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Biological Augmentation of Rotator Cuff Tendon Repair

  • Symposium: New Approaches to Shoulder Surgery
  • Published:
Clinical Orthopaedics and Related Research

Abstract

A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due to abnormal or insufficient gene expression and/or cell differentiation at the repair site. Techniques to manipulate the biologic events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive growth factors and BMP-12 on tendon-to-bone healing. Magnetic resonance imaging and histology showed increased formation of new bone and fibrocartilage at the healing tendon attachment site in the treated animals, and biomechanical testing showed improved load-to-failure. Other techniques with potential to augment repair site biology include use of platelets isolated from autologous blood to deliver growth factors to a tendon repair site. Modalities that improve local vascularity, such as pulsed ultrasound, have the potential to augment rotator cuff healing. Important information about the biology of tendon healing can also be gained from studies of substances that inhibit healing, such as nicotine and antiinflammatory medications. Future approaches may include the use of stem cells and transcription factors to induce formation of the native tendon-bone insertion site after rotator cuff repair surgery.

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Authors and Affiliations

  1. Laboratory for Soft Tissue Research, The Hospital for Special Surgery, New York, NY, USA

    David Kovacevic BS

  2. Sports Medicine and Shoulder Service, The Hospital for Special Surgery, 525 East 71st St., New York, NY, 10021, USA

    Scott A. Rodeo MD

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  1. David Kovacevic BS
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  2. Scott A. Rodeo MD
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Correspondence to Scott A. Rodeo MD.

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One or more of the authors (SAR) has received funding from Wyeth Research, Inc.

Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Kovacevic, D., Rodeo, S.A. Biological Augmentation of Rotator Cuff Tendon Repair. Clin Orthop Relat Res 466, 622–633 (2008). https://doi.org/10.1007/s11999-007-0112-4

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