The failure rate of rotator cuff repair is high. Regenerative techniques using material scaffolds, stem cells, and growth factors help augment repair and regenerate tissue. We reviewed the literature of various regenerative techniques in terms of (1) enhancing the repair process, (2) tissue regeneration, (3) mechanical strength, and (4) clinical outcome.
MarxRGKoulouvarisPChuSKLevyBA. Indications for surgery in clinical outcome studies of rotator cuff repair. Clin Orthop Relat Res2009;467:450–6.
2.
NhoSJDelosDYadavHPensakMRomeoAAWarrenRF. Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears. Am J Sports Med2010;38:619–29.
3.
AndersenMBPingelJKjaerMLangbergH. Interleukin-6: A growth factor stimulating collagen synthesis in human tendon. J Appl Physiol2011;110:1549–54.
4.
ThomopoulosSHarwoodFLSilvaMJAmielDGelbermanRH. Effect of several growth factors on canine flexor tendon fibroblast proliferation and collagen synthesis in vitro. J Hand Surg Am2005;30:441–7.
5.
ChanBPFuSQinLLeeKRolfCGChanK. Effects of basic fibroblast growth factor (bFGF) on early stages of tendon healing: A rat patellar tendon model. Acta Orthop Scand2000;71:513–8.
6.
HamadaYKatohSHibinoNKosakaHHamadaDYasuiN. Effects of monofilament nylon coated with basic fibroblast growth factor on endogenous intrasynovial flexor tendon healing. J Hand Surg Am2006;31:530–40.
7.
GulottaLVRodeoSA. Growth factors for rotator cuff repair. Clin Sports Med2009;28:13–23.
8.
UggenJCDinesJUggenCWMasonJSRazzanoPDinesD. Tendon gene therapy modulates the local repair environment in the shoulder. J Am Osteopath Assoc2005;105:20–1.
9.
UggenCDinesJMcGarryMGrandeDLeeTLimpisvastiO. The effect of recombinant human platelet-derived growth factor BB-coated sutures on rotator cuff healing in a sheep model. Arthroscopy2010;26:1456–62.
10.
RodeoSAPotterHGKawamuraSTurnerASKimHJAtkinsonBL. Biologic augmentation of rotator cuff tendon-healing with use of a mixture of osteoinductive growth factors. J Bone Joint Surg Am2007;89:2485–97.
11.
GulottaLVKovacevicDPackerJDEhteshamiJRRodeoSA. Adenoviral-mediated gene transfer of human bone morphogenetic protein-13 does not improve rotator cuff healing in a rat model. Am J Sports Med2011;39:180–7.
12.
AspenbergPForslundC. Enhanced tendon healing with GDF 5 and 6. Acta Orthop Scand1999;70:51–4.
13.
KurtzCALoebigTGAndersonDDDeMeoPJCampbellPG. Insulin-like growth factor I accelerates functional recovery from Achilles tendon injury in a rat model. Am J Sports Med1999;27:363–9.
14.
DahlgrenLAvan der MeulenMCBertramJEStarrakGSNixonAJ. Insulin-like growth factor-I improves cellular and molecular aspects of healing in a collagenase-induced model of flexor tendinitis. J Orthop Res2002;20:910–9.
15.
AhmadZHowardDBrooksRAWardaleJHensonFMGetgoodA. The role of platelet rich plasma in musculoskeletal science. JRSM Short Rep2012;3:40.
16.
GulottaLVHidakaCMaherSACunninghamMERodeoSA. What's new in orthopaedic research. J Bone Joint Surg Am2007;89:2092–101.
de MosMvan der WindtAEJahrHvan SchieHTWeinansHVerhaarJA. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med2008;36:1171–8.
19.
CastriciniRLongoUGDe BenedettoMPanfoliNPiraniPZiniR. Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: A randomized controlled trial. Am J Sports Med2011;39:258–65.
20.
AhmadZSiddiquiNAbdus-SameeMMalikSTytherleigh-StrongGRushtonN. Lateral epicondylitis: A review of pathology and management. Bone Joint J [in press].
21.
AhmadZBrooksRKangSWeaverHNunneyITytherleigh-StrongG. The effect of platelet rich plasma on clinical outcomes in lateral epicondylitis: A meta-analysis of the English language literature. Arthroscopy [in press].
22.
AhmadZWardaleJBrooksRHensonFNooraniARushtonN. Exploring the application of stem cells in tendon repair and regeneration. Arthroscopy2012;28:1018–29.
23.
ConnellDDatirAAlyasFCurtisM. Treatment of lateral epicondylitis using skin-derived tenocyte-like cells. Br J Sports Med2009;43:293–8.
24.
ClarkeAWAlyasFMorrisTRobertsonCJBellJConnellDA. Skin-derived tenocyte-like cells for the treatment of patellar tendinopathy. Am J Sports Med2011;39:614–23.
25.
MazzoccaADMcCarthyMBChowaniecDMCoteMPArcieroRADrissiH. Rapid isolation of human stem cells (connective tissue progenitor cells) from the proximal humerus during arthroscopic rotator cuff surgery. Am J Sports Med2010;38:1438–47.
26.
MazzoccaADMcCarthyMBChowaniecDCoteMPJudsonCHApostolakosJ. Bone marrow-derived mesenchymal stem cells obtained during arthroscopic rotator cuff repair surgery show potential for tendon cell differentiation after treatment with insulin. Arthroscopy2011;27:1459–71.
27.
GomesEllera JLda SilvaRCSillaLMAbreuMRPellandaR. Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells. Knee Surg Sports Traumatol Arthrosc2011;20:373–7.
28.
BarberFAHerbertMABoothbyMH. Ultimate tensile failure loads of a human dermal allograft rotator cuff augmentation. Arthroscopy2008;24:20–4.
29.
DerwinKABakerARSpraggRKLeighDRIannottiJP. Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am2006;88:2665–72.
30.
SchlegelTFHawkinsRJLewisCWMottaTTurnerAS. The effects of augmentation with Swine small intestine submucosa on tendon healing under tension: Histologic and mechanical evaluations in sheep. Am J Sports Med2006;34:275–80.
31.
NicholsonGPBreurGJVan SickleDYaoJQKimJBlanchardCR. Evaluation of a cross-linked acellular porcine dermal patch for rotator cuff repair augmentation in an ovine model. J Shoulder Elbow Surg2007;16(5 Suppl):S184–90.
32.
ChenJXuJWangAZhengM. Scaffolds for tendon and ligament repair: Review of the efficacy of commercial products. Expert Rev Med Devices2009;6:61–73.
33.
IannottiJPCodsiMJKwonYWDerwinKCicconeJBremsJJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am2006;88:1238–44.
BurkheadWZSchiffernSCJrKrishnanSG. Use of GraftJacket as an augmentation for massive rotator cuff tears. Semin Arthroplasty2007;1:11–18.
36.
KimuraAOkamuraKFukushimaSIshiiSAokiM. Clinical results of rotator cuff reconstruction with PTFE felt augmentation for irreparable massive rotator cuff tears. Shoulder Joint2000;24:485–8.
37.
OzakiJFujimotoSMasuharaKTamaiSYoshimotoS. Reconstruction of chronic massive rotator cuff tears with synthetic materials. Clin Orthop Relat Res1986;202:173–83.
38.
HirookaAYonedaMWakaitaniSIsakaYHayashidaKFukushimaS. Augmentation with a Gore-Tex patch for repair of large rotator cuff tears that cannot be sutured. J Orthop Sci2002;7:451–6.
39.
NadaANDebnathUKRobinsonDAJordanC. Treatment of massive rotator-cuff tears with a polyester ligament (Dacron) augmentation: Clinical outcome. J Bone Joint Surg Br2010;92:1397–402.
40.
ChenCHChangCHWangKCSuCILiuHTYuCM. Enhancement of rotator cuff tendon-bone healing with injectable periosteum progenitor cells-BMP-2 hydrogel in vivo. Knee Surg Sports Traumatol Arthrosc2011;19:1597–607.
41.
HeeCKDinesJSDinesDMRodenCMWisner-LynchLATurnerAS. Augmentation of a rotator cuff suture repair using rhPDGF-BB and a type I bovine collagen matrix in an ovine model. Am J Sports Med2011;39:1630–9.
ChanBPFuSCQinLRolfCChanKM. Supplementation-time dependence of growth factors in promoting tendon healing. Clin Orthop Relat Res2006;448:240–7.
44.
van den DolderJMoorenRVloonAPStoelingaPJJansenJA. Platelet-rich plasma: Quantification of growth factor levels and the effect on growth and differentiation of rat bone marrow cells. Tissue Eng2006;12:3067–73.
45.
CastilloTNPouliotMAKimHJDragooJL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med2011;39:266–71.