Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA; Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA; Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA; Department of Biomedical Engineering, University of Connecticut, Storrs, CT, 06269, USA.
Institute for Regenerative Engineering, University of Connecticut Health Center, Farmington, CT 06030, USA; Raymond and Beverly Sackler Center for Biomedical, Biological, Physical and Engineering Sciences, University of Connecticut Health Center, Farmington, CT 06030, USA; Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA.
Int J Pharm. 2018 Jun 15;544(2):358-371. doi: 10.1016/j.ijpharm.2018.01.006. Epub 2018 Jan 6.
The high incidence of degenerative tears and prevalence of retears (20-95%) after surgical repair makes rotator cuff injuries a significant health problem. This high retear rate is attributed to the failure of the repaired tissue to regenerate the native tendon-to-bone insertion (enthesis). Biological augmentation of surgical repair such as autografts, allografts, and xenografts are confounded by donor site morbidity, immunogenicity, and disease transmission, respectively. In contrast, these risks may be alleviated via growth factor therapy, which can actively influence the healing environment to promote functional repair. Several challenges have to be overcome before growth factor delivery can translate into clinical practice such as the selection of optimal growth factor(s) or combination, identification of the most efficient stage and duration of delivery, and the design considerations for the delivery device. Emerging insight into the injury-repair microenvironment and our understanding of growth factor mechanisms in healing are informing the design of advanced delivery scaffolds to effectively treat rotator cuff tears. Here, we review potential growth factor candidates, design parameters and material selection for growth factor delivery, innovative and dynamic delivery scaffolds, and novel therapeutic targets from tendon and developmental biology for the structural and functional healing of rotator cuff repair.
肩袖损伤是一个严重的健康问题，其高发病率和再撕裂率（20-95%）使得外科修复变得尤为重要。这种高再撕裂率归因于修复组织未能再生天然肌腱-骨附着点（附着处）。自体移植物、同种异体移植物和异种移植物等生物增强外科修复分别受到供体部位发病率、免疫原性和疾病传播的影响。相比之下，通过生长因子治疗可以减轻这些风险，其可以积极影响愈合环境，促进功能修复。在生长因子的递送转化为临床实践之前，需要克服几个挑战，例如选择最佳的生长因子（或组合）、确定最有效的递送阶段和持续时间，以及设计递送装置的考虑因素。对损伤-修复微环境的深入了解以及我们对愈合过程中生长因子机制的理解，为设计有效的治疗肩袖撕裂的先进递送支架提供了信息。在这里，我们回顾了潜在的生长因子候选物、生长因子递送的设计参数和材料选择、创新和动态的递送支架，以及来自肌腱和发育生物学的新型治疗靶点，以实现肩袖修复的结构和功能愈合。
