Will Platelet Rich Plasma Open New Era for Treatment of Rotator Cuff Tear?

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Clin Shoulder Elb. 2018;21(1):1-2
Publication date (electronic) : 2018 March 1
doi : https://doi.org/10.5397/cise.2018.21.1.1
Department of Orthopaedic Surgery, Jeju National University School of Medicine, Jeju, Korea
Correspondence to: Sungwook Choi Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju 63241, Korea Tel: +82-64-717-1690, Fax: +82-64-717-1131, E-mail: swchoi1115@gmail.com

About 30% to 70% of chronic shoulder pain is developed by rotator cuff tear, impairing daily living activities, and quality of life [1-3]. It is repoarted that progression of tears is not only characterized by cellular but also extracellular matrix changes including reduced cell number, decreased vascularization, poor matrix organization, changed gene expression and alterations in proteoglycans and collagens, which play an important role in rotator cuff tear pathology [4-6]. Some of the up-to-date literatures point out that platelet rich plasma (PRP) provides potential healing enviorment for tendon to bone attachement [7,8]. However, there has been no comparative study of PRP effect on tenocytes collected from the rotator cuff between normal and degenerative torn tendon.

It is well known by many other literatures state that the cell proliferation, or density of tenocytes are much more higher in teared rotator cuff than normal rotator cuff [4,9]. Moreover, Anitua et al. [10,11] reported that 20% PRP releasate (vol/vol) increased cell proliferation and the production of vascular endothelial growth factor and hepatocyte growth factor in human healthy hamstring tendon. It is proven in the research by Jo et al. [12] that PRP activated calcium with or without thrombin significantly stimulated the proliferation of tenocytes from human rotator cuff tendons with degenerative tears in a dose-dependent manner.

The mechanism of proteoglyan transformation is also found to be critial in pathology of rotator cuff tear. Lo et al. [13] revealed changes in proteoglycans; aggrecan increased while decorin decreased in the ruptured rotator cuff tendon when compared with normal cadaveric controls. Elevated level of proteoglycan, tenascin-C and fibronectin, in ruptured rotator cuff was reported [14,15].

The enhancement of gene expression of makers for collagen type I, and decrease of collagen type III level is carried out by PRP, and resultant positive collagen I/III ratio was achieved in equine tendon explants [16]. de Mos et al. [17] claimed that when PRP was injected to normal tendon of 13 to 15 aged children, number of cell, and total level of collagen were significantly increased, but decreased the gene expressions of type I and III collagen without affecting the III/I ratio was identified.

The effect of PRP was quiet different from that of de Mos et al. [17], since the gene expression of type I and III collagen in both tenocytes from normal and degenerative tendon were increased, and Yoon et al. [18] showed that there were no statistically significant differences between normal and degenerative tendon. The gene expression of type III collagen was only significantly increased in degenerative tendon. However, the fold-change of type I collagen in degenerative tendon was higher than in normal tendon. Although there were no statistical significances, this increased rate can be considered to reflect a greater impact of PRP on the degenerative tendon.

The retear rate after rotator cuff repair varies depending on tear size of tendon, number of tendons involved, and the age of patients. It is described that rates of retear are up to 80% to 90% exist in the radiology literature and are as high as 57% in the orthopaedic literature [19-21]. However, according to the previously published studies, when PRP technique is added, decrease of the retear rate of rotator cuff is expected.

PRP, which promotes cellular proliferation and regeneration, is being utilized in many field of medical science and related researches are in full swing. PRP expedites tenocyte proliferation in both normal and degenetively torn rotator cuff and facilitates tendon matrix synthesis. Not only PRP has a positive effect on cell proliferation, but also elevated matrix gene expression and synthesis in tenocytes from degenerative torn tendon than tenocytes from normal tendon. Applying properly administrated PRP in treating rotator cuff tear will promise excellent functional outcome.


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1. Bongers PM. The cost of shoulder pain at work. BMJ 2001;322(7278):64–5.
2. Urwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998;57(11):649–55.
3. Jo CH, Shin WH, Park JW, Shin JS, Kim JE. Degree of tendon degeneration and stage of rotator cuff disease. Knee Surg Sports Traumatol Arthrosc 2017;25(7):2100–8.
4. Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br 2006;88(4):489–95.
5. Chaudhury S, Carr AJ. Lessons we can learn from gene expression patterns in rotator cuff tears and tendinopathies. J Shoulder Elbow Surg 2012;21(2):191–9.
6. Riley GP. Gene expression and matrix turnover in overused and damaged tendons. Scand J Med Sci Sports 2005;15(4):241–51.
7. Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med 2015;43(9):2102–10.
8. Kim SJ, Lee SM, Kim JE, Kim SH, Jung Y. Effect of platelet-rich plasma with self-assembled peptide on the rotator cuff tear model in rat. J Tissue Eng Regen Med 2017;11(1):77–85.
9. Lundgreen K, Lian OB, Engebretsen L, Scott A. Tenocyte apoptosis in the torn rotator cuff: a primary or secondary pathological event. Br J Sports Med 2011;45(13):1035–9.
10. Anitua E, Sánchez M, Orive G, Andía I. The potential impact of the preparation rich in growth factors (PRGF) in different medical fields. Biomaterials 2007;28(31):4551–60.
11. Anitua E, Sánchez M, Zalduendo MM, et al. Fibroblastic response to treatment with different preparations rich in growth factors. Cell Prolif 2009;42(2):162–70.
12. Jo CH, Kim JE, Yoon KS, Shin S. Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears. Am J Sports Med 2012;40(5):1035–45.
13. Lo IK, Boorman R, Marchuk L, Hollinshead R, Hart DA, Frank CB. Matrix molecule mRNA levels in the bursa and rotator cuff of patients with full-thickness rotator cuff tears. Arthroscopy 2005;21(6):645–51.
14. Riley GP, Harrall RL, Cawston TE, Hazleman BL, Mackie EJ. Tenascin-C and human tendon degeneration. Am J Pathol 1996;149(3):933–43.
15. Tillander B, Franzén L, Norlin R. Fibronectin, MMP-1 and histologic changes in rotator cuff disease. J Orthop Res 2002;20(6):1358–64.
16. McCarrel T, Fortier L. Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res 2009;27(8):1033–42.
17. de Mos M, van der Windt AE, Jahr H, et al. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med 2008;36(6):1171–8.
18. Yoon JY, Lee SY, Shin S, Yoon KS, Jo CH. Comparative analysis of platelet-rich plasma effect on tenocytes from normal human rotator cuff tendon and human rotator cuff tendon with degenerative tears. Clin Shoulder Elbow 2018;21(1):3–14.
19. Charousset C, Bellaïche L, Kalra K, Petrover D. Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy 2010;26(3):302–9.
20. Liem D, Bartl C, Lichtenberg S, Magosch P, Habermeyer P. Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: a magnetic resonance imaging-controlled matched-pair analysis. Arthroscopy 2007;23(5):514–21.
21. Liem D, Lichtenberg S, Magosch P, Habermeyer P. Magnetic resonance imaging of arthroscopic supraspinatus tendon repair. J Bone Joint Surg Am 2007;89(8):1770–6.

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