MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48106, USA.
J Shoulder Elbow Surg. 2012 Feb;21(2):218-27. doi: 10.1016/j.jse.2011.09.020.
The pathogenesis of rotator cuff degeneration remains poorly defined, and the incidence of degenerative tears is increasing in the aging population. Rates of recurrent tear and incomplete tendon-to-bone healing after repair remain significant for large and massive tears. Previous studies have documented a disorganized, fibrous junction at the tendon-to-bone interface after rotator cuff healing that does not recapitulate the organization of the native enthesis. Many biologic factors have been implicated in coordinating tendon-to-bone healing and maintenance of the enthesis after rotator cuff repair, including the expression and activation of transforming growth factor-β, basic fibroblast growth factor, platelet-derived growth factor-β, matrix metalloproteinases, and tissue inhibitors of metalloproteinases. Future techniques to treat tendinopathy and enhance tendon-to-bone healing will be driven by our understanding of the biology of this healing process after rotator cuff repair surgery. The use of cytokines to provide important signals for tissue formation and differentiation, the use of gene therapy techniques to provide sustained cytokine delivery, the use of stem cells, and the use of transcription factors to modulate endogenous gene expression represent some of these possibilities.
肩袖退变的发病机制仍不清楚，老龄化人群中退行性撕裂的发生率正在增加。对于大撕裂和巨大撕裂，修复后撕裂复发和不完全肌腱-骨愈合的发生率仍然很高。先前的研究已经证明，肩袖愈合后肌腱-骨界面存在一种紊乱的纤维连接，无法重现天然附着点的组织结构。许多生物学因素被认为与协调肌腱-骨愈合以及修复后的附着点维持有关，包括转化生长因子-β、碱性成纤维细胞生长因子、血小板衍生生长因子-β、基质金属蛋白酶和金属蛋白酶组织抑制剂的表达和激活。未来治疗肌腱病和增强肌腱-骨愈合的技术将取决于我们对肩袖修复手术后愈合过程生物学的理解。细胞因子的使用为组织形成和分化提供了重要信号，基因治疗技术的使用为持续细胞因子输送提供了可能，干细胞的使用以及转录因子的使用来调节内源性基因表达就是其中的一些可能性。
