Orthopedics Department, Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
Curr Rev Musculoskelet Med. 2015 Mar;8(1):9-17. doi: 10.1007/s12178-015-9257-z.
Injuries of the Achilles tendon are relatively common with potentially devastating outcomes. Healing Achilles tendons form a fibrovascular scar resulting in a tendon which may be mechanically weaker than the native tendon. The resulting strength deficit causes a high risk for reinjury and other complications. Treatments using biologics aim to restore the normal properties of the native tendon and reduce the risk of rerupture and maximize tendon function. The purpose of this review was to summarize the current findings of various therapies using biologics in an attempt to improve the prognosis of Achilles tendon ruptures and tendinopathies. A PubMed search was performed using specific search terms. The search was open for original manuscripts and review papers limited to publication within the last 10 years. From these searches, papers were included in the review if they investigated the effects of biological augmentation on Achilles tendon repair or healing. Platelet-rich plasma may assist in the healing process of Achilles tendon ruptures, while the evidence to support its use in the treatment of chronic Achilles tendinopathies remains insufficient. The use of growth factors such as hepatocyte growth factor, recombinant human platelet-derived growth factor-BB, interleukin-6, and transforming growth factor beta as well as several bone morphogenetic proteins have shown promising results for Achilles tendon repair. In vitro and preclinical studies have indicated the potential effectiveness of bone marrow aspirate as well. Stem cells also have positive effects on Achilles tendon healing, particularly during the early phases. Polyhydroxyalkanoates (PHA), decellularized tendon tissue, and porcine small intestinal submucosa (SIS) are biomaterials which have shown promising results as scaffolds used in Achilles tendon repair. The application of biological augmentation techniques in Achilles tendon repair appears promising; however, several techniques require further investigation to evaluate their clinical application.
跟腱损伤较为常见，可能会导致严重后果。跟腱愈合后形成纤维血管瘢痕，导致跟腱的机械强度不如正常跟腱。由此产生的强度缺陷会导致再损伤和其他并发症的风险增加。使用生物制剂的治疗旨在恢复正常的跟腱特性，降低再断裂的风险，并最大限度地提高跟腱功能。本综述的目的是总结使用生物制剂治疗各种疾病的最新发现，以期改善跟腱断裂和跟腱病的预后。我们使用特定的搜索词在 PubMed 上进行了搜索。搜索范围为在过去 10 年内发表的原始手稿和综述论文。从这些搜索中，如果论文调查了生物增强对跟腱修复或愈合的影响，则将其纳入综述。富血小板血浆可能有助于跟腱断裂的愈合过程，而支持其用于治疗慢性跟腱病的证据仍然不足。生长因子如肝细胞生长因子、重组人血小板衍生生长因子-BB、白细胞介素-6 和转化生长因子-β以及几种骨形态发生蛋白在跟腱修复方面显示出良好的效果。体外和临床前研究也表明骨髓抽吸具有潜在的有效性。干细胞对跟腱愈合也有积极影响，特别是在早期阶段。聚羟基烷酸酯（PHA）、脱细胞肌腱组织和猪小肠黏膜下层（SIS）是生物材料，作为跟腱修复的支架显示出良好的效果。生物增强技术在跟腱修复中的应用前景广阔；然而，一些技术需要进一步研究，以评估其临床应用。
