Advances in biology and mechanics of rotator cuff repair
Advances in biology and mechanics of rotator cuff repair
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DOI：
10.1007/s00167-014-3487-2
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发表时间：
2015-02-01
影响因子：
3.8
通讯作者：
Milano, Giuseppe
中科院分区：
文献类型：
--
作者：
Lorbach, Olaf;Baums, Mike H.;Milano, Giuseppe
高初始固定强度、机械稳定性和肌腱-骨界面的生物愈合是肩袖修复手术后的主要目标。对肩袖生物学和生物力学的理解的进步以及手术技术的改进导致了新的策略的发展，这些策略可能允许肌腱-骨界面愈合过程，而不是形成纤维血管疤痕组织。虽然单排修复术仍然是解决肩袖撕裂最经济有效的技术，但最近引入了一些生物干预来改善组织愈合和肩袖修复的临床结果。动物模型对于确保新治疗策略的安全性和有效性至关重要；然而，尽管大鼠肩膀以及绵羊和山羊被认为是研究肩袖病理最合适的模型，但它们都不能完全复制人类的情况。新兴疗法包括生长因子、干细胞和组织工程。生长因子和富血小板血浆的实验应用显示出良好的结果，但尚未转化为标准化的临床实践。尽管临床前动物研究显示增强生物学方法的有效性有希望的结果，但这些技术在人类肩袖修复中的应用仍然非常有限。需要随机对照临床试验和上市后监测来明确证明临床疗效，并确定使用联合生物学方法的适当适应症。以下综述文章概述了肩袖修复技术的现状以及生长因子、支架和干细胞治疗的应用，为改善肩袖修复后肌腱愈合提供了未来的方向。证据等级专家意见，V级。
High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair. Animal models are critical to ensure safety and efficacy of new treatment strategies; however, although rat shoulders as well as sheep and goats are considered the most appropriate models for studying rotator cuff pathology, no one of them can fully reproduce the human condition. Emerging therapies involve growth factors, stem cells and tissue engineering. Experimental application of growth factors and platelet-rich plasma demonstrated promising results, but has not yet been transferred into standardized clinical practice. Although preclinical animal studies showed promising results on the efficacy of enhanced biological approaches, application of these techniques in human rotator cuff repairs is still very limited. Randomized controlled clinical trials and post-marketing surveillance are needed to clearly prove the clinical efficacy and define proper indications for the use of combined biological approaches. The following review article outlines the state of the art of rotator cuff repair and the use of growth factors, scaffolds and stem cells therapy, providing future directions to improve tendon healing after rotator cuff repair.Level of evidence Expert opinion, Level V.