Growth factors in Rotator Cuff, Presented in SIA- AANA Meeting - Trieste 2012

1. A. Busilacchi ,
Clinical Orthopedics – Department of Clinical and
Experimental Science
Università Politecnica delle Marche – Ancona- Italy
albertobusilacchi@yahoo.it

2. •Scaffolds
•Growth Factors
•Gene Therapy
•MSCs

3. GROWTH FACTORS & ROTATOR CUFF
2 ways to reach the same “destination” :
Deliver GFs around the cuff
LOW FARE (Free)
•Acromioplasty
•Microfractures (Crimson – Duvet)
HI-FARE (Hundreds €)
•Commercial Kits for Autologous
PRP, PRFM, PRGF ….
•Donor-derived PRP

5. “CRIMSON – DUVET”
SJ Snyder, Burns J.
Techniques in Shoulder & Elbow Surgery:
December 2009 - Volume 10 - Issue 4 - pp 130-137
simple method for
initiating bone marrow
egress from the
proximal humeral
metaphysis
Good Hystological
Results
(Arnoczky )
Courtesy of Dr. F. Campi

6. Platelet Rich Plasma
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PDGF(ab)
TGF β1
EGF
IGF-1
VEGF
PDEGF
MGF
HGF
bFGF
BMPs
VARIABLES:
-Variability in platelets content
-Different centrifugation systems
-Leucocyte inclusion or removal from final product
- Impossibility to know exactly what we inject

8. …Our study does not support the use of autologous PRFM for augmentation
of a double-row repair of a small or medium rotator cuff tear to improve the
healing of the rotator cuff. Our results are applicable to small and medium
rotator cuff tears …it is possible that PRFM may be beneficial for large and
massive rotator cuff tears.
The American Journal of Sports Medicine, Vol. 39, No. 10

9. The American Journal of Sports Medicine, Vol. 40, No. 2

11. The American Journal of Sports Medicine, Vol. 40, No. 5

12. My concerns and doubts…
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Choice of proper Shoulder Scores (Longo, 2012) to
evaluate the outcomes
Make it sense to place PRP intraoperatively when similar
results actually come from conventional techniques??
Long term safety not available
COST /EFFECTIVENESS for PRP kits has NOT proven yet!
GFs Concetration
Gel or Lisate
PRFM - PRGF
Leucocytes YES/NO
Autologous/Homologous
Injections: how many?
ml of PRP per admin..

13. CONCLUSIONS
A. Busilacchi, M. Del Torto, S. Manzotti,F. Orlando, A. Gigante
OUR FINDINGS
•Analgesia
•Neoangiogenesis
• Cells improved chemiotaxis (Higher density than controls)
•Increased synthesis of collagen ( I & III)
GFs as triggers o accelerators, in the very early reparative process
(inflamatory phase).
Preclicnical study
on Wistar rat’s
tendons
In press
Tendon Treated 60 days
Tendon Control 60 days

14. OUR PHILOSOPY…
PREVENTION IN BURSITIS AND PARTIAL/DELAMINATION TEARS:
Subacromial/ intra articular PRP injections
INTRA-OPERATIVELY :
Acromioplasty and/or Microfractures in cuff footprint and around (beware
of iatrogenic fractures and anchors pullout)
POST-OPERATIVELY :
Subacromial/ intra articular PRP injections
Our Ongoing Clinical Study :
”Subacromial injections of homologus PRP vs HA
in subacromial bursitis and partial cuff tears. RCT Study”
no preliminary results available yet