The Role of Platelet-Rich Plasma and Growth Factors in Rotator Cuff Repair

Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients’ motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.

Download Full-text

The Role of Platelet Rich Plasma (PRP) and Other Biologics for Rotator Cuff Repair

The Open Orthopaedics Journal ◽

10.2174/1874325001610010309 ◽

2016 ◽

Vol 10 (1) ◽

pp. 309-314 ◽

Cited By ~ 7

Author(s):

Joshua A. Greenspoon ◽

Samuel G. Moulton ◽

Peter J. Millett ◽

Maximilian Petri

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Functional Outcomes ◽

Animal Studies ◽

Platelet Rich Plasma ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Targeted Drug ◽

Cuff Repair

Background: Surgical treatment of rotator cuff tears has consistently demonstrated good clinical and functional outcomes. However, in some cases, the rotator cuff fails to heal. While improvements in rotator cuff constructs and biomechanics have been made, the role of biologics to aid healing is currently being investigated. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: Biologic augmentation of rotator cuff repairs can for example be performed wtableith platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). Clinical results on PRP application have been controversial. Application of MSCs has shown promise in animal studies, but clinical data on its effectiveness is presently lacking. The role of Matrix Metalloproteinase (MMP) inhibitors is another interesting field for potential targeted drug therapy after rotator cuff repair. Conclusions: Large randomized clinical studies need to confirm the benefit of these approaches, in order to eventually lower retear rates and improve clinical outcomes after rotator cuff repair.

Download Full-text

The Role of Platelet-rich Plasma in Rotator Cuff Repair

Sports Medicine and Arthroscopy Review ◽

10.1097/jsa.0b013e318227b2dc ◽

2011 ◽

Vol 19 (3) ◽

pp. 244-250 ◽

Cited By ~ 27

Author(s):

Omer Mei-Dan ◽

Michael R. Carmont

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Platelet Rich Plasma ◽

Cuff Repair

Download Full-text

Predictors of hospital admission after rotator cuff repair: the role of peripheral nerve blockade

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00423 ◽

2013 ◽

Vol 30 ◽

pp. 135-136

Author(s):

O. Stundner ◽

T. Danninger ◽

R. Rasul ◽

M. Mazumdar ◽

P. Gerner ◽

...

Keyword(s):

Rotator Cuff ◽

Peripheral Nerve ◽

Hospital Admission ◽

Rotator Cuff Repair ◽

Nerve Blockade ◽

Peripheral Nerve Blockade ◽

Cuff Repair

Download Full-text

Freeze-dried chitosan-platelet-rich plasma implants improve supraspinatus tendon attachment in a transosseous rotator cuff repair model in the rabbit

Journal of Biomaterials Applications ◽

10.1177/0885328218811386 ◽

2018 ◽

Vol 33 (6) ◽

pp. 792-807 ◽

Cited By ~ 4

Author(s):

Gabrielle Deprés-Tremblay ◽

Anik Chevrier ◽

Martyn Snow ◽

Scott Rodeo ◽

Michael D Buschmann

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Platelet Rich Plasma ◽

Rabbit Model ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Polymorphonuclear Cells ◽

Post Surgery ◽

Freeze Dried ◽

Cuff Repair

Rotator cuff tears result in shoulder pain, stiffness, weakness and loss of motion. After surgical repair, high failure rates have been reported based on objective imaging and it is recognized that current surgical treatments need improvement. The aim of the study was to assess whether implants composed of freeze-dried chitosan (CS) solubilized in autologous platelet-rich plasma (PRP) can improve rotator cuff repair in a rabbit model. Complete tears were created bilaterally in the supraspinatus tendon of New Zealand White rabbits ( n = 4 in a pilot feasibility study followed by n = 13 in a larger efficacy study), which were repaired using transosseous suturing. On the treated side, CS-PRP implants were injected into the transosseous tunnels and the tendon itself, and healing was assessed histologically at time points ranging from one day to two months post-surgery. CS-PRP implants were resident within transosseous tunnels and adhered to tendon surfaces at one day post-surgery and induced recruitment of polymorphonuclear cells from 1 to 14 days. CS-PRP implants improved attachment of the supraspinatus tendon to the humeral head through increased bone remodelling at the greater tuberosity and also inhibited heterotopic ossification of the supraspinatus tendon at two months. In addition, the implants did not induce any detectable deleterious effects. This preliminary study provides the first evidence that CS-PRP implants could be effective in improving rotator cuff tendon attachment in a small animal model.

Download Full-text

Effect of Platelet-Rich Plasma and Amniotic Membrane in Patients with Rotator Cuff Repair

Journal of Biomimetics Biomaterials and Biomedical Engineering ◽

10.4028/www.scientific.net/jbbbe.39.98 ◽

2018 ◽

Vol 39 ◽

pp. 98-102

Author(s):

Heri Suroto ◽

Ameria Pribadi ◽

Dwikora Novembri Utomo ◽

Ferdiansyah Mahyudin ◽

Lukas Widhiyanto

Keyword(s):

Soft Tissue ◽

Rotator Cuff ◽

Pain Score ◽

Amniotic Membrane ◽

Rotator Cuff Repair ◽

Platelet Rich Plasma ◽

Soft Tissue Healing ◽

Disability Score ◽

Tissue Healing ◽

Cuff Repair

Rotator cuff disorders are the most common source of shoulder problems, ranging from mild strain to massive tears. Platelet-rich plasma (PRP), an autologous blood with platelets concentration above baseline values represents a source of multiple growth factors that promotes tissue repair. This review examines the potential of using PRP to augment rotator cuff repair. Reporting 4 patients with impingement syndrome and supraspinatus tear who underwent decompression acromioplasty and supraspinatus repair augmented with platelet-rich plasma and amniotic membrane. An evaluation was made 3-24 months postoperative using Shoulder Pain and Disability Index (SPADI). Average preoperative pain score is 64%, disability score 54.58%, and total score 58.19%. Average postoperative pain score is 0%, disability score 0.42%, and total score 0.26% (Minimum Detectable Change at 90% confidence for pain score is 18%, disability score 13%, and total score 11%). This result is consequent with research by Luoay Fallouh, stating that improvement is caused by growth factor effects in platelet-rich plasma which promotes soft tissue healing. It can be concluded that platelet-rich plasma and amniotic membrane have promising effects to enhance soft tissue healing in patients with rotator cuff syndrome. Shoulder function is restored with no limitation on daily activity and pain is no longer present.

Download Full-text