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Rotator Cuff Tendinopathy: Biologics

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Orthobiologics

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Abstract

Rotator cuff tendinopathy is one of the most common causes of painful shoulder, whose pathoetiology is still poorly defined, but it is surely multifactorial including extrinsic and intrinsic pathogenetic mechanisms. Intrinsic factors, including alterations in biology, mechanical properties, morphology, and vascularity, could explain the rationale for the use of biologics in the treatment of rotator cuff tendinopathy, having demonstrated an influence on tendon morphology and function. Platelet-rich plasma (PRP) has been widely studied either in conservative treatment or in rotator cuff repair. Results of in vitro and in vivo studies are very encouraging, but clinical trials have shown inconsistent evidences, making it difficult to reach definitive conclusions. Similarly, clinical trials with hyaluronic acid (HA) have shown less promising results compared to in vitro and animal studies.

In order to support the routine use in clinical practice of PRP and HA injections for the treatment of rotator cuff tendinopathy, further studies should be performed to clarify the best timing, doses, injection intervals, and type of PRP and HA formulations. Moreover, the promising results obtained with growth factors and cytokines in in vitro and animal studies could allow to better understand the structural and compositional deficiencies of the injured rotator cuff tissue to identify the biological needs and create a targeted injection therapy in the future.

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Authors and Affiliations

  1. Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Pietro Simone Randelli, Chiara Fossati & Alessandra Menon

  2. U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy

    Pietro Simone Randelli, Chiara Fossati, Marianna Vitale, Francesca Pedrini & Alessandra Menon

  3. Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy

    Pietro Simone Randelli

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  1. Pietro Simone Randelli
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  2. Chiara Fossati
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  3. Marianna Vitale
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Editors and Affiliations

  1. Rizzoli Orthopaedic Institute, Bologna, Italy

    Giuseppe Filardo

  2. Orthopaedic & Sports Medicine Group, Santa Monica Orthopaedic & Sports Medicine, Santa Monica, CA, USA

    Bert R. Mandelbaum

  3. Orthopaedic Surgery and Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA

    George F. Muschler

  4. Hospital for Special Surgery, New York, NY, USA

    Scott A. Rodeo

  5. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

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Randelli, P.S., Fossati, C., Vitale, M., Pedrini, F., Menon, A. (2022). Rotator Cuff Tendinopathy: Biologics. In: Filardo, G., Mandelbaum, B.R., Muschler, G.F., Rodeo, S.A., Nakamura, N. (eds) Orthobiologics. Springer, Cham. https://doi.org/10.1007/978-3-030-84744-9_14

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  • DOI: https://doi.org/10.1007/978-3-030-84744-9_14

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