title: Apoptosis and rotator cuff tears: scientific evidence from basic science to clinical findings.
abstract: Excessive apoptosis has been hypothesized as possible cause of tendinopathy and tear in the tendons of the rotator cuff (RC). Different mechanisms and molecules play a key role in cell regulation. Biological interventions can affect the process of apoptosis to control the tendinopathy process, and may be useful to design new treatments.
  
  
  
  We identified basic science, in vitro and in vivo preclinical and clinical studies listed in the Pubmed Google Scholar, CINAHL, Cochrane Central and Embase Biomedical databases in English, Spanish, Italian and French concerning the effects of apoptosis on RC tendons.
  
  
  
  The homeostasis between the apoptotic and inflammatory processes is dynamic and controlled by pro- and anti-apoptotic mechanisms and signals, with variable balance in different areas of the RC tendons in human specimens.
  
  
  
  Apoptosis can be identified along the whole tendon, not only in the area of the lesion. Therefore, it is not necessary to undertake wide debridement of the torn edges of the tendon when undertaking a repair.
  
  
  
  The identification of the various factors that control apoptosis and its mechanisms can help to design new treatments and exert positive effects in the recovery from tendon tears.
  
  
  
  Further studies are needed to produce clear guidelines to determine how to balance the apoptosis process to reduce the failed healing response found in non-traumatic RC tears.
authors.affiliation: Unit of Arthroscopy and Sports Medicine, Hesperia Hospital, Via Arqua', Modena, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Osti
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Buda
authors.affiliation: Department of Orthopedic and Trauma Surgery, Fidenza Hospital, Via Tincati, Fidenza, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Del Buono
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Osti
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Ferrara, S.Anna Hospital, Via Aldo Moro, Ferrara, Italy.
authors.forename: Leo
authors.initials: L
authors.lastname: Massari
authors.affiliation: Department of Trauma and Orthopaedic Surgery, University of Salerno, Italy.|Centre for Sports and Exercise Medicine Queen Mary University of London Barts and The London School of Medicine and Dentistry, Mile End Hospital London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
mesh_terms: D017209:Apoptosis / Q000502:physiology*; D006801:Humans; D000070636:Rotator Cuff Injuries / Q000209:etiology* / Q000517:prevention & control; D012421:Rupture / Q000209:etiology
keywords: apoptosis; rotator cuff; shoulder; tendinopathy; tendons; tenocytes