Special issue on rotator cuff biology and healingCytokines in rotator cuff degeneration and repair
Section snippets
Pathogenesis of tendinopathy
The pathogenesis of rotator cuff tendinopathy is multifactorial and reflects a combination of mechanical and biologic factors. Rotator cuff tendinosis may be secondary to disorganization in collagen fibril morphology and tendon ultrastructure. Prior studies have documented the histopathologic changes associated with rotator cuff tendinopathy, including loss of cellularity, thinning and disorganization of tendon fibers, increased granulation tissue, and fibrocartilaginous changes.17, 27, 55
Rotator cuff repair and tendon-to-bone healing
Rotator cuff healing occurs by reactive scar formation rather than by regeneration of a histologically normal enthesis (Fig. 1). The overall structure, composition, and organization of a normal insertion site with transition from unmineralized fibrocartilage to mineralized fibrocartilage and bone is not achieved. The poor healing response is multifactorial but likely relates to insufficient and disorganized expression of cytokines to direct formation of the complex structure and composition of
Role of specific cytokines in rotator cuff tendon-to-bone repair
Given the complex cascade of cellular and molecular signals at the healing tendon–bone interface, attention has turned toward methods to augment the biologic response after rotator cuff repair surgery. Because cytokines play important roles in cell chemotaxis, proliferation, matrix synthesis, and cell differentiation, these molecules have the potential to improve rotator cuff tendon healing via autocrine and paracrine signaling. The healing process is a carefully timed and organized event
Conclusion
Improved understanding of the biology of tendon–bone healing has led to the application of specific cytokines to treat tendinopathy and augment healing after rotator cuff repair surgery. Improved healing with cytokines depends on the dosage, timing, and delivery vehicle used, and a multifactorial approach will likely be needed to optimize the healing environment. Osteoinductive cytokines can improve bone formation at the healing tendon–bone interface. BMP-12, BMP-13, and BMP-14 increase
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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2021, Bioactive MaterialsCitation Excerpt :Growth factors are vital for cell proliferation, differentiation, recruitment and ECM synthesis during the healing process [10]. The enthesis healing process is a carefully-timed and organized event involving multiple factors [95]. To apply growth factors in tissue engineering, the most important challenge is the utilization of optimal factors and appropriate delivery vehicles that deliver factors to the repair site for a relevant period with suitable concentrations [16,30].
Institutional Review Board approval was not applicable for this article.