Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jun 11:9:657584.
doi: 10.3389/fbioe.2021.657584. eCollection 2021.

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

Cheng Zhang  1   2 , Jun Wu  1 , Xiang Li  1 , Zejin Wang  1 , Weijia William Lu  1   2   3 , Tak-Man Wong  1   2
Affiliations
Review

Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair

Cheng Zhang et al. Front Bioeng Biotechnol. .

Abstract

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.

Keywords: exosomes; growth factor; platelet-rich plasma; rotator cuff repair; stem cell; tendon healing.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Anatomy of rotator cuff (Micallef et al., 2019).
FIGURE 2
FIGURE 2
Supraspinatus tendon-bone interface structure. T, supraspinatus tendon; E, enthesis; B, humeral bone; A, acromion (Bianco et al., 2019).
FIGURE 3
FIGURE 3
Diagram of rotator cuff injury (Craig et al., 2017).
FIGURE 4
FIGURE 4
Arthroscopic-assisted rotator cuff repair surgery (RC, rotator cuff) (Sheean et al., 2019). (A) Posterior subacromial viewing portal. (B) Lateral subacromial viewing portal.
FIGURE 5
FIGURE 5
(a) Venous blood without centrifugation. (b) Blood contents centrifuged and the upper content is platelet-rich plasma and lower is red blood cells. (c) Platelet-rich plasma isolated from blood contents (Charles et al., 2018).
FIGURE 6
FIGURE 6
Injecting platelet-rich plasma into the repair site (Ersen et al., 2014).
FIGURE 7
FIGURE 7
Inflammation, repair, and remodeling stages are three main stages in rotator cuff repair. All kinds of growth factors play an important role in the repair process (Gulotta and Rodeo, 2009).
FIGURE 8
FIGURE 8
Stem cells can be combined with biomimetic scaffolds and then implanted into injured site for rotator cuff repair (Bianco et al., 2019). (A) Biomimetic Scaffold. (B) Stem/Progenitor Cells. (C) Stem Cells Embedded in a Biomimetic Scaffold.
FIGURE 9
FIGURE 9
Cellular niche of tendon tissue. Tenocytes and relative stem cells can be found in the tendon (Costa-Almeida et al., 2019).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Abu-Bakr E., Abu-Ahmed H., Elblehi S., El-Kammar M., Abdelwahed R. (2020). Platelet-rich plasma (PRP) vs propolis for cutaneous equine wound healing. Alex. J. Vet. Sci. 64 69–75. 10.5455/ajvs.67207 - DOI
    1. Arnoczky S. P., Lavagnino M., Egerbacher M. J. (2007). The mechanobiological aetiopathogenesis of tendinopathy: is it the over-stimulation or the under-stimulation of tendon cells? Int. J. Exp. Pathol. 88 217–226. 10.1111/j.1365-2613.2007.00548.x - DOI - PMC - PubMed
    1. Asmar G., Goubier J. N., Falcone M. (2020). Improving the detection of subscapularis tears using a specific transverse CT arthrography image. Orthop. Traumatol. 106 1107–1111. 10.1016/j.otsr.2020.04.016 - DOI - PubMed
    1. Awad H. A., Boivin G. P., Dressler M. R., Smith F. N., Young R. G., Butler D. L. (2003). Repair of patellar tendon injuries using a cell–collagen composite. J. Orthop. Res. 21 420–431. 10.1016/s0736-0266(02)00163-8 - DOI - PubMed
    1. Baldwin M., Nagra N., Greenall G., Carr A. J., Beard D., Rees J., et al. (2020). Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis. BMJ Open 10:e039552. 10.1136/bmjopen-2020-039552 - DOI - PMC - PubMed

LinkOut - more resources