Rotator cuff tears (RCT) are a common problem encountered by orthopaedic surgeons. The incidence of re-tears (up to 94%) following surgical repair of RCTs renders the management of RCTs challenging. This higher re-tear rate has been attributed to the failure of healing at the tendon-bone junction. Biological augmentation methods such as growth factors, stem cell therapies, and biomaterials have been developed to promote the healing at the tendon-bone junction. Growth factors and stem cell therapies have been intensively studied in mid to large RCTs. Biomaterials have been generally utilized for large or massive RCTs. However, these newly generated biological augmentation strategies are mostly studied in animal models. The efficacy and safety of the biological augmentation methods in humans need further investigation. In this review, we aimed to highlight the most recent advancements in RCT surgical repair with biological augmentation.
Hakimi O, Mouthuy P, Carr A. Synthetic and degradable patches: an emerging solution for rotator cuff repair. Int J Exp Pathol. 2013;287–92.
2.
Ensor K, Kwon Y, Dibeneditto M, Zuckerman J, Rokito A. The rising incidence of rotator cuff repairs. J Shoulder Elbow Surg. 2013;1628–32.
3.
Mcelvany M, Mcgoldrick E, Gee A, Neradilek M, Matsen F. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. 2015;491–500.
4.
Le B, Wu X, Lam P, Murrell G. Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med. 2014;1134–42.
5.
Mirzayan R, Weber A, Petrigliano F, Chahla J. Rationale for biologic augmentation of rotator cuff repairs. J Am Acad Orthop Surg. 2019;468–78.
6.
Thomopoulos S, Genin G, Galatz L. The development and morphogenesis of the tendon-to-bone insertion -what development can teach us about healing. J Musculoskelet Neuronal Interact. 2010;35–45.
7.
Galatz L, Ball C, Teefey S, Middleton W, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;219–24.
8.
Kaizawa Y, Franklin A, Leyden J, Behn A, Tulu U, Leon S, et al. Augmentation of chronic rotator cuff healing using adipose-derived stem cell-seeded human tendon-derived hydrogel. J Orthop Res. 2019;877–86.
9.
Morton-Gonzaba N, Carlisle D, Emukah C, Chorath K, Moreira A. Mesenchymal stem cells and their application to rotator cuff pathology: a meta-analysis of pre-clinical studies. Osteoarthritis and Cartilage Open. 2020;100047.
10.
Karuppaiah K, Sinha J. Scaffolds in the management of massive rotator cuff tears: current concepts and literature review. EFORT Open Rev. 2019;557–66.
11.
Cavendish P, Everhart J, Dibartola A, Eikenberry A, Cvetanovich G, Flanigan D. The effect of perioperative platelet-rich plasma injections on postoperative failure rates following rotator cuff repair: a systematic review with meta-analysis. J Shoulder Elbow Surg. 2020;1059–70.
12.
Flury M, Rickenbacher D, Schwyzer H, Jung C, Schneider M, Stahnke K, et al. Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair? A randomized controlled trial. Am J Sports Med. 2016;2136–46.
13.
Dolkart O, Chechik O, Zarfati Y, Brosh T, Alhajajra F, Maman E. A single dose of platelet-rich plasma improves the organization and strength of a surgically repaired rotator cuff tendon in rats. Arch Orthop Trauma Surg. 2014;1271–7.
14.
Chahal J, Thiel V, Mall G, Heard N, Bach W, Cole B, et al. Romeo AA. The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy. 2012;1718–27.
15.
Saltzman B, Jain A, Campbell K, Mascarenhas R, Romeo A, Verma N, et al. Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses. Arthroscopy. 2016;906–18.
16.
Thomopoulos S, Parks W, Rifkin D, Derwin K. Mechanisms of tendon injury and repair. J Orthop Res. 2015;832–9.
17.
Lamplot J, Angeline, Beederman A, Wagner M, Rastegar E, Scott F, et al. Distinct effects of platelet-rich plasma and BMP13 on rotator cuff tendon injury healing in a rat model. Am J Sports Med. 2014;2877–87.
18.
Xu Q, Sun W, Zhang Z. High expression of VEGFA in MSCs promotes tendon-bone healing of rotator cuff tear via microRNA-205-5p. Eur Rev Med Pharmacol Sci. 2019;4081–8.
19.
Rodeo S, Potter H, Kawamura S, Turner A, Kim H, Atkinson B. Biologic augmentation of rotator cuff tendon-healing with use of a mixture of osteoinductive growth factors. J Bone Joint Surg Am. 2007;2485–97.
20.
Kabuto Y, Morihara T, Sukenari T, Kida Y, Oda R, Arai Y, et al. Stimulation of rotator cuff repair by sustained release of bone morphogenetic protein-7 using a gelatin hydrogel sheet. Tissue Eng Part A. 2015;2025–33.
21.
Savitskaya Y, Izaguirre A, Sierra L, Perez F, Cruz F, Villalobos E, et al. Effect of angiogenesis-related cytokines on rotator cuff disease: the search for sensitive biomarkers of early tendon degeneration. Clin Med Insights Arthritis Musculoskelet Disord. 2011;43–53.
22.
Kobayashi M, Itoi E, Minagawa H, Miyakoshi N, Takahashi S, Tuoheti Y, et al. Expression of growth factors in the early phase of supraspinatus tendon healing in rabbits. J Shoulder Elbow Surg. 2006;371–7.
23.
Caplan A, Dennis J. Mesenchymal stem cells as trophic mediators. J Cell Biochem. 2006;1076–84.
24.
Omi R, Gingery A, Steinmann S, Amadio P, An K, Zhao C. Rotator cuff repair augmentation in a rat model that combines a multilayer xenograft tendon scaffold with bone marrow stromal cells. J Shoulder Elbow Surg. 2016;469–77.
25.
Berebichez-Fridman R, Gómez-García R, Granados-Montiel J, Berebichez-Fastlicht E, Olivos-Meza A, Granados J, et al. The holy grail of orthopedic surgery: mesenchymal stem cells-their current uses and potential applications. Stem Cells Int. 2017;2638305.
26.
Patel S, Gualtieri A, Lu H, Levine W. Advances in biologic augmentation for rotator cuff repair. Ann N Y Acad Sci. 2016;97–114.
27.
Gomes E, Da Silva J, Silla R, Abreu L, Pellanda M, R. Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells. Knee Surg Sports Traumatol Arthrosc. 2012;373–7.
28.
Hernigou P, Lachaniette F, Delambre C, Zilber J, Duffiet S, Chevallier P, et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014;1811–8.
29.
Otto A, Muench L, Kia C, Baldino J, Mehl J, Dyrna F, et al. Proximal humerus and ilium are reliable sources of bone marrow aspirates for biologic augmentation during arthroscopic surgery. Arthroscopy. 2020;2403–11.
30.
Jo C, Chai J, Jeong E, Oh S, Kim P, Yoon J, et al. Intratendinous injection of autologous adipose tissue-derived mesenchymal stem cells for the treatment of rotator cuff disease: a first-in-human trial. Stem Cells. 2018;1441–50.
31.
Jo C, Chai J, Jeong E, Oh S, Yoon K. Intratendinous injection of mesenchymal stem cells for the treatment of rotator cuff disease: a 2-year follow-up study. Arthroscopy. 2020;971–80.
32.
Cho C, Lee S, Lee Y, Shin H. Mini-open suture bridge repair with porcine dermal patch augmentation for massive rotator cuff tear: surgical technique and preliminary results. Clin Orthop Surg. 2014;329–35.
33.
Soler J, Gidwani S, Curtis M. Early complications from the use of porcine dermal collagen implants (Permacol) as bridging constructs in the repair of massive rotator cuff tears. A report of 4 cases. Acta Orthop Belg. 2007;432–6.
34.
Gupta A, Hug K, Boggess B, Gavigan M, Toth A. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft. Am J Sports Med. 2013;872–9.
35.
Arnoczky S, Bishai S, Schofield B, Sigman S, Bushnell B, Hommen J, et al. Histologic evaluation of biopsy specimens obtained after rotator cuff repair augmented with a highly porous collagen implant. Arthroscopy. 2017;278–83.
36.
Agrawal V. Healing rates for challenging rotator cuff tears utilizing an acellular human dermal reinforcement graft. Int J Shoulder Surg. 2012;36–44.
37.
Barber F, Burns J, Deutsch A, Labbé M. Litchfield RB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;8–15.
38.
Hohn E, Gillette B, Burns J. Outcomes of arthroscopic revision rotator cuff repair with acellular human dermal matrix allograft augmentation. J Shoulder Elbow Surg. 2018;816–23.
39.
Mccormack R, Shreve M, Strauss E. Biologic augmentation in rotator cuff repair--should we do it, who should get it, and has it worked? Bull Hosp Jt Dis. 2014;89–96.
40.
Encalada-Diaz I, Cole B, Macgillivray J, Ruiz-Suarez M, Kercher J, Friel N, et al. Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months’ follow-up. J Shoulder Elbow Surg. 2011;788–94.
41.
Proctor C. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg. 2014;1508–13.
42.
Ciampi P, Scotti C, Nonis A, Vitali M, Serio D, Peretti C, et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year followup study. Am J Sports Med. 2014;1169–75.
43.
Ranebo M, Hallgren B, Norlin H, R. Adolfsson LE. Long-term clinical and radiographic outcome of rotator cuff repair with a synthetic interposition graft: a consecutive case series with 17 to 20 years of follow-up. J Shoulder Elbow Surg. 2018;1622–8.
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