Sunday, March 2, 2014
Not much support for the use of biologics in rotator cuff repair.
Abstract: «Advances in our knowledge of cell signaling and biology have led to the development of products that may guide the healing/regenerative process. Therapies are emerging that involve growth factors, blood-derived products, marrow-derived products, and stem cells. Animal studies suggest that genetic modification of stem cells will be necessary; studies of cartilage and meniscus regeneration indicate that immature cells are effective and that scaffolds are not always necessary. Current preclinical animal and clinical human data and regulatory requirements are important to understand in light of public interest in these products.»
Rotator Cuff 13 – Full thickness rotator cuff tears – repair
The ideal reattachment technique has the following properties:
(1) yields a smooth upper surface which can articulate congruously with the intact undersurface of the coracoacromal arch
(2) excludes joint fluid from the repair site and accommodates some slippage in the sutures and knots without separation of tendon from bone
(3) creates a secure isometric junction between the tendon and bone spreading the load among numerous sutures
(4) can accommodate weakened bone at the greater tuberosity
(5) can be accomplished without sacrificing acromion, the acromioclavicular joint, or the deltoid origin
If there is insufficient quantity and quality of tendon to reach the tuberosity with the arm at the side, consideration can be given to moving the insertion site up to 1 cm medially on the humeral articular surface. If a robust repair cannot be performed, the priority shifts from repair to achieving the smoothest possible upper aspect of the proximal humerus for articulating with the undersurface of the coracoacromial arch. Often the head is translated superiorly because of the loss of the spacer effect of the superior cuff tendon and secondary erosion of the superior glenoid lip
and then ‘protecting’ the arm in abduction
tends to lead to cuff insertion failure when the arm is brought down to the patient’s side.