M Schaer

Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial

HYPOTHESIS We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing. METHODS Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks. RESULTS There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs. DISCUSSION/CONCLUSIONS Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate.

SECEC Research Grant 2008 II: Use of platelet- and leucocyte-rich fibrin (L-PRF) does not affect late rotator cuff tendon healing: a prospective randomized controlled study

BACKGROUND Because the retear rate after rotator cuff repairs remains high, methods to improve healing are very much needed. Platelet-rich concentrates have been shown to enhance tenocyte proliferation and promote extracellular matrix synthesis in vitro; however, their clinical benefit remains unclear. We hypothesized that arthroscopic rotator cuff repair with leucocyte- and platelet-rich fibrin (L-PRF) results in better clinical and radiographic outcome at 12 months of follow-up than without L-PRF. METHODS Thirty-five patients were randomized to receive arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group, n = 17) or without L-PRF (L-PRF- group, n = 18). Preoperative and postoperative clinical evaluation included the Subjective Shoulder Value, visual analog score for pain, Simple Shoulder Test, and Constant-Murley score. The anatomic watertight healing, tendon thickness, and tendon quality was evaluated using magnetic resonance arthrography at 12 months of follow-up. RESULTS No complications were reported in either group. The mean Subjective Shoulder Value, Simple Shoulder Test, and Constant-Murley scores increased from preoperatively to postoperatively, showing no significant differences between the groups. Complete anatomic watertight healing was found in 11 of 17 in the L-PRF+ group and in 11 of 18 in the L-PRP- group (P = .73). The mean postoperative defect size (214 ± 130 mm(2) in the L-PRF+ group vs 161 ± 149 mm(2) in the L-PRF- group; P = .391) and the mean postoperative tendon quality according to Sugaya (L-PRF+ group: 3.0 ± 1.4, L-PRF- group: 3.0 ± 0.9) were similar in both groups at 12 months of follow-up. CONCLUSION Arthroscopic rotator cuff repair with application of L-PRF yields no beneficial effect in clinical outcome, anatomic healing rate, mean postoperative defect size, and tendon quality at 12 months of follow-up.

Biologically based strategies to augment rotator cuff tears

Lesions of the rotator cuff (RC) are among the most frequent tendon injuries. In spite of the developments in both open and arthroscopic surgery, RC repair still very often fails. In order to reduce the failure rate after surgery, several experimental in vitro and in vivo therapy methods have been developed for biological improvement of the reinsertion. This article provides an overview of the current evidence for augmentation of RC reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed. We performed a comprehensive search of the PubMed database using various combinations of the keywords “tendon,” “rotator cuff,” “augmentation,” “growth factor,” “platelet-rich fibrin,” and “platelet-rich plasma” for publications up to 2011. Given the linguistic capabilities of the research team, we considered publications in English, German, French, and Spanish. We excluded literature reviews, case reports, and letters to the editor.

BiPOD Arthroscopic Acromioclavicular Repair Restores Bidirectional Stability

Stabilizing the acromioclavicular joint in the vertical and horizontal planes is challenging, and most current techniques do not reliably achieve this goal. The BiPOD repair is an arthroscopically assisted procedure performed with image intensifier guidance that reconstructs the coracoclavicular ligaments as well as the acromioclavicular ligaments to achieve bidirectional stability. Repair is achieved with a combination of 2-mm FiberTape (Arthrex, Naples, Florida) and 20-mm Poly-Tape (Neoligaments, Leeds, England) to achieve rigid repair, prevent bone abrasion, and promote tissue ingrowth. This study is a prospective review of the first 6 patients treated for high-grade acute acromioclavicular injury with the BiPOD technique. The study included 6 men who were 21 to 36 years old (mean, 27 years). At 6-month follow-up, complications were recorded and radiographic analysis was used to determine the coracoclavicular distance for vertical reduction and the amount of acromioclavicular translation on the Alexander axillary view was used to determine horizontal reduction. One patient had a superficial infection over the tape knot. The difference in coracoclavicular distance between the operated side and the uninvolved side was 9±2 mm preoperatively and 0.3±2 mm at 6-month follow-up. On Alexander axillary view, all 6 patients showed stable reduction, which is defined as a clavicle that is in line with the acromion. The findings show that BiPOD acromioclavicular reconstruction restores bidirectional stability of the acromioclavicular joint at 6 months. [Orthopedics. 2017; 40(1):e35-e43.].

Die Biologie der Heilung der RotatorenmanschettenläsionThe biology of the healing of rotator cuff tears

ZusammenfassungDie Rotatorenmanschettenläsion ist eine häufige Diagnose in der orthopädischen Sprechstunde. Die Rerupturrate ist trotz Weiterentwicklung der Nahtmaterialien und -techniken im offenen und arthroskopischen Bereich nach wie vor hoch. In den letzten Jahren wurden den physiologischen Vorgängen der natürlichen Insertion wie auch den biologischen Eigenschaften der Rotatorenmanschettenheilung in der Forschung vermehrt Aufmerksamkeit geschenkt. Es hat sich gezeigt, dass die Heilung der Sehnen-Knochen-Insertion der Rotatorenmanschette ein komplexes Zusammenspiel von lokalen Zellen, Stammvorläuferzellen, extrazellulärer Matrix sowie von Wachstumsfaktoren und anderen Zytokinen ist. Dementsprechend wurden verschiedene biologische In-vitro- und In-vivo-Therapieverfahren zur potenziellen Verbesserung der Reinsertion entwickelt. Ziel dieses Artikels ist es, einen Überblick über die heutige Evidenz der Augmentation der Rotatorenmanschettenrekonstruktion mit Wachstumsfaktoren zu geben. Weiterhin werden mögliche zukünftige Therapieansätze diskutiert.AbstractRotator cuff tears are a common orthopedic diagnosis in daily practice. The failure rate is still high despite the continued developments in suture material and techniques in both the open and arthroscopic approaches. In recent years, the physiological processes in the bone tendon insertion as well as the biological characteristics of rotator cuff healing have received increasing attention by researchers. It has been shown that the healing of the tendon bone insertion is a complex interplay of local cells, progenitor stem cells, extracellular matrix, growth factors, and other cytokines. Accordingly, several biological in vitro and in vivo therapy methods were developed to improve reinsertion. This article provides an overview of the current evidence for augmentation of rotator cuff reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed.

Die Biologie der Heilung der Rotatorenmanschettenläsion

ZusammenfassungDie Rotatorenmanschettenläsion ist eine häufige Diagnose in der orthopädischen Sprechstunde. Die Rerupturrate ist trotz Weiterentwicklung der Nahtmaterialien und -techniken im offenen und arthroskopischen Bereich nach wie vor hoch. In den letzten Jahren wurden den physiologischen Vorgängen der natürlichen Insertion wie auch den biologischen Eigenschaften der Rotatorenmanschettenheilung in der Forschung vermehrt Aufmerksamkeit geschenkt. Es hat sich gezeigt, dass die Heilung der Sehnen-Knochen-Insertion der Rotatorenmanschette ein komplexes Zusammenspiel von lokalen Zellen, Stammvorläuferzellen, extrazellulärer Matrix sowie von Wachstumsfaktoren und anderen Zytokinen ist. Dementsprechend wurden verschiedene biologische In-vitro- und In-vivo-Therapieverfahren zur potenziellen Verbesserung der Reinsertion entwickelt. Ziel dieses Artikels ist es, einen Überblick über die heutige Evidenz der Augmentation der Rotatorenmanschettenrekonstruktion mit Wachstumsfaktoren zu geben. Weiterhin werden mögliche zukünftige Therapieansätze diskutiert.AbstractRotator cuff tears are a common orthopedic diagnosis in daily practice. The failure rate is still high despite the continued developments in suture material and techniques in both the open and arthroscopic approaches. In recent years, the physiological processes in the bone tendon insertion as well as the biological characteristics of rotator cuff healing have received increasing attention by researchers. It has been shown that the healing of the tendon bone insertion is a complex interplay of local cells, progenitor stem cells, extracellular matrix, growth factors, and other cytokines. Accordingly, several biological in vitro and in vivo therapy methods were developed to improve reinsertion. This article provides an overview of the current evidence for augmentation of rotator cuff reconstruction with growth factors. Furthermore, potential future therapeutic approaches are discussed.