Skip to main content

Advertisement

SpringerLink
Log in

The Role of Biologic Therapy in Rotator Cuff Tears and Repairs

  • Rotator Cuff Repair (M Tao and M Teusink, section editors)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review was to establish the foundation of the major biologic adjuvants to rotator cuff repairs and review recent scientific findings.

Recent Findings

Platelet-rich plasma (PRP) overall has no significant impact on functional outcomes and repair integrity, but may be more advantageous in small to medium tears. Further studies should focus on leukocyte-rich versus poor preparations and the use of PRP in patients that are high risk for repair failure. Biologic and synthetic patches or augments provide mechanical stability for large and massive rotator cuff tears and decrease re-tear rates. Mesenchymal stem cells have demonstrated improved healing rates without an impact on outcomes. Cytokines and growth factors show promise in animal models, but require human trials to further evaluate.

Summary

In massive or revision repairs, allograft or synthetic patch augmentation should be considered. Platelet-rich plasma may have benefit in smaller tears. Further studies are needed to evaluate the value of mesenchymal stem cells and various cytologic chemical signals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006;88(8):1699–704. https://doi.org/10.2106/JBJS.E.00835.

    Article  PubMed  Google Scholar 

  2. Mather RC 3rd, Koenig L, Acevedo D, Dall TM, Gallo P, Romeo A, et al. The societal and economic value of rotator cuff repair. J Bone Joint Surg Am. 2013;95(22):1993–2000. https://doi.org/10.2106/JBJS.L.01495.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lafosse L, Brozska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am. 2007;89(7):1533–41. https://doi.org/10.2106/JBJS.F.00305.

    PubMed  Google Scholar 

  4. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86-A(2):219–24.

    Article  PubMed  Google Scholar 

  5. Derwin KA, Badylak SF, Steinmann SP, Iannotti JP. Extracellular matrix scaffold devices for rotator cuff repair. J Shoulder Elb Surg. 2010;19(3):467–76. https://doi.org/10.1016/j.jse.2009.10.020.

    Article  Google Scholar 

  6. Slabaugh MA, Nho SJ, Grumet RC, Wilson JB, Seroyer ST, Frank RM, et al. Does the literature confirm superior clinical results in radiographically healed rotator cuffs after rotator cuff repair? Arthroscopy. 2010;26(3):393–403. https://doi.org/10.1016/j.arthro.2009.07.023.

    Article  PubMed  Google Scholar 

  7. Kim KC, Shin HD, Lee WY. Repair integrity and functional outcomes after arthroscopic suture-bridge rotator cuff repair. J Bone Joint Surg Am. 2012;94(8):e48. https://doi.org/10.2106/JBJS.K.00158.

    Article  PubMed  Google Scholar 

  8. Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am. 2014;96(4):265–71. https://doi.org/10.2106/JBJS.M.00265.

    Article  PubMed  Google Scholar 

  9. Verma NN, Bhatia S, Baker CL 3rd, Cole BJ, Boniquit N, Nicholson GP, et al. Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older. Arthroscopy. 2010;26(10):1273–80. https://doi.org/10.1016/j.arthro.2010.01.031.

    Article  PubMed  Google Scholar 

  10. Tashjian RZ, Hollins AM, Kim HM, Teefey SA, Middleton WD, Steger-May K, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38(12):2435–42. https://doi.org/10.1177/0363546510382835.

    Article  PubMed  Google Scholar 

  11. Angeline ME, Dines JS. Factors affecting the outcome of rotator cuff surgery. In: Nicholson GP, editor. Orthopaedic knowledge update 4: shoulder and elbow. Rosemont: American Academy of Orthopaedic Surgeons; 2013. p. 217–28.

    Google Scholar 

  12. Garbis N, Romeo AA, Van Thiel G, Ghodadra N, Provencher MT, Cole BJ, et al. Clinical indications and techniques for the use of platelet-rich plasma in the shoulder. Oper Tech Sports Med. 2011;19(3):165–9. https://doi.org/10.1053/j.otsm.2011.03.002.

    Article  Google Scholar 

  13. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012;28(3):429–39. https://doi.org/10.1016/j.arthro.2011.10.018.

    Article  PubMed  Google Scholar 

  14. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39(10):2135–40. https://doi.org/10.1177/0363546511417792.

    Article  PubMed  Google Scholar 

  15. Kesikburun S, Tan AK, Yilmaz B, Yasar E, Yazicioglu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609–16. https://doi.org/10.1177/0363546513496542.

    Article  PubMed  Google Scholar 

  16. • Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surg Sports Traumatol Arthrosc. 2016; Meta-analysis of the effect of PRP on tendinopathy including 32 studies investigating rotator cuff pathology. They found no significant difference in non-operative outcomes between single and multiple injection protocols.

  17. Zhang JY, Fabricant PD, Ishmael CR, Wang JC, Petrigliano FA, Jones KJ. Utilization of platelet-rich plasma for musculoskeletal injuries: an analysis of current treatment trends in the United States. Orthop J Sports Med. 2016;4(12):2325967116676241. https://doi.org/10.1177/2325967116676241.

    Article  PubMed  PubMed Central  Google Scholar 

  18. • Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016;26(8):837–42. Randomized control trial comparing PRP and corticosteroid for non-operative treatment of partial rotator cuff tears. Both groups improved and the PRP group showed superior VAS, ASES, SST and Constant-Murley scores at 12 weeks, although no difference between groups was noted at 6 months. https://doi.org/10.1007/s00590-016-1826-3.

    Article  PubMed  Google Scholar 

  19. Cross JA, Cole BJ, Spatny KP, Sundman E, Romeo AA, Nicholson GP, et al. Leukocyte-reduced platelet-rich plasma normalizes matrix metabolism in torn human rotator cuff tendons. Am J Sports Med. 2015;43(12):2898–906. https://doi.org/10.1177/0363546515608157.

    Article  PubMed  Google Scholar 

  20. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elb Surg. 2011;20(4):518–28. https://doi.org/10.1016/j.jse.2011.02.008.

    Article  Google Scholar 

  21. Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, et al. Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med. 2011;39(2):258–65. https://doi.org/10.1177/0363546510390780.

    Article  PubMed  Google Scholar 

  22. Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD. Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. Am J Sports Med. 2013;41(2):263–70. https://doi.org/10.1177/0363546512467621.

    Article  PubMed  Google Scholar 

  23. Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med. 2012;40(6):1234–41. https://doi.org/10.1177/0363546512442924.

    Article  PubMed  Google Scholar 

  24. Chahal J, Van Thiel GS, Mall N, Heard W, Bach BR, Cole BJ, et al. The role of platelet-rich plasma in arthroscopic rotator cuff repair: a systematic review with quantitative synthesis. Arthroscopy. 2012;28(11):1718–27. https://doi.org/10.1016/j.arthro.2012.03.007.

    Article  PubMed  Google Scholar 

  25. • Warth RJ, Dornan GJ, James EW, Horan MP, Millett PJ. Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression. Arthroscopy. 2015;31(2):306–20. Meta-analysis investigating the effect of PRP augmentation on rotator cuff repairs. They found no significant difference overall but on sub-group analysis found a significantly decreased re-tear rate in tears greater than 3cm. https://doi.org/10.1016/j.arthro.2014.09.007.

    Article  PubMed  Google Scholar 

  26. Bergeson AG, Tashjian RZ, Greis PE, Crim J, Stoddard GJ, Burks RT. Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears. Am J Sports Med. 2012;40(2):286–93. https://doi.org/10.1177/0363546511424402.

    Article  PubMed  Google Scholar 

  27. • Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2015;43(9):2102–10. Randomized control trial comparing rotator cuff repair with PRP versus repair alone in medium to large rotator cuff tears showing a significantly lower re-tear rate in the PRP groupl. https://doi.org/10.1177/0363546515587081.

    Article  PubMed  Google Scholar 

  28. Malavolta EA, Gracitelli ME, Ferreira Neto AA, Assuncao JH, Bordalo-Rodrigues M, de Camargo OP. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med. 2014;42(10):2446–54. https://doi.org/10.1177/0363546514541777.

    Article  PubMed  Google Scholar 

  29. Barber FA. Triple-loaded single-row versus suture-bridge double-row rotator cuff tendon repair with platelet-rich plasma fibrin membrane: a randomized controlled trial. Arthroscopy. 2016;32(5):753–61. https://doi.org/10.1016/j.arthro.2015.11.020.

    Article  PubMed  Google Scholar 

  30. • D'Ambrosi R, Palumbo F, Paronzini A, Ragone V, Facchini RM. Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial. Musculoskelet Surg. 2016;100(Suppl 1):25–32. Randomized clincal trial comparing repair with PRP versus repair alone in full thickness rotator cuff repairs showing that PRP reduced pain in short term, but made no difference in re-tear rate or functional outcomes. https://doi.org/10.1007/s12306-016-0415-2.

    Article  PubMed  Google Scholar 

  31. Holtby R, Christakis M, Maman E, MacDermid JC, Dwyer T, Athwal GS, et al. Impact of platelet-rich plasma on arthroscopic repair of small- to medium-sized rotator cuff tears: a randomized controlled trial. Orthop J Sports Med. 2016;4(9):2325967116665595. https://doi.org/10.1177/2325967116665595.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Flury M, Rickenbacher D, Schwyzer HK, Jung C, Schneider MM, Stahnke K, et al. Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair? A randomized controlled trial. Am J Sports Med. 2016;44(8):2136–46. https://doi.org/10.1177/0363546516645518.

    Article  PubMed  Google Scholar 

  33. Zumstein MA, Rumian A, Thelu CE, Lesbats V, O'Shea K, Schaer M, et al. SECEC research grant 2008 II: use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study. J Shoulder Elb Surg. 2016;25(1):2–11. https://doi.org/10.1016/j.jse.2015.09.018.

    Article  Google Scholar 

  34. Wang A, McCann P, Colliver J, Koh E, Ackland T, Joss B, et al. Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair? A randomized controlled trial. Am J Sports Med. 2015;43(6):1430–7. https://doi.org/10.1177/0363546515572602.

    Article  PubMed  Google Scholar 

  35. Ebert JR, Wang A, Smith A, Nairn R, Breidahl W, Zheng MH, et al. A Midterm Evaluation of Postoperative Platelet-Rich Plasma Injections on Arthroscopic Supraspinatus Repair: A Randomized Contreolled Trial. Am J Sports Med 2017;45(13):2965–74. Randomized control trial comparing rotator cuff repair with post-operative PRP injections versus repair alone. PRP post-operative injections improved abduction strength, but otherwise provided no other functional improvement or benefit to tendon integrity.

  36. • Cai YZ, Zhang C, Lin XJ. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. J Shoulder Elb Surg. 2015;24(12):1852–9. Meta-analysis including 7 randomized control trials showing no significant benefit overall of PRP in rotator cuff repairs, however, sub-analysis showed significant decrease in re-tear rates in small to medium tears. https://doi.org/10.1016/j.jse.2015.07.035.

    Article  Google Scholar 

  37. • Saltzman BM, Jain A, Campbell KA, Mascarenhas R, Romeo AA, Verma NN, et al. Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses. Arthroscopy. 2016;32(5):906–18. Systematic review of 7 meta-analyses showing no benefit of PRP on rotator cuff repair in terms of functional outcomes or repair integrity. https://doi.org/10.1016/j.arthro.2015.10.007.

    Article  PubMed  Google Scholar 

  38. Vavken P, Sadoghi P, Palmer M, Rosso C, Mueller AM, Szoelloesy G, et al. Platelet-rich plasma reduces Retear rates after arthroscopic repair of small- and medium-sized rotator cuff tears but is not cost-effective. Am J Sports Med. 2015;43(12):3071–6. https://doi.org/10.1177/0363546515572777.

    Article  PubMed  Google Scholar 

  39. Samuelson EM, Odum SM, Fleischli JE. The cost-effectiveness of using platelet-rich plasma during rotator cuff repair: a Markov model analysis. Arthroscopy. 2016;32(7):1237–44. https://doi.org/10.1016/j.arthro.2015.12.018.

    Article  PubMed  Google Scholar 

  40. Rodeo SA. Biologic augmentation of rotator cuff tendon repair. J Shoulder Elb Surg. 2007;16(5 Suppl):S191–7. https://doi.org/10.1016/j.jse.2007.03.012.

    Article  Google Scholar 

  41. Adams JE, Zobitz ME, Reach JS Jr, An KN, Steinmann SP. Rotator cuff repair using an acellular dermal matrix graft: an in vivo study in a canine model. Arthroscopy. 2006;22(7):700–9. https://doi.org/10.1016/j.arthro.2006.03.016.

    Article  PubMed  Google Scholar 

  42. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S. Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elb Surg. 2004;13(5):538–41. https://doi.org/10.1016/j.jse.2004.03.005.

    Article  Google Scholar 

  43. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(6):1238–44. https://doi.org/10.2106/JBJS.E.00524.

    Article  PubMed  Google Scholar 

  44. Walton JR, Bowman NK, Khatib Y, Linklater J, Murrell GA. Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs. J Bone Joint Surg Am. 2007;89(4):786–91. https://doi.org/10.2106/JBJS.F.00315.

    PubMed  Google Scholar 

  45. Gilbert TW, Freund JM, Badylak SF. Quantification of DNA in biologic scaffold materials. J Surg Res. 2009;152(1):135–9. https://doi.org/10.1016/j.jss.2008.02.013.

    Article  CAS  PubMed  Google Scholar 

  46. Badhe SP, Lawrence TM, Smith FD, Lunn PG. An assessment of porcine dermal xenograft as an augmentation graft in the treatment of extensive rotator cuff tears. J Shoulder Elb Surg. 2008;17(1 Suppl):35S–9S. https://doi.org/10.1016/j.jse.2007.08.005.

    Article  Google Scholar 

  47. Cho CH, Lee SM, Lee YK, Shin HK. Mini-open suture bridge repair with porcine dermal patch augmentation for massive rotator cuff tear: surgical technique and preliminary results. Clin Orthop Surg. 2014;6(3):329–35. https://doi.org/10.4055/cios.2014.6.3.329.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Gupta AK, Hug K, Boggess B, Gavigan M, Toth AP. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft. Am J Sports Med. 2013;41(4):872–9. https://doi.org/10.1177/0363546512475204.

    Article  PubMed  Google Scholar 

  49. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy. 2008;24(4):403–409.e1. https://doi.org/10.1016/j.arthro.2007.07.033.

    Article  PubMed  Google Scholar 

  50. Wong I, Burns J, Snyder S. Arthroscopic GraftJacket repair of rotator cuff tears. J Shoulder Elb Surg. 2010;19(2 Suppl):104–9. https://doi.org/10.1016/j.jse.2009.12.017.

    Article  Google Scholar 

  51. Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC, et al. Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med. 2012;40(1):141–7. https://doi.org/10.1177/0363546511422795.

    Article  PubMed  Google Scholar 

  52. Barber FA, Burns JP, Deutsch A, Labbe MR, Litchfield RB. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy. 2012;28(1):8–15. https://doi.org/10.1016/j.arthro.2011.06.038.

    Article  PubMed  Google Scholar 

  53. • Smith RDJ, Zargar N, Brown CP, Nagra NS, Dakin SG, Snelling SJB, et al. Characterizing the macro and micro mechanical properties of scaffolds for rotator cuff repair. J Shoulder Elbow Surg 2017. Characterized the mechanical properties of available scaffolds and none matched the mechanics of the supraspinatus tendon.

  54. Arnoczky SP, Bishai SK, Schofield B, Sigman S, Bushnell BD, Hommen JP, et al. Histologic evaluation of biopsy specimens obtained after rotator cuff repair augmented with a highly porous collagen implant. Arthroscopy. 2017;33(2):278–83. https://doi.org/10.1016/j.arthro.2016.06.047.

    Article  PubMed  Google Scholar 

  55. Beitzel K, McCarthy MB, Cote MP, Russell RP, Apostolakos J, Ramos DM, et al. Properties of biologic scaffolds and their response to mesenchymal stem cells. Arthroscopy. 2014;30(3):289–98. https://doi.org/10.1016/j.arthro.2013.11.020.

    Article  PubMed  Google Scholar 

  56. Voss A, McCarthy MB, Hoberman A, Cote MP, Imhoff AB, Mazzocca AD, et al. Extracellular matrix of current biological scaffolds promotes the differentiation potential of mesenchymal stem cells. Arthroscopy. 2016;32(11):2381–2392.e1. https://doi.org/10.1016/j.arthro.2016.04.033.

    Article  PubMed  Google Scholar 

  57. • Consigliere P, Polyzois I, Sarkhel T, Gupta R, Levy O, Narvani AA. Preliminary results of a consecutive series of large & massive rotator cuff tears treated with arthroscopic rotator cuff repairs augmented with extracellular matrix. Arch Bone Jt Surg. 2017;5(1):14–21. Case series investigating primary repair of large and massive rotator cuff tears augmented with an extracellular matrix. The results showed significant pain reduction and improved function at 7-month follow-up.

    PubMed  PubMed Central  Google Scholar 

  58. • Petri M, Warth RJ, Horan MP, Greenspoon JA, Millett PJ. Outcomes after open revision repair of massive rotator cuff tears with biologic patch augmentation. Arthroscopy. 2016;32(9):1752–60. Case series investigating the use of an acellular dermal patch for use in revision repair of massive rotator cuff tears showing significant functional improvement and high patient satisfaction. https://doi.org/10.1016/j.arthro.2016.01.037.

    Article  PubMed  Google Scholar 

  59. Sears BW, Choo A, Yu A, Greis A, Lazarus M. Clinical outcomes in patients undergoing revision rotator cuff repair with extracellular matrix augmentation. Orthopedics. 2015;38(4):e292–6. https://doi.org/10.3928/01477447-20150402-57.

    Article  PubMed  Google Scholar 

  60. Gilot GJ, Alvarez-Pinzon AM, Barcksdale L, Westerdahl D, Krill M, Peck E. Outcome of large to massive rotator cuff tears repaired with and without extracellular matrix augmentation: a prospective comparative study. Arthroscopy. 2015;31(8):1459–65. https://doi.org/10.1016/j.arthro.2015.02.032.

    Article  PubMed  Google Scholar 

  61. • Steinhaus ME, Makhni EC, Cole BJ, Romeo AA, Verma NN. Outcomes after patch use in rotator cuff repair. Arthroscopy. 2016;32(8):1676–90. Meta-analysis investigating the results of patch augmented rotator cuff repairs showing significant functional improvement. This analysis confirmed the superiority of results with allografts compared to xenografts. https://doi.org/10.1016/j.arthro.2016.02.009.

    Article  PubMed  Google Scholar 

  62. • Ferguson DP, Lewington MR, Smith TD, Wong IH. Graft utilization in the augmentation of large-to-massive rotator cuff repairs: a systematic review. Am J Sports Med. 2016;44(11):2984–92. Systematic review investigating rotator cuff repair with allograft augmentation showing significantly higher repair integrity at final follow-up compared to repair alone. https://doi.org/10.1177/0363546515624463.

    Article  PubMed  Google Scholar 

  63. Ono Y, Davalos Herrera DA, Woodmass JM, Boorman RS, Thornton GM, Lo IK. Can grafts provide superior tendon healing and clinical outcomes after rotator cuff repairs?: a meta-analysis. Orthop J Sports Med. 2016;4(12):2325967116674191. https://doi.org/10.1177/2325967116674191.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Gillespie RJ, Knapik DM, Akkus O. Biologic and synthetic grafts in the reconstruction of large to massive rotator cuff tears. J Am Acad Orthop Surg. 2016;24(12):823–8. https://doi.org/10.5435/JAAOS-D-15-00229.

    Article  PubMed  Google Scholar 

  65. McCormack RA, Shreve M, Strauss EJ. Biologic augmentation in rotator cuff repair--should we do it, who should get it, and has it worked? Bull Hosp Jt Dis (2013). 2014;72(1):89–96.

    Google Scholar 

  66. Cole BJ, Gomoll AH, Yanke A, Pylawka T, Lewis P, Macgillivray JD, et al. Biocompatibility of a polymer patch for rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2007;15(5):632–7. https://doi.org/10.1007/s00167-006-0187-6.

    Article  PubMed  Google Scholar 

  67. Derwin KA, Codsi MJ, Milks RA, Baker AR, McCarron JA, Iannotti JP. Rotator cuff repair augmentation in a canine model with use of a woven poly-L-lactide device. J Bone Joint Surg Am. 2009;91(5):1159–71. https://doi.org/10.2106/JBJS.H.00775.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Proctor CS. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elb Surg. 2014;23(10):1508–13. https://doi.org/10.1016/j.jse.2014.01.010.

    Article  Google Scholar 

  69. Encalada-Diaz I, Cole BJ, Macgillivray JD, Ruiz-Suarez M, Kercher JS, Friel NA, et al. Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months' follow-up. J Shoulder Elb Surg. 2011;20(5):788–94. https://doi.org/10.1016/j.jse.2010.08.013.

    Article  Google Scholar 

  70. Nada AN, Debnath UK, Robinson DA, Jordan C. Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation: clinical outcome. J Bone Joint Surg Br. 2010;92(10):1397–402. https://doi.org/10.1302/0301-620X.92B10.24299.

    Article  CAS  PubMed  Google Scholar 

  71. Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med. 2014;42(5):1169–75. https://doi.org/10.1177/0363546514525592.

    Article  PubMed  Google Scholar 

  72. Depres-Tremblay G, Chevrier A, Snow M, Hurtig MB, Rodeo S, Buschmann MD. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development. J Shoulder Elb Surg. 2016;25(12):2078–85. https://doi.org/10.1016/j.jse.2016.06.009.

    Article  Google Scholar 

  73. Snyder SJ, Burns J. Rotator cuff healing and the bone marrow “crimson duvet” from clinical observations to science. Tech Should Surg. 2009;10(4):130–7. https://doi.org/10.1097/BTE.0b013e3181c2a940.

    Article  Google Scholar 

  74. Kida Y, Morihara T, Matsuda K, Kajikawa Y, Tachiiri H, Iwata Y, et al. Bone marrow-derived cells from the footprint infiltrate into the repaired rotator cuff. J Shoulder Elb Surg. 2013;22(2):197–205. https://doi.org/10.1016/j.jse.2012.02.007.

    Article  Google Scholar 

  75. Gulotta LV, Kovacevic D, Ehteshami JR, Dagher E, Packer JD, Rodeo SA. Application of bone marrow-derived mesenchymal stem cells in a rotator cuff repair model. Am J Sports Med. 2009;37(11):2126–33. https://doi.org/10.1177/0363546509339582.

    Article  PubMed  Google Scholar 

  76. Tornero-Esteban P, Hoyas JA, Villafuertes E, Rodriguez-Bobada C, Lopez-Gordillo Y, Rojo FJ, et al. Efficacy of supraspinatus tendon repair using mesenchymal stem cells along with a collagen I scaffold. J Orthop Surg Res 2015;10:124-015-0269-6.

  77. Thangarajah T, Sanghani-Kerai A, Henshaw F, Lambert SM, Pendegrass CJ, Blunn GW. Application of a Demineralized Cortical Bone Matrix and Bone Marrow-Derived Mesenchymal Stem Cells in a Model of Chronic Rotator Cuff Degeneration. Am J Sports Med 2017;46(1):98–108.

  78. • Hernigou P, Flouzat Lachaniette CH, Delambre J, Zilber S, Duffiet P, Chevallier N, et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014;38(9):1811–8. Case control study investigating rotator cuff repair augmented with mesenchymal stem cells from bone marrow aspiration compared to repair alone. The stem cell augmented repair group showed 100% intact repairs versus 67% at 6 month follow-up and 87% versus 44% at 10 years. https://doi.org/10.1007/s00264-014-2391-1.

    Article  PubMed  Google Scholar 

  79. Kim YS, Sung CH, Chung SH, Kwak SJ, Koh YG. Does an injection of adipose-derived mesenchymal stem cells loaded in fibrin glue influence rotator cuff repair outcomes? A clinical and magnetic resonance imaging study. Am J Sports Med. 2017;45(9):2010–8. https://doi.org/10.1177/0363546517702863.

    Article  PubMed  Google Scholar 

  80. Seeherman HJ, Archambault JM, Rodeo SA, Turner AS, Zekas L, D'Augusta D, et al. rhBMP-12 accelerates healing of rotator cuff repairs in a sheep model. J Bone Joint Surg Am. 2008;90(10):2206–19. https://doi.org/10.2106/JBJS.G.00742.

    Article  PubMed  Google Scholar 

  81. Rodeo SA, Potter HG, Kawamura S, Turner AS, Kim HJ, Atkinson BL. Biologic augmentation of rotator cuff tendon-healing with use of a mixture of osteoinductive growth factors. J Bone Joint Surg Am. 2007;89(11):2485–97. https://doi.org/10.2106/JBJS.C.01627.

    PubMed  Google Scholar 

  82. Kovacevic D, Fox AJ, Bedi A, Ying L, Deng XH, Warren RF, et al. Calcium-phosphate matrix with or without TGF-beta3 improves tendon-bone healing after rotator cuff repair. Am J Sports Med. 2011;39(4):811–9. https://doi.org/10.1177/0363546511399378.

    Article  PubMed  Google Scholar 

  83. Manning CN, Kim HM, Sakiyama-Elbert S, Galatz LM, Havlioglu N, Thomopoulos S. Sustained delivery of transforming growth factor beta three enhances tendon-to-bone healing in a rat model. J Orthop Res. 2011;29(7):1099–105. https://doi.org/10.1002/jor.21301.

    Article  CAS  PubMed  Google Scholar 

  84. Gotoh M, Mitsui Y, Shibata H, Yamada T, Shirachi I, Nakama K, et al. Increased matrix metalloprotease-3 gene expression in ruptured rotator cuff tendons is associated with postoperative tendon retear. Knee Surg Sports Traumatol Arthrosc. 2013;21(8):1807–12. https://doi.org/10.1007/s00167-012-2209-x.

    Article  PubMed  Google Scholar 

  85. Bedi A, Fox AJ, Kovacevic D, Deng XH, Warren RF, Rodeo SA. Doxycycline-mediated inhibition of matrix metalloproteinases improves healing after rotator cuff repair. Am J Sports Med. 2010;38(2):308–17. https://doi.org/10.1177/0363546509347366.

    Article  PubMed  Google Scholar 

  86. Gulotta LV, Kovacevic D, Montgomery S, Ehteshami JR, Packer JD, Rodeo SA. Stem cells genetically modified with the developmental gene MT1-MMP improve regeneration of the supraspinatus tendon-to-bone insertion site. Am J Sports Med. 2010;38(7):1429–37. https://doi.org/10.1177/0363546510361235.

    Article  PubMed  Google Scholar 

  87. Hee CK, Dines JS, Dines DM, Roden CM, Wisner-Lynch LA, Turner AS, et al. Augmentation of a rotator cuff suture repair using rhPDGF-BB and a type I bovine collagen matrix in an ovine model. Am J Sports Med. 2011;39(8):1630–9. https://doi.org/10.1177/0363546511404942.

    Article  PubMed  Google Scholar 

  88. Uggen C, Dines J, McGarry M, Grande D, Lee T, Limpisvasti O. The effect of recombinant human platelet-derived growth factor BB-coated sutures on rotator cuff healing in a sheep model. Arthroscopy. 2010;26(11):1456–62. https://doi.org/10.1016/j.arthro.2010.02.025.

    Article  PubMed  Google Scholar 

  89. Ide J, Kikukawa K, Hirose J, Iyama K, Sakamoto H, Fujimoto T, et al. The effect of a local application of fibroblast growth factor-2 on tendon-to-bone remodeling in rats with acute injury and repair of the supraspinatus tendon. J Shoulder Elb Surg. 2009;18(3):391–8. https://doi.org/10.1016/j.jse.2009.01.013.

    Article  Google Scholar 

  90. Ide J, Kikukawa K, Hirose J, Iyama K, Sakamoto H, Mizuta H. The effects of fibroblast growth factor-2 on rotator cuff reconstruction with acellular dermal matrix grafts. Arthroscopy. 2009;25(6):608–16. https://doi.org/10.1016/j.arthro.2008.11.011.

    Article  PubMed  Google Scholar 

  91. Tokunaga T, Karasugi T, Arimura H, Yonemitsu R, Sakamoto H, Ide J, et al. Enhancement of rotator cuff tendon-bone healing with fibroblast growth factor 2 impregnated in gelatin hydrogel sheets in a rabbit model. J Shoulder Elb Surg. 2017;26(10):1708–17. https://doi.org/10.1016/j.jse.2017.03.020.

    Article  Google Scholar 

  92. Tokunaga T, Shukunami C, Okamoto N, Taniwaki T, Oka K, Sakamoto H, et al. FGF-2 stimulates the growth of Tenogenic progenitor cells to facilitate the generation of Tenomodulin-positive tenocytes in a rat rotator cuff healing model. Am J Sports Med. 2015;43(10):2411–22. https://doi.org/10.1177/0363546515597488.

    Article  PubMed  Google Scholar 

  93. Honda H, Gotoh M, Kanazawa T, Ohzono H, Nakamura H, Ohta K, et al. Hyaluronic Acid Accelerates Tendon-to-Bone Healing After Rotator Cuff Repair. Am J Sports Med 2017;45(14):3322–30.

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA

    Michael D. Charles, David R. Christian & Brian J. Cole

  2. Chicago, USA

    Brian J. Cole

Authors
  1. Michael D. Charles
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David R. Christian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian J. Cole
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Conflict of Interest

Brian J. Cole reports other from Aesculap/B.Braun, other from American Journal of Orthopedics, other from American Orthopedic Society for Sports Medicine, other from American Shoulder and Elbow Surgeons, personal fees and other from Arthrex, Inc., other from Arthroscopy, other from Arthroscopy Association of North America, other from Athletico, other from Cytori, other from Elsevier Publishing, other from international Cartilage Repair Society, other from Journal of Bone and Joint Surgery-American, other from Journal of Shoulder and Elbow Surgery, other from Journal of the American Academy of Orthopedic Surgeons, other from National Institutes of Health (NIAMS & NICHD), other from Ossur, personal fees and other from Regentis, other from Saunders/Mosby-Elsevier, other from Smith & Nephew, other from Tornier, outside the submitted work.

The other authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Rotator Cuff Repair

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Charles, M.D., Christian, D.R. & Cole, B.J. The Role of Biologic Therapy in Rotator Cuff Tears and Repairs. Curr Rev Musculoskelet Med 11, 150–161 (2018). https://doi.org/10.1007/s12178-018-9469-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-018-9469-0

Keywords

Search

Navigation