I fattori di crescita e gli “scaffold” biologici nella chirurgia della cuffia dei rotatori

Università degli Studi di Milano, IRCCS Istituto Ortopedico Galeazzi Dipartimento di Tecnologie per la Vita, Facoltà di Medicina Milano Italy; Università degli Studi di Milano Istituto di Patologia Generale, Facoltà di Medicina Milano Italy
LO SCALPELLO-OTODI Educational 10/2008; 22(1):66-76. DOI: 10.1007/s11639-008-0092-5

ABSTRACT Rotator cuff injuries are a common source of pain and an important cause of reduction of quality of life. In Italy, it is
estimated that 30% of individuals over 60 years of age experience rotator cuff injuries. Despite the advances in surgical
techniques, the rate of recurrent tears after surgical repair is high (up to 40%). Tendon healing forms lower quality tissue
and, despite remodelling the healed tendon’s tissue never matches that of intact tendon. Due to the frequency of these injuries,
as well as the rate of re-tear, it is not surprising that new and innovative strategies like tissue engineering have become
more appealing. Tissue engineering strategies involve the use of scaffolds, cells, and/or bioactive factors to promote tendon
regeneration via natural processes. The present paper reviews the current state of knowledge regarding regeneration of tendon’s
tissue from cells with the support of scaffolds and growth factors.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Porcine small intestine submucosal grafts have been successful in enhancing soft tissue repair, as demonstrated by animal studies. Currently, there are no reports of the use of such implants in human rotator cuff repair. Case series; Level of evidence, 4. Over a 6-month period, 25 patients underwent rotator cuff repair by one surgeon using the Restore Orthobiologic Implant to augment the repaired tendon or fill a defect. Four of 25 patients experienced an overt inflammatory reaction at a mean of 13 days postoperatively. All patients underwent open irrigation and debridement of the rotator cuff and porcine small intestine submucosal implant. Porcine small intestine submucosal implants should be used in rotator cuff surgery with the awareness that a non-specific inflammatory reaction can occur in the early postoperative period. This inflammatory reaction may cause breakdown of the repair. Further studies are needed to further characterize the reaction and determine which patients are susceptible.
    The American Journal of Sports Medicine 07/2005; 33(6):907-11. · 4.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cellular responsiveness to growth factors that can affect tendon healing may be site-specific. We have compared the dose-response effects of platelet-derived growth factor-BB (PDGF-BB) on proteoglycan, collagen, noncollagen protein and DNA synthesis between intrasynovial intermediate and proximal segments of deep flexor tendons, and extrasynovial peroneal tendons of rabbits during short-term cultures. PDGF-BB stimulated matrix and DNA synthesis of the three types of tendon segments in a dose-dependent manner in the range from 0.1 to 100 ng/mL. PDGF-BB stimulated collagen synthesis and noncollagen protein synthesis (calculated from LogED50) in proximal intrasynovial tendon segments more than in extrasynovial peroneal tendon segments, and DNA synthesis less in proximal than in intermediate intrasynovial tendons. However, the estimated maximal stimulations (Emax) by PDGF-BB were similar in the three types of tendon segments. These findings show that PDGF-BB stimulates DNA and matrix synthesis differently in various types and regions of tendons during short term explant culture and suggests that there may be differences in cellular responsiveness during tendon healing.
    Acta Orthopaedica Scandinavica 07/2001; 72(3):287-92.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Tenocytes were isolated from the rotator cuff tendons of healthy (HT) and glucocorticoid (GC)-treated rats (GCT) and were cultured on polystyrene wells (TCP) as control, and on 2 de-cellularized collagen matrices: porcine small intestinal submucosa (SIS), and human dermal matrix (Graftjacket, GJ). At 3 and 7 days cell proliferation and synthesis were evaluated. Proliferation of HT tenocytes increased between experimental times for both tested membranes, but already at 3 days, HT tenocytes cultured on GJ showed the highest WST-1 value. The collagen-I (CICP) synthesis on GJ membrane did not change between experimental times and was significantly higher than TCP and SIS at 7 days. Proteoglycans (PG), and fibronectin (FBN) synthesis increased when HT were cultured on GJ, between experimental times, and both PG and FBN synthesis on GJ membrane were higher than TCP and SIS at 7 days. GC determined decreases in cell proliferation, CICP and PG syntheses at 3 days of culture on TCP when compared to HT tenocytes while a decrease in WST-1 was maintained at 7 days. CICP, PG and FBN (only at 3 days) syntheses were significantly higher in GCT tenocytes cultured on GJ. The negative effects on GC on GCT tenocytes cultured on membrane were particularly evident on SIS for CICP (-18%) and FBN (-67%) synthesis. The obtained results support the conclusion that GJ is more suitable than SIS as a scaffold for in situ tissue engineering and for the in vitro bioengineering of tendons to heal massive tears of the rotator cuff tendon.
    Journal of Orthopaedic Research 02/2007; 25(1):98-107. · 2.97 Impact Factor