Longo Umile Giuseppe, Lamberti Alfredo, Rizzello Giacomo, Maffulli Nicola, Denaro Vincenzo
Med Sport Sci. 2012;57:168-177. doi: 10.1159/000328891. Epub 2011 Oct 4.
Massive rotator cuff tears represent a great challenge in orthopaedic. They are associated with persistent defects, weakness, and poor outcomes and can cause an uncoupling of forces across the glenohumeral joint, with unstable shoulder kinematics. In the last few years, a notable interest has emerged to develop new treatment strategies that provide effective mechanical reinforcement of rotator cuff repair and stimulate and enhance the patient's intrinsic healing potential. Tissue engineering techniques using novel scaffold materials offer potential alternatives for managing massive irreparable rotator cuff tears. Synthetic scaffolds, manufactured from chemical compounds, have gained much interest to bridge massive rotator cuff tears. Preliminary studies support the idea that synthetic scaffolds can provide an alternative for rotator cuff augmentation with an enormous therapeutic potential. Despite the growing clinical use of synthetic scaffold devices for rotator cuff repair, there are numerous questions related to their indication, surgical application, safety, mechanism of action, and efficacy that remain to be clarified or addressed. We review the current basic science and clinical understanding of synthetic scaffolds for massive rotator cuff repair, reporting the preclinical and clinical studies carried out to date in this field. We underline the benefits and limitations of the available synthetic scaffolds for augmentation of rotator cuff tears, and discuss the implications of these literature data on the future directions for the use of these scaffolds in tendon repair procedures.
巨大肩袖撕裂是骨科领域的一大挑战。它们与持续性缺损、无力及不良预后相关,可导致盂肱关节力的解耦,伴肩关节运动学不稳定。在过去几年中,人们对开发新的治疗策略产生了浓厚兴趣,这些策略可有效增强肩袖修复的机械强度,并刺激和提高患者自身的愈合潜力。使用新型支架材料的组织工程技术为处理巨大不可修复肩袖撕裂提供了潜在的替代方法。由化合物制成的合成支架在桥接巨大肩袖撕裂方面引起了广泛关注。初步研究支持这样的观点,即合成支架可为肩袖增强提供一种具有巨大治疗潜力的替代方法。尽管合成支架装置在肩袖修复中的临床应用日益增加,但关于其适应证、手术应用、安全性、作用机制和疗效等仍有许多问题有待阐明或解决。我们回顾了目前对用于巨大肩袖修复的合成支架的基础科学和临床认识,报告了该领域迄今为止开展的临床前和临床研究。我们强调了现有合成支架用于增强肩袖撕裂的益处和局限性,并讨论了这些文献数据对这些支架在肌腱修复手术中未来应用方向的影响。