Soft Tissue to Bone Healing in Rotator Cuff Repair - Structural Interfaces and Attachments in Biology - page 262

American Shoulder and Elbow Surgeons Open Meeting, 2010). Jo et al . performed
a level 2 study which also demonstrated no clinical difference [ 89 ]. There was a
lower re-tear rate in the treated group, but the difference was not statistically
significant. Randelli et al . , in a follow-up study of 2 years, showed improvement
in pain scores at early timepoints; however, the differences did not persist at longer
timepoints and there was no benefit of PRP application in larger tears [ 90 ].
Castricini et al . also showed no difference in outcome scores or tendon integrity
based on MRI [ 91 ]. Bergeson et al . showed no benefit of fibrin matrix in a
prospective study [ 92 ]. Alternatively, there is one recent human study which
showed that the application of PRP fibrin matrix resulted in better healing of rotator
cuff tears measuring less than 3 cm [ 93 ]. However, there were no differences in
clinical outcomes. Taken together, these studies shed concern over the potential
applicability of PRP for rotator cuff repair in the clinical setting. Based on currently
available scientific information, there is no strong evidence to support its use.
12.8 Conclusions
The repair of the rotator cuff to its humeral head insertion presents a major
challenge due to the disparity in the properties of the two tissues. Healing of tendon
to bone is characterized by the formation of a fibrovascular scar and bone loss,
leading to a repaired attachment that is prone to rupture. Further complicating the
repair is the muscle degeneration that is typical in the retracted rotator cuff muscle
(s). Current surgical treatment techniques attempt to securely attach the torn tendon
to its bony footprint using an arthroscopic approach and a double-row suturing
technique. Future treatment approaches may include delivery of growth factors and/
or mesenchymal stem cells to stimulate regeneration of a fibrocartilaginous
insertion.
References
1. AAOS by group. The Burden of Musculoskeletal Disease in the U.S. (2011) American
Academy of Orthopedic Surgery, Rosemont, IL pp. 129-179
2. Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJH (2006) Dead men and radiologists
don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R
Coll Surg Engl 88:116-121
3. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and
repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.
J Bone Joint Surg Am 86-A:219-224
4. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG (2005)
Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?
J Bone Joint Surg Am 87:1229-1240