<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

Abstract

Large and massive rotator cuff tears have the highest risk of retear. Common biologic modalities that can potentially reduce the retear rate and improve healing include platelet-rich plasma (PRP), scaffolds, and mesenchymal stem cells (MSCs). PRP has been studied for its role in improving rotator cuff healing and results of randomized controlled trials and meta-analyses show mixed results. Most studies in large and massivge tears show that PRP decreases the retear rate, but the connection between structural integrity and clinical outcomes is still unknown. Extracellular matrix (ECM) and synthetic scaffolds can increase healing in augmentation and bridging repair. Acellular dermal allografts have shown better healing rates and outcomes than xenografts in meta-analyses. Synthetic scaffolds augmented with bone marrow-derived stem cells have only been studied in vitro but are promising for the combination of mechanical stability and induction of a biological response. Superior capsule reconstruction is an exciting type of interposition graft reconstruction that has shown favorable early clinical outcomes for large and massive tears. Bone marrow-derived stem cells and adipose-derived stem cells improve the biomechanical characteristics of tendon repair and enhance the histological findings of the healing process in animal studies. However, evidence from human studies is lacking, especially in patients with large and massive tears. In summary, there are many biological options to augment rotator cuff repair in patients with large and massive tears. Due to mixed results and a lack of standardization in high-quality studies, we cannot recommend PRP at this time as an adjunct to rotator cuff repair. Both ECM and synthetic scaffolds, as well as SCR, can be used, especially in situations where native tendon is compromised, and additional mechanical augmentation is needed. Stem cells have been the least studied to date, so it is difficult to give recommendations for or against their use at this time.

Combination of graphene oxide and platelet-rich plasma improves tendon–bone healing in a rabbit model of supraspinatus tendon reconstruction

“…PRP, which is rich in a variety of GFs, has aroused considerable interest among researchers [ 31 ]. However, there has been some controversy concerning the extent of the effect of PRP on tendon repair, with explanations for the inconsistent results focusing on the different PRP preparation methods and the short half-life of many GFs [ 14 , 32 ]. Therefore, we incorporated GO, a 2D material widely used in tissue engineering, with the aim of improving the physical and biological properties of PRP and enhancing the repair effect of PRP on TBI healing.…”

A bio-inductive collagen scaffold that supports human primary tendon-derived cell growth for rotator cuff repair

“…6 a; 61.1 ​± ​17.0 [range 21.7–85.0] vs 91.0 ​± ​13.3 [range 50–100]; p ​< ​0.001), OSS ( Fig. 6 b; 27.5 ​± ​9.3 [range 7–40] vs 42.2 ​± ​5.8 [ [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] ]; p ​< ​0.001) and Constant-Murley ( Fig. 6 c; 51.4 ​± ​17.7 [range 18.8–90] vs 83.6 ​± ​8.6 [range 70.0–99.1]; p ​< ​0.001).…”

Transplant of Autologous Mesenchymal Stem Cells Halts Fatty Atrophy of Detached Rotator Cuff Muscle After Tendon Repair: Molecular, Microscopic, and Macroscopic Results From an Ovine Model

“… 25 , 26 , 34 , 36 , 38 Currently, it is difficult to give recommendations for or against the use of stem cells to treat rotator cuff tears. 16 Specifically, the influence and efficiency of stem cell–based therapy on muscle degeneration in rotator cuff disease are poorly understood because previous investigations targeted MSC injection to bone or tendon structures and/or used small laboratory species 25 , 26 that are not useful for developing surgical procedures and stem cell isolation in humans. 22 , 28 To provide insight into the potential of MSCs to halt muscle-to-fat conversion in rotator cuff disease, we characterized molecular, microscopic, and macroscopic effects of implanting bone marrow–derived microtissues of MSCs into a detached rotator cuff muscle of a large animal model (sheep) that reproduces the massive degree of lipid accumulation and atrophy seen in humans.…”