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Growth factors in Rotator Cuff, Presented in SIA- AANA Meeting - Trieste 2012
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A. Busilacchi , Clinical Orthopedics – Department of Clinical and
Experimental Science
Università Politecnica delle Marche – Ancona- Italy
ESSKA European Arthroscopy Fellow ( EAF) 2010
USE OF GROWTH FACTORS IN THE ROTATOR CUFF
PATHOLOGY
• Scaffolds
• Growth Factors
• Gene Therapy
• MSCs
ATTEMPT TO REGENERATE NATIVE TISSUE
BIOTECHNOLOGIES IN CUFFREPAIR
GROWTH FACTORS & ROTATOR CUFF
• Acromioplasty• Microfractures (Crimson – Duvet)
• Commercial Kits for Autologous PRP, PRFM, PRGF ….
• Donor-derived PRP
LOW FARE (Free) HI-FARE (Hundreds €)
2 ways to reach the same “destination” :
Deliver GFs around the cuff
“CRIMSON – DUVET”
Courtesy of Dr. F. Campi
SJ Snyder, Burns J.Techniques in Shoulder & Elbow Surgery:December 2009 - Volume 10 - Issue 4 - pp 130-137
simple method for initiating bone marrow egress from the proximal humeral metaphysis
Good Hystological Results
(Arnoczky )
Platelet Rich Plasma• PDGF(ab)• TGF β1• EGF• IGF-1• VEGF • PDEGF • MGF• HGF• bFGF• BMPs
VARIABLES:- Variability in platelets content- Different centrifugation systems- Leucocyte inclusion or removal from final product- Impossibility to know exactly what we inject
…Our study does not support the use of autologous PRFM for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff. Our results are applicable to small and medium rotator cuff tears …it is possible that PRFM may be beneficial for large and massive rotator cuff tears.
The American Journal of Sports Medicine, Vol. 39, No. 10
The American Journal of Sports Medicine, Vol. 40, No. 2
The American Journal of Sports Medicine, Vol. 40, No. 5
• Choice of proper Shoulder Scores (Longo, 2012) to evaluate the outcomes
• Make it sense to place PRP intraoperatively when similar results actually come from conventional techniques??
• Long term safety not available• COST /EFFECTIVENESS for PRP kits has NOT proven yet!
My concerns and doubts…
GFs ConcetrationGel or LisatePRFM - PRGFLeucocytes YES/NOAutologous/HomologousInjections: how many?ml of PRP per admin..
?METHODS
NOT RELIABILE
A. Busilacchi, M. Del Torto, S. Manzotti,F. Orlando, A. Gigante
Experimental basis and EBM Of GFs on Tendon
OUR FINDINGS
• Analgesia • Neoangiogenesis • Cells improved chemiotaxis (Higher density than controls)• Increased synthesis of collagen ( I & III)
GFs as triggers o accelerators, in the very early reparative process (inflamatory phase).
Tendon Treated 60 days Tendon Control 60 days
CONCLUSIONS
Preclicnical study on Wistar rat’s
tendonsIn press
OUR PHILOSOPY…
Our Ongoing Clinical Study :
”Subacromial injections of homologus PRP vs HA in subacromial bursitis and partial cuff tears. RCT Study”
no preliminary results available yet
INTRA-OPERATIVELY :Acromioplasty and/or Microfractures in cuff footprint and around (beware of iatrogenic fractures and anchors pullout)
PREVENTION IN BURSITIS AND PARTIAL/DELAMINATION TEARS: Subacromial/ intra articular PRP injections
POST-OPERATIVELY :Subacromial/ intra articular PRP injections
