title: Advances in biology and mechanics of rotator cuff repair.
abstract: High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair.
  
  
  METHODS
  Expert opinion, Level V.
authors.affiliation: Department of Orthopaedic Surgery, Saarland University, Homburg, Germany.
authors.forename: Olaf
authors.initials: O
authors.lastname: Lorbach
authors.forename: Mike H
authors.initials: MH
authors.lastname: Baums
authors.forename: Tanja
authors.initials: T
authors.lastname: Kostuj
authors.forename: Stephan
authors.initials: S
authors.lastname: Pauly
authors.forename: Markus
authors.initials: M
authors.lastname: Scheibel
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
authors.forename: Nasim
authors.initials: N
authors.lastname: Zargar
authors.forename: Maristella F
authors.initials: MF
authors.lastname: Saccomanno
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milano
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D064987:Cell- and Tissue-Based Therapy; D004195:Disease Models, Animal; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000627:therapeutic use; D017006:Rotator Cuff / Q000503:physiopathology* / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology* / Q000601:surgery; D013708:Tendon Injuries / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D013710:Tendons / Q000503:physiopathology / Q000601:surgery; D054457:Tissue Scaffolds
chemical_list: D036341:Intercellular Signaling Peptides and Proteins