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. 2014 Jul;6(4):348-55.
doi: 10.1177/1941738113512261.

Therapeutic approaches to skeletal muscle repair and healing

Natalie R Danna  1 , Bryan G Beutel  1 , Kirk A Campbell  1 , Joseph A Bosco 3rd  1
Affiliations

Therapeutic approaches to skeletal muscle repair and healing

Natalie R Danna et al. Sports Health. 2014 Jul.

Abstract

Context: Skeletal muscle is comprised of a highly organized network of cells, neurovascular structures, and connective tissue. Muscle injury is typically followed by a well-orchestrated healing response that consists of the following phases: inflammation, regeneration, and fibrosis. This review presents the mechanisms of action and evidence supporting the effectiveness of various traditional and novel therapies at each phase of the skeletal muscle healing process.

Evidence acquisition: Relevant published articles were identified using MEDLINE (1978-2013).

Study design: Clinical review.

Level of evidence: Level 3.

Results: To facilitate muscle healing, surgical techniques involving direct suture repair, as well as the implantation of innovative biologic scaffolds, have been developed. Nonsteroidal anti-inflammatory drugs may be potentially supplanted by nitric oxide and curcumin in modulating the inflammatory pathway. Studies in muscle regeneration have identified stem cells, myogenic factors, and β-agonists capable of enhancing the regenerative capabilities of injured tissue. Furthermore, transforming growth factor-β1 (TGF-β1) and, more recently, myostatin and the rennin-angiotensin system have been implicated in fibrous tissue formation; several antifibrotic agents have demonstrated the ability to disrupt these systems.

Conclusion: Effective repair of skeletal muscle after severe injury is unlikely to be achieved with a single intervention. For full functional recovery of muscle there is a need to control inflammation, stimulate regeneration, and limit fibrosis.

Strength-of-recommendation taxonomy sort: B.

Keywords: injury; repair; skeletal muscle.

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Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this manuscript.

Figures

Figure 1.
Figure 1.
Phases of skeletal muscle healing. These general phases are precipitated by a variety of cell types, cytokines, and growth factors, ultimately leading to muscle regeneration and fibrosis. TNFα, tumor necrosis factor α; EGF, epidermal growth factor; PDGF, platelet-derived growth factor; TGF-β1, transforming growth factor-β1.
See this image and copyright information in PMC

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