Effectiveness of Biologic Factors in Shoulder Disorders

Abstract

Background:Shoulder pathology can cause significant pain, discomfort, and loss of function that all interfere with activities of daily living and may lead to poor quality of life. Primary osteoarthritis and rotator cuff diseases with its sequalae are the main culprits. Management of shoulder disorders using biological factors gained an increasing interest over the last years. This interest reveals the need of effective treatments for shoulder degenerative disorders, and highlights the importance of a comprehensive and detailed understanding of the rapidly increasing knowledge in the field.Methods:This study will describe most of the available biology-based strategies that have been recently developed, focusing on their effectiveness in animal and clinical studies.Results:Data from in vitro work will also be briefly presented; in order to further elucidate newly acquired knowledge regarding mechanisms of tissue degeneration and repair that would probably drive translational work in the next decade. The role of platelet rich-plasma, growth factors, stem cells and other alternative treatments will be described in an evidence-based approach, in an attempt to provide guidelines for their clinical application. Finally, certain challenges that biologic treatments face today will be described as an initiative for future strategies.Conclusion:The application of different growth factors and mesenchymal stem cells appears as promising approaches for enhancing biologic repair. However, data from clinical studies are still limited, and future studies need to improve understanding of the repair process in cellular and molecular level and evaluate the effectiveness of biologic factors in the management of shoulder disorders.

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

“…The rate of success with conservative treatment for rotator cuff tears varies widely from 15 to 85% [4][5][6][7][8][9][10]. 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].…”

“…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].…”

Does Greater Trochanter Decortication Affect Suture Anchor Pullout Strength in Abductor Tendon Repairs? A Biomechanical Study

“…Theoretically, decortication is performed with tendon repair to promote marrow stimulation and the release of mesenchymal stem cells (MSCs). 24,27,36,41 The technique of creating a trough of bleeding bone was proposed by McLaughlin 38 in 1944. However, results from the literature have been inconclusive on whether decortication biologically improves bone to tendon healing and whether the biomechanical risks of decortication merit the theoretical biological benefits.…”

“…To date, no human randomized controlled trial has definitively proven that decortication improves bone-to-tendon healing or clinical outcome. 24 Given that the literature regarding the benefits of decortication is limited and largely based on animal models and that the authors have demonstrated a significant decrease in anchor strength, the deleterious effects of decortication may outweigh the theoretical positives.…”

Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review

“…Efforts to augment nonoperative treatment with orthoregenerative approaches exist but have not been widely published in relation to GH chondral conditions. 79 When nonoperative management fails, total shoulder arthroplasty (TSA) has proven to be an excellent option for older patients with OA. In younger patients, and/or in patients with early-stage pathology, reparative and restorative surgical techniques, such as microfracture, autologous chondrocyte implantation, and allograft resurfacing options have been described.…”