Gulotta Lawrence V, Rodeo Scott A
Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
Clin Sports Med. 2009 Jan;28(1):13-23. doi: 10.1016/j.csm.2008.09.002.
The 4 fibrocartilagenous transition zones of the rotator cuff insertion site are not recreated following surgical repair. Instead, a layer of scar tissue is formed between the tendon and the bone, which makes repairs prone to failure. Growth factors are a group of cytokines that induce mitosis, extracellular matrix production, neovascularization, cell maturation, and differentiation. Research has focused on their ability to augment rotator cuff repairs. Studies have shown that several factors are capable of increasing the strength of repairs in animal models. However, this appears to be accomplished through the production of more scar tissue, as opposed to regeneration of native tissue. It is becoming clear that multiple factors may be needed to regenerate the native tendon-bone insertion site. The optimal timing and vehicle for growth factor delivery have remained elusive. Gene therapy and tissue scaffolds provide promising options for the future, but the engineering still needs to be optimized for clinical use. Growth factor therapy for rotator cuff repairs remains a promising therapeutic for the future; however, much work needs to be done to optimize its effectiveness.
肩袖插入部位的4个纤维软骨过渡区在手术修复后无法重建。相反，在肌腱和骨骼之间会形成一层瘢痕组织，这使得修复容易失败。生长因子是一类可诱导有丝分裂、细胞外基质产生、新血管形成、细胞成熟和分化的细胞因子。研究聚焦于它们增强肩袖修复的能力。研究表明，几种因子能够在动物模型中增强修复强度。然而，这似乎是通过产生更多瘢痕组织来实现的，而非原生组织的再生。越来越明显的是，可能需要多种因子来再生原生的肌腱-骨插入部位。生长因子递送的最佳时机和载体仍然难以确定。基因治疗和组织支架为未来提供了有前景的选择，但工程学仍需针对临床应用进行优化。肩袖修复的生长因子治疗在未来仍是一种有前景的治疗方法；然而，要优化其有效性仍有许多工作要做。
