The Role of Biologic Therapy in Rotator Cuff Tears and Repairs

Abstract

Platelet-rich plasma (PRP) overall has no significant impact on functional outcomes and repair integrity, but may be more advantageous in small to medium tears. Further studies should focus on leukocyte-rich versus poor preparations and the use of PRP in patients that are high risk for repair failure. Biologic and synthetic patches or augments provide mechanical stability for large and massive rotator cuff tears and decrease re-tear rates. Mesenchymal stem cells have demonstrated improved healing rates without an impact on outcomes. Cytokines and growth factors show promise in animal models, but require human trials to further evaluate. In massive or revision repairs, allograft or synthetic patch augmentation should be considered. Platelet-rich plasma may have benefit in smaller tears. Further studies are needed to evaluate the value of mesenchymal stem cells and various cytologic chemical signals.

Biologics and stem cell‐based therapies for rotator cuff repair

“…14,15,48 PRP is the most commonly tested, undefined biological adjuvant for rotator cuff repairs, and several randomized clinical trials have studied the functional effects and patient outcomes of this treatment, with the goal of increasing healing of the enthesis and reducing pain and inflammation of patients after repair. 14,15,48 There are several reviews that summarize patient outcomes and compare data across multiple studies, with few finding significant improvements in patient outcomes and pain levels in patients with PRP-treated rotator cuff repairs versus control repairs. 15,49 The majority of studies fail to find significant results, as most clinical studies have shown that PRP has no significant effects on healing, retear rate, pain, or functional outcomes at long-term follow-up tests.…”

“…14,15,48 There are several reviews that summarize patient outcomes and compare data across multiple studies, with few finding significant improvements in patient outcomes and pain levels in patients with PRP-treated rotator cuff repairs versus control repairs. 15,49 The majority of studies fail to find significant results, as most clinical studies have shown that PRP has no significant effects on healing, retear rate, pain, or functional outcomes at long-term follow-up tests. 50,51 However, interesting differences have been observed when comparing treatment subgroups.…”

“…In recent years, the clinical community has focused mainly on advancing operation and suturing technologies to better restore the native biomechanical footprint of tendon attachment to bone. However, efficacy of these methods has been low or mixed, highlighting the limitations in suture‐based approaches . Further improvements to rotator cuff repair will likely reside in the development of new cell‐ or biologically based technologies to augment surgery.…”

“…However, efficacy of these methods has been low or mixed, highlighting the limitations in suturebased approaches. [11][12][13][14][15] Further improvements to rotator cuff repair will likely reside in the development of new cell-or biologically based technologies to augment surgery. Advancing this area of research thus has vast potential to revolutionize orthopedic practice.…”

Are orthobiologics the next chapter in clinical orthopedics? A literature review

“…Platelet-rich plasma, biologic matrix augmentation, synthetic scaffolds, growth factors, and stem cells are the most studied topics in rotator cuff tears. In a very recent review, Charles et al [50] concluded that overall consensus of current literature shows that PRP does not provide a benefit and is not cost effective. They also found that matrix augmentations instead provide mechanical reinforcement, lower re-tear rates, and better functional outcomes.…”