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Orthobiologics in Shoulder Surgery

Authors: L Funk

References: The Annual Meeting of the Israel Society of Sports Medicine. 11-12 June 2008.

Orthobiologics comprises materials that influence tissue healing in orthopaedic surgery. This is one of the largest areas of growth in the orthopaedic product market and expected to double by 2012, as the use of these products becomes widespread. Bone products that provide support, fill voids and enhance healing are already widely used. Similar biological products are being developed for soft tissue repair. These include scaffolds, reinforcement patches and growth factor products.

In the shoulder, traumatic rotator cuff tear is a common problem. With an increasingly active elderly population there are more demands for high level of function and sports in older people. Therefore, there is an increasing demand for repair of rotator cuff tears. However, despite many advances in repair techniques, high strength sutures and  strong anchors the rates of failure of cuff repairs is still approximately 10-20%. This is due to the poor healing potential of degenerative cuff tissue.

We currently use a number of orthobiologic materials, including regenerative tissue matrix patches, platelet rich plasma (PRP) and hyaluronans.

Matrix patches have been shown to provide reinforcement for repairs and also a biological scaffold for tissue ingrowth. Human dermal derived collagen patches are composed of biological substrate components including collagen types I, III, IV, and VII, elastin, chondroitin sulfate, and proteoglycans. These can be inserted both open and arthroscopically. Early results in massive and revision cuff repairs are promising.

Platelets contain alpha-granules that contain multitude of growth factors. Growth factors derived from platelets play an essential role in tendon healing. PRP is concentrated and activated platelets from the patient. This is applied to the repair site at the time of surgery. Early results are encouraging and products evolving.

Hyaluronans are widely used to prevent adhesions after surgery and for knee arthroscopic surgery. As an essential component of synovial fluid hyaluronans provide the following benefits to surgery: Anti-inflammatory, pain barrier, stimulates endogenous hyaluronans, joint lubrication, inhibits phagocytosis and reduces levels of  Prostaglandins, IL-1, Free Radicals and CaMP. Hyaluronan use has been shown to enhance tissue properties and recovery.

In this presentation I discuss the use of these orthobiologics in shoulder surgery, our experiences, techniques, research projects and early results.

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