion: Mechanical stimulation combined with PRP can effectively promote the early stage of healing after a rotator cuff injury. Clinical Relevance: These findings imply that mechanical stimulation combined with PRP can serve as a potential therapeutic strategy for rotator cuff healing.

Menstrual Blood–Derived Mesenchymal Stem Cells Encapsulated in Autologous Platelet-Rich Gel Facilitate Rotator Cuff Healing in a Rabbit Model of Chronic Tears

“…As a complicated mixture of these growth factors, PRP effectively stimulates MSC proliferation, synthesizing the extracellular matrix proteins (proteoglycans, collagen, etc), and promoting angiogenesis. 24,32,38,43 Our in vitro study confirmed that the MSCs cocultured in APG proliferated significantly better than the cell culture plate. In addition, under osteogenic or chondrogenic induction, the MenSCs cocultured in APG expressed significantly higher osteogenic-specific mRNA (Runx2) or chondrogenic-specific mRNA (Sox9) than the BMSCs or the MenSCs cultured without APG.…”

“…APG is a gel material of PRP that is capable of releasing growth factors such as transforming growth factor–β, platelet-derived growth factor, insulin-like growth factor, basic fibroblast growth factor, and vascular endothelial growth factor. 24,32,38,43 The transplanted MenSCs@APG may be activated by these released growth factors and then proliferated quickly, as well as spatially differentiated into the osteogenic or chondrogenic lineage, thus facilitating RC healing. Indeed, our in vitro study determined that the MenSCs cultured within APG showed better osteogenic or chondrogenic differentiation than BMSCs alone.…”

Platelet-derived growth factor AA-modified electrospun fibers promote tendon healing

“…After preparation for the surgery, the skin flap of the right hind limb of the mice was lifted, with later cutting at the tendon of the right hind limb of the mice to simulate the damage to the tendon of the acute lower limb due to motor injury. 15 Poly(lactide-co-glycolide) acid fibers and PLGA-PDGF-AA fibers were fixed using an interrupted suture technique and 8/0 silk was thread at the Achilles tendon of the right hind limb of tendon injured mice. Our method of fixation was to wrap the tendon after tendon injury and then fix it with 8/0 silk.…”

Efficacy of platelet‐rich plasma and platelet‐rich fibrin in arthroscopic rotator cuff repair: A systematic review and meta‐analysis

“…These autologous blood biologics products contain a high concentration of platelets, which release growth factors and cytokines 8 that promote tissue healing by inducing cell differentiation, extracellular matrix production, and angiogenesis 9,10 . Several studies have demonstrated their effectiveness and safety 11,12 . Based on their properties, platelet‐rich products can be classified as platelet‐rich plasma (PRP) and platelet‐rich fibrin (PRF).…”

“…9,10 Several studies have demonstrated their effectiveness and safety. 11,12 Based on their properties, platelet-rich products can be classified as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). PRP and PRF are extracted from the blood by centrifugation but prepared differently.…”