title: Biologic and pharmacologic augmentation of rotator cuff repairs.
abstract: As rotator cuff repair techniques have improved, failure of the tendon to heal to the proximal humerus is less likely to occur from weak tendon-to-bone fixation. More likely causes of failure include biologic factors such as intrinsic tendon degeneration, fatty atrophy, fatty infiltration of muscle, and lack of vascularity of the tendons. High failure rates have led to the investigation of biologic augmentation to potentially enhance the healing response. Histologic studies have shown that restoration of the rotator cuff footprint during repair can help reestablish the enthesis. In animal models, growth factors and their delivery scaffolds as well as tissue engineering have shown promise in decreasing scar tissue while maintaining biomechanical strength. Platelet-rich plasma may be a safe adjuvant to rotator cuff repair, but it has not been shown to improve healing or function. Many of these strategies need to be further defined to permit understanding of, and to optimize, the biologic environment; in addition, techniques need to be refined for clinical use.
authors: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
authors: Sara L
authors: SL
authors: Edwards
authors: T Sean
authors: TS
authors: Lynch
authors: Matthew D
authors: MD
authors: Saltzman
authors: Michael A
authors: MA
authors: Terry
authors: Gordon W
authors: GW
authors: Nuber
mesh_terms: D000818:Animals; D019485:Bone Morphogenetic Proteins / Q000627:therapeutic use; D004164:Diphosphonates / Q000627:therapeutic use; D005346:Fibroblast Growth Factors / Q000627:therapeutic use; D015316:Genetic Therapy / Q000379:methods; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D053657:Platelet-Rich Plasma / Q000737:chemistry; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000601:surgery / Q000628:therapy*; D023822:Tissue Engineering; D054457:Tissue Scaffolds; D014945:Wound Healing / Q000502:physiology*
chemical_list: D019485:Bone Morphogenetic Proteins; D004164:Diphosphonates; D036341:Intercellular Signaling Peptides and Proteins; D005346:Fibroblast Growth Factors