Growht Factors in Rotator Cuff
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This document discusses the use of growth factors and platelet rich plasma (PRP) for rotator cuff injuries. It provides an overview of techniques like acromioplasty and microfractures that can be used to deliver growth factors. While some studies have found PRP does not improve healing of small or medium tears, it may be beneficial for large tears. The document outlines concerns with PRP like variable platelet content and cost effectiveness. It also describes the authors' preclinical study findings that growth factors can accelerate the early reparative process in rat tendons. Their philosophy is outlined for using PRP injections preventatively and intraoperatively along with techniques like acromioplasty and microfractures. An ongoing
Growht Factors in Rotator Cuff
- 1. A. Busilacchi , Clinical Orthopedics Department of Clinical and Experimental Science Universit Politecnica delle Marche Ancona- Italy albertobusilacchi@yahoo.it
- 3. GROWTH FACTORS & ROTATOR CUFF 2 ways to reach the same destination : Deliver GFs around the cuff LOW FARE (Free) Acromioplasty Microfractures (Crimson Duvet) HI-FARE (Hundreds ) Commercial Kits for Autologous PRP, PRFM, PRGF . Donor-derived PRP
- 5. CRIMSON DUVET 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 ) Courtesy of Dr. F. Campi
- 6. Platelet Rich Plasma PDGF(ab) TGF 硫1 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
- 8. 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
- 9. The American Journal of Sports Medicine, Vol. 40, No. 2
- 11. The American Journal of Sports Medicine, Vol. 40, No. 5
- 12. My concerns and doubts 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! GFs Concetration Gel or Lisate PRFM - PRGF Leucocytes YES/NO Autologous/Homologous Injections: how many? ml of PRP per admin..
- 13. CONCLUSIONS A. Busilacchi, M. Del Torto, S. Manzotti,F. Orlando, A. Gigante 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). Preclicnical study on Wistar rats tendons In press Tendon Treated 60 days Tendon Control 60 days
- 14. OUR PHILOSOPY PREVENTION IN BURSITIS AND PARTIAL/DELAMINATION TEARS: Subacromial/ intra articular PRP injections INTRA-OPERATIVELY : Acromioplasty and/or Microfractures in cuff footprint and around (beware of iatrogenic fractures and anchors pullout) POST-OPERATIVELY : Subacromial/ intra articular PRP injections 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