Biological strategies to enhance rotator cuff healing.
Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair. Growth factors are delivered to the repair site using tissue-engineered scaffolding, coated sutures, or dissolved in a fibrin sealant. Platelet-rich plasma is an autologous concentration of platelets and contains an high density of growth factors. There is some evidence that platelet-rich plasma may improve pain and recovery of function in a short time period, but it does not improve healing rates in rotator cuff. Thus the routine use of platelet-rich plasma in rotator cuff repair is not recommended. The addition of mesenchymal stem cells to scaffolds can lead to the production of a better quality healing tissue. Gene therapy is a gene transfer from a cell into another, in order to over-express the gene required. In this way, cultures of stem cells can over-express growth factors. Better understanding of the mechanisms of physiological tendon healing can promote the correct use of these new biological therapies for a better healing tissue.
Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy. g.longo@unicampus.it.
Umile Giuseppe
UG
Longo
Giacomo
G
Rizzello
Alessandra
A
Berton
Ludovica
L
Maltese
Caterina
C
Fumo
Wasim S
WS
Khan
Vincenzo
V
Denaro
D000818:Animals; D001691:Biological Therapy / Q000379:methods* / Q000639:trends; D018925:Chemokines / Q000627:therapeutic use*; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use*; D045164:Mesenchymal Stem Cell Transplantation; D059630:Mesenchymal Stem Cells / Q000502:physiology*; D017006:Rotator Cuff / Q000502:physiology*; D000070636:Rotator Cuff Injuries; D023822:Tissue Engineering; D054457:Tissue Scaffolds; D014945:Wound Healing; D014947:Wounds and Injuries / Q000628:therapy*
D018925:Chemokines; D036341:Intercellular Signaling Peptides and Proteins