Rotator Cuff Repair Healing Influenced by Platelet-Rich Plasma Construct Augmentation: A Novel Molecular Mechanism

Abstract

Rotator cuff tear is one of the leading causes of shoulder pain and disability. Obtaining a good outcome after surgical repair is dependent on reducing the retear rate.1Oh L.S. Wolf B.R. Hall M.P. Levy B.A. Marx R.G. Indications for rotator cuff repair: A systematic review.Clin Orthop Relat Res. 2007; 455: 52-63Crossref PubMed Scopus (231) Google Scholar During a review of recent studies on rotator cuff healing, I read with great interest the article by Barber et al.2Barber F.A. Hrnack S.A. Snyder S.J. Hapa O. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation.Arthroscopy. 2011; 27: 1029-1035Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar I would like to complete the discussion of these authors by introducing a major route by which platelet-rich plasma could reduce the rotator cuff retear rate. Recent studies have shown the essential role of angiogenesis-related cytokines in rotator cuff tendinopathy. These studies have shown that the interleukin 1β (IL-1β) level was significantly correlated with degeneration of the rotator cuff tendon. Increased concentrations of IL-1β significantly correlate with a higher incidence of cuff tear. In contrast, transforming growth factor β can enhance cuff tendon repair strength.3Savitskaya Y.A. Izaguirre A. Sierra L. et al.Effect of angiogenesis-related cytokines on rotator cuff disease: The search for sensitive biomarkers of early tendon degeneration.Clin Med Insights Arthritis Musculoskelet Disord. 2011; 4: 43-53Crossref PubMed Scopus (29) Google Scholar Platelet-rich plasma, which is also known as platelet-enriched plasma, not only can inhibit inflammatory effects of IL-1β but also can potentiate transforming-growth-factor-β production.4van Buul GM, Koevoet WL, Kops N, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med in press, available online 19 August, 2011. doi:10.1177/0363546511419278.Google Scholar, 5Kakudo N. Minakata T. Mitsui T. Kushida S. Notodihardjo F.Z. Kusumoto K. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts.Plast Reconstr Surg. 2008; 122: 1352-1360Crossref PubMed Scopus (257) Google Scholar Therefore these important mechanisms should be borne in mind as the major mechanisms for platelet-rich plasma–reduced cuff retear rates. Author's ReplyArthroscopyVol. 27Issue 11PreviewWe would like to thank Dr. Namazi for his comments regarding potential mechanisms by which platelet-rich plasma (PRP) may have contributed to the decrease in retear rate reported in our study.1 Platelets contain over 1,100 bioactive proteins involved in various aspects of tissue repair.2,3 In addition, the plasma component of PRP also adds a variety of adhesion proteins and other bioactive factors that play a crucial role in wound repair.4 We agree that the ability to add increased concentrations of growth factors such as transforming growth factor β (TGF-β) through the local application of PRP may help to optimize the healing environment in rotator cuff repairs. Full-Text PDF