Biologic Treatments for Sports Injuries II Think Tank—Current Concepts, Future Research, and Barriers to Advancement, Part 2

Abstract

Rotator cuff tears are common and result in considerable morbidity. Tears within the tendon substance or at its insertion into the humeral head represent a considerable clinical challenge because of the hostile local environment that precludes healing. Tears often progress without intervention, and current surgical treatments are inadequate. Although surgical implants, instrumentation, and techniques have improved, healing rates have not improved, and a high failure rate remains for large and massive rotator cuff tears. The use of biologic adjuvants that contribute to a regenerative microenvironment have great potential for improving healing rates and function after surgery. This article presents a review of current and emerging biologic approaches to augment rotator cuff tendon and muscle regeneration focusing on the scientific rationale, preclinical, and clinical evidence for efficacy, areas for future research, and current barriers to advancement and implementation.

A Randomized Controlled Trial of the Treatment of Rotator Cuff Tears with Bone Marrow Concentrate and Platelet Products Compared to Exercise Therapy: A Midterm Analysis

“…Tears of these crucial active shoulder joint stabilizers are commonly associated with trauma and age-related degeneration [1]. Rotator cuff disorders (RCD), which can be found in 30%-50% of the population aged over 50, account for over 4.5 million physician visits per year, with over 250,000 repairs performed annually in the United States [1,2].…”

“…When conservative therapy is ineffective, open or arthroscopic surgery using suture anchors in a variety of configurations is used with the goal of reducing pain and increasing function [11]. Despite traditional management with surgery to repair partial and full-thickness rotator cuff tears, several studies have shown high failure rates of tendon to bone rotator cuff repairs ranging from 30% to 94% [1,2,11,12]. It can be difficult to determine which types and sizes of tears will benefit from surgical management as tear size and morphology have been shown to be poor predictors for pain and functional scores [13].…”

“…When appropriately stimulated, MSCs can differentiate into bone, cartilage, fat, and tendon cells. This provides a promising mechanism to promote the healing of injured tissues [2,23,24]. They likely promote tendon healing through paracrine effects by secreting exosomes, growth factors, chemokines, and cytokines [25].…”

Platelet-rich plasma. Evidenze, limiti e prospettive future

“…Se i progressi nel campo della ricerca di base hanno chiarito gran parte degli aspetti biologici fino a pochi anni fa sconosciuti, il problema è il passaggio alla ricerca clinica. A fronte di numerosi studi pubblicati, infatti, sono pochi gli ambiti nei quali vi sia un consenso unanime, come circa l'ottimale metodica di preparazione e composizione del PRP per ciascuna differente indicazione clinica [16]. Oltre a ciò, vi sono numerosi dubbi sul fatto che un singolo preparato possa trattare condizioni patologiche differenti.…”

Equipoise and the technology curve

“…10-13 An increasing number of clinical trials evaluating the use of platelet rich plasma (PRP) across a wide range of applications have not supported promising initial in vitro and early clinical data. 14-16 While a number of clinicians have become disillusioned with PRP, it is possible that further analysis of emerging and published literature may reveal particular indications in which such therapies are effective. These new therapies are likely to follow the ‘technology/hype’ curve, whereas others have followed a more damped pattern such as metal-on-metal joint arthroplasties, 17,18 which has been cited as an example of Scott’s parabola.…”