Special issue on rotator cuff biology and healingCell- and gene-based approaches to tendon regeneration
Section snippets
Tendon healing
Healing of the rotator cuff or flexor tendons in most locations goes through the traditional phases of an initial inflammatory response, characterized by acute inflammation, with accumulation of hemorrhage and leukocytes, local synthesis of bioactive and chemotactic factors, and the stimulation of angiogenesis.53 These culminate in the initiation of tenocyte proliferation, migration of tenocytes into the wound, and an increased synthesis of collagen and vascular structures to form immature
Treatment methods
Depending on the results of physical examination, radiographs, and magnetic resonance imaging (MRI) examination, initial therapy is often nonsurgical, including rest and modifications to shoulder action, and use of nonsteroidal anti-inflammatory drugs. This if often followed by corticosteroid injections, physical therapy, and surface-acting agents, such as extracorporeal shockwave therapy, pulsed magnetic therapy, laser phototherapy, deep ultrasound therapy, and muscle stimulation. Failures in
Current strategies for rotator cuff repair
Primary repair of rotator cuff injury often results in inadequate strength of the repair or limited mobility. Cell implantation, growth factor injections or depot composites, and gene-enhanced cell therapy aim to improve the quality and mechanical function of rotator cuff repair. Relying on native intrinsic and extrinsic repair systems lends itself well to augmented repair with biologic scaffolds with or without the addition of growth factors.53, 61, 62
Future directions
Repair of Achilles tendon rupture and rotator cuff tears in experimental models has been significantly improved by the use of enhanced biologic approaches. Most evidence indicates that cultured bone marrow–derived MSCs will not be particularly useful as a standalone supplement to debridement and suture repair of the affected tendon at the tendon-bone interface. The use of a scaffold as a carrier vehicle, as well as the use of stem cells as transport vectors for local anabolic and
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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2019, Acta BiomaterialiaCitation Excerpt :Fibrin scaffolds have also been employed as three-dimensional matrices containing growth factors and embryonic stem cells prone to differentiate into neurons in animal models of spinal cord injury [18]. Tendon regeneration and bone-tendon junction repair have also been accelerated in animal models after the application of mesenchymal stem cells engrafted in fibrin matrices [19]. Accelerated healing of acute and chronic non-healing cutaneous wounds has been achieved in patients treated with fibrin-based sprays containing autologous mesenchymal stem cells [20].
Autologous Conditioned Plasma for tendon healing following arthroscopic rotator cuff repair. Prospective comparative assessment with magnetic resonance arthrography at 6 months’ follow-up
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Institutional review board: not applicable (review article).