Combined therapy of platelet-rich plasma and basic fibroblast growth factor using gelatin-hydrogel sheet for rotator cuff healing in rat models

Abstract

Introduction Excellent outcomes of arthroscopic rotator cuff repair for small and medium tears have been recently reported. However, re-tears after surgery have been a common complication after surgical repair of large and massive rotator cuff tears and often occur in early postoperative phase. It was previously reported that basic fibroblast growth factor and platelet-rich plasma enhanced rotator cuff tear healing. We hypothesized that this combined therapy could enhance rotator cuff healing after rotator cuff repair in a rat model. This study aimed to evaluate the efficacy of combined therapy of platelet-rich plasma and basic fibroblast growth factor with gelatin-hydrogel sheet. Methods To create a rotator cuff defect, the infraspinatus tendon of Sprague Dawley rat was resected from the greater tuberosity. The infraspinatus tendons were repaired and covered with gelatin-hydrogel sheet impregnated with PBS (control group), basic fibroblast growth factor (bFGF group), platelet-rich plasma (PRP group), or both basic fibroblast growth factor and platelet-rich plasma (combined group). Histological examinations were conducted using hematoxylin and eosin, safranin O, and immunofluorescence staining, such as Isolectin B4, type II collagen at 2 weeks postoperatively. For mechanical analysis, ultimate failure load of the tendon-humeral head complex was evaluated at 6 weeks postoperatively. Results In the hematoxylin and eosin staining, the tendon maturing score of the combined group was higher than that of the control group at postoperative 2 weeks. In the safranin O staining, stronger proteoglycan staining was observed in the combined group compared with the other groups at postoperative 2 weeks. Vascular staining with isolectin B4 in 3 treatment groups was significantly higher than that in the control group. Type II collagen expression in the combined group was significantly higher than those in the other groups. The ultimate failure load of the combined group was significantly higher than that of the control group. Conclusion Combined therapy of basic fibroblast growth factor and platelet-rich plasma promoted angiogenesis, tendon maturing and fibrocartilage regeneration at the enthesis, which could enhance the mechanical strength. It was suggested that combined basic fibroblast growth factor and platelet-rich plasma might enhance both tendon and bone–tendon junction healing, and basic fibroblast growth factor and platelet-rich plasma might be synergistic.

Three Medial All Suture Anchors Improves Contact Force Compared to Two Hard Body Anchors in a Biomechanical Two-Tendon Rotator Cuff Tear Model

“… 2 While this technique has been found to be effective for small tears, it is less likely to restore the anatomical footprint of the rotator cuff 3 and is associated with greater retear rates when compared with other construct types. 4 , 5 , 6 , 7 To address these shortcomings, particularly for larger rotator cuff tears, DR rotator cuff repairs were developed. 8 , 9 , 10 The initial suture-bridging DR repairs used constructs with two 5.5-mm medial hard body (HB) anchors linked to 2 lateral knotless anchors.…”

Advanced strategies for constructing interfacial tissues of bone and tendon/ligament

“…[261][262][263] Therefore, for optimum enhancement of enthesis regeneration, two or more kinds of growth factors should be applied simultaneously, successively, or even iteratively in accordance with the different phases of enthesis healing. 130,264,265 Notably, heparin effectively reduced the release rate of TGF-β2 and GDF-5 from the enthesis scaffold and significantly increased their validity, which reinforced their fibrogenesis and chondrogenesis activities during enthesis regeneration. 266 Thus, heparin is a possible general potentiator of the beneficial effects of these growth factors in enthesis TE.…”

The Functions and Mechanisms of Basic Fibroblast Growth Factor in Tendon Repair

“…When an acute injury is not healed for a prolonged period of time, it will largely develop into a chronic injury ( Aicale et al, 2018 ). In recent years, growth factors have been a popular treatment for tendon injuries, which provides new thoughts on the healing of tendon injuries ( Kataoka et al, 2021 ). It was confirmed that the combination of multiple growth factors had superior efficacy compared with individual growth factors ( Thomopoulos et al, 2005 ; Kobayashi et al, 2006 ).…”

“…Many researches have shown that bFGF has an important role in tendon healing process ( Kataoka et al, 2021 ; Yan et al, 2021 ). Related experiments regarding the effect of bFGF (or viruses and plasmids carrying the bFGF gene) on tendon healing are summarized in Table 1 .…”