Progress and prospect of biological treatment for rotator cuff injury repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YIN Zhengbo ¹ , CHEN Zhian ¹ , YIN Ni ² , ZHU Yifei ³ , ZHANG Bihuan ¹ , ZHOU Tianhua ⁴ , TAN Hongbo ⁴ ,  XU Yongqing ⁴

1. Graduate School of Kunming Medical University, Kunming Yunnan, 650500, P. R. China;
2. Department of Renal Rheumatology Immunology, the Third Xiangya Hospital of Central South University, Changsha Hunan, 410013, P. R. China;
3. Graduate School of Dali University, Dali Yunnan, 671003, P. R. China;
4. Department of Orthopedics, 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;

Corresponding author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Rotator cuff injury; biotherapy; platelet rich plasma; stem cells; growth factor; exosome

DOI：

10.7507/1002-1892.202303122

Video：

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Objective To review the research progress in biotherapy of rotator cuff injury in recent years, in order to provide help for clinical decision-making of rotator cuff injury treatment. Methods The literature related to biotherapy of rotator cuff injury at home and abroad in recent years was widely reviewed, and the mechanism and efficacy of biotherapy for rotator cuff injury were summarized from the aspects of platelet-rich plasma (PRP), growth factors, stem cells, and exosomes. Results In order to relieve patients’ pain, improve upper limb function, and improve quality of life, the treatment of rotator cuff injury experienced an important change from conservative treatment to open surgery to arthroscopic rotator cuff repair. Arthroscopic rotator cuff repair plus a variety of biotherapy methods have become the mainstream of clinical treatment. All kinds of biotherapy methods have ideal mid- and long-term effectiveness in the repair of rotator cuff injury. The biotherapy method to promote the healing of rotator cuff injury is controversial and needs to be further studied. Conclusion All kinds of biotherapy methods show a good effect on the repair of rotator cuff injury. It will be an important research direction to further develop new biotherapy technology and verify its effectiveness.

Citation： YIN Zhengbo, CHEN Zhian, YIN Ni, ZHU Yifei, ZHANG Bihuan, ZHOU Tianhua, TAN Hongbo, XU Yongqing. Progress and prospect of biological treatment for rotator cuff injury repair. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1169-1176. doi: 10.7507/1002-1892.202303122 Copy

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1. Lorbach O, Tompkins M. Rotator cuff: biology and current arthroscopic techniques. Knee Surg Sports Traumatol Arthrosc, 2012, 20(6): 1003-1011.
2. Snedeker JG, Foolen J. Tendon injury and repair-A perspective on the basic mechanisms of tendon disease and future clinical therapy. Acta Biomater, 2017, 63: 18-36.
3. Schairer WW, Nwachukwu BU, Fu MC, et al. Risk factors for short-term complications after rotator cuff repair in the United States. Arthroscopy, 2018, 34(4): 1158-1163.
4. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg, 2010, 19(1): 116-120.
5. Wasserman A, Matthewson G, MacDonald P. Platelet-rich plasma and the knee-applications in orthopedic surgery. Curr Rev Musculoskelet Med, 2018, 11(4): 607-615.
6. Bielecki T, Dohan Ehrenfest DM. Platelet-rich plasma (PRP) and Platelet-Rich Fibrin (PRF): surgical adjuvants, preparations for in situ regenerative medicine and tools for tissue engineering. Curr Pharm Biotechnol, 2012, 13(7): 1121-1130.
7. Mei-Dan O, Carmont MR. The role of platelet-rich plasma in rotator cuff repair. Sports Med Arthrosc Rev, 2011, 19(3): 244-250.
8. Lana JFSD, Purita J, Paulus C, et al. Contributions for classification of platelet rich plasma-proposal of a new classification: MARSPILL. Regen Med, 2017, 12(5): 565-574.
9. Yan R, Gu Y, Ran J, et al. Intratendon delivery of leukocyte-poor platelet-rich plasma improves healing compared with leukocyte-rich platelet-rich plasma in a rabbit Achilles tendinopathy model. Am J Sports Med, 2017, 45(8): 1909-1920.
10. Lin KY, Chen P, Chen AC, et al. Leukocyte-rich platelet-rich plasma has better stimulating effects on tenocyte proliferation compared with leukocyte-poor platelet-rich plasma. Orthop J Sports Med, 2022, 10(3): 23259671221084706.
11. Peng Y, Wu W, Li X, et al. Effects of leukocyte-rich platelet-rich plasma and leukocyte-poor platelet-rich plasma on the healing of bone-tendon interface of rotator cuff in a mice model. Platelets, 2022, 33(7): 1075-1082.
12. Peng Y, Guanglan W, Jia S, et al. Leukocyte-rich and leukocyte-poor platelet-rich plasma in rotator cuff repair: A meta-analysis. Int J Sports Med, 2022, 43(11): 921-930.
13. Hurley ET, Hannon CP, Pauzenberger L, et al. Nonoperative treatment of rotator cuff disease with platelet-rich plasma: A systematic review of randomized controlled trials. Arthroscopy, 2019, 35(5): 1584-1591.
14. Lin MT, Wei KC, Wu CH. Effectiveness of platelet-rich plasma injection in rotator cuff tendinopathy: A systematic review and meta-analysis of randomized controlled trials. Diagnostics (Basel), 2020, 10(4): 189.
15. Giovannetti de Sanctis E, Franceschetti E, De Dona F, et al. The efficacy of injections for partial rotator cuff tears: A systematic review. J Clin Med, 2020, 10(1): 51.
16. Zhao D, Han YH, Pan JK, et al. The clinical efficacy of leukocyte-poor platelet-rich plasma in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg, 2021, 30(4): 918-928.
17. Rossi LA, Piuzzi N, Tanoira I, et al. Subacromial platelet-rich plasma injections produce significantly worse improvement in functional outcomes in patients with partial supraspinatus tears than in patients with isolated tendinopathy. Arthroscopy, 2023.
18. Moretti L, Bizzoca D, Cassano GD, et al. One-shot platelet-rich plasma (PRP) injection is non-inferior to extracorporeal shockwave therapy in the management of supraspinatus tendinosis. Musculoskelet Surg, 2023.
19. Feltri P, Gonalba GC, Boffa A, et al. Platelet-rich plasma does not improve clinical results in patients with rotator cuff disorders but reduces the retear rate. A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2023, 31(5): 1940-1952.
20. Cavendish PA, Everhart JS, DiBartola AC, et al. The effect of perioperative platelet-rich plasma injections on postoperative failure rates following rotator cuff repair: a systematic review with meta-analysis. J Shoulder Elbow Surg, 2020, 29(5): 1059-1070.
21. Xu W, Xue Q. Application of platelet-rich plasma in arthroscopic rotator cuff repair: A systematic review and meta-analysis. Orthop J Sports Med, 2021, 9(7): 23259671211016847.
22. Li Y, Li T, Li J, et al. Platelet-rich plasma has better results for retear rate, pain, and outcome than platelet-rich fibrin after rotator cuff repair: A systematic review and meta-analysis of randomized controlled trials. Arthroscopy, 2022, 38(2): 539-550.
23. Ryan J, Imbergamo C, Sudah S, et al. Platelet-rich product supplementation in rotator cuff repair reduces retear rates and improves clinical outcomes: A meta-analysis of randomized controlled trials. Arthroscopy, 2021, 37(8): 2608-2624.
24. Zhang C, Cai YZ, Wang Y. Injection of leukocyte-poor platelet-rich plasma for moderate-to-large rotator cuff tears does not improve clinical outcomes but reduces retear rates and fatty infiltration: A prospective, single-blinded randomized study. Arthroscopy, 2022, 38(8): 2381-2388.
25. Pandey V, Bandi A, Madi S, et al. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg, 2016, 25(8): 1312-1322.
26. Martinelli D, Fornara P, Stecco A, et al. Does intraoperative platelet-rich plasma improve clinical and structural outcomes after arthroscopic repair of isolated tears of the supraspinatus tendon? Indian J Orthop, 2019, 53(1): 77-81.
27. Wang A, McCann P, Colliver J, et al. Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair? A randomized controlled trial. Am J Sports Med, 2015, 43(6): 1430-1437.
28. Ebert JR, Wang A, Smith A, et al. A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: A randomized controlled trial. Am J Sports Med, 2017, 45(13): 2965-2974.
29. Thepsoparn M, Thanphraisan P, Tanpowpong T, et al. Comparison of a platelet-rich plasma injection and a conventional steroid injection for pain relief and functional improvement of partial supraspinatus tears. Orthop J Sports Med, 2021, 9(9): 23259671211024937.
30. Cai YU, Sun Z, Liao B, et al. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Med Sci Sports Exerc, 2019, 51(2): 227-233.
31. Kwong CA, Woodmass JM, Gusnowski EM, et al. Platelet-rich plasma in patients with partial-thickness rotator cuff tears or tendinopathy leads to significantly improved short-term pain relief and function compared with corticosteroid injection: A double-blind randomized controlled trial. Arthroscopy, 2021, 37(2): 510-517.
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