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Background Because the retear rate after rotator cuff repairs remains high, methods to improve healing are very much needed. Platelet-rich concentrates have been shown to enhance tenocyte proliferation and promote extracellular matrix synthesis in vitro; however, their clinical benefit remains unclear. We hypothesized that arthroscopic rotator cuff repair with leucocyte- and platelet-rich fibrin (L-PRF) results in better clinical and radiographic outcome at 12 months of follow-up than without L-PRF. Methods Thirty-five patients were randomized to receive arthroscopic rotator cuff repair with L-PRF locally applied to the repair site (L-PRF+ group, n = 17) or without L-PRF (L-PRF− group, n = 18). Preoperative and postoperative clinical evaluation included the Subjective Shoulder Value, visual analog score for pain, Simple Shoulder Test, and Constant-Murley score. The anatomic watertight healing, tendon thickness, and tendon quality was evaluated using magnetic resonance arthrography at 12 months of follow-up. Results No complications were reported in either group. The mean Subjective Shoulder Value, Simple Shoulder Test, and Constant-Murley scores increased from preoperatively to postoperatively, showing no significant differences between the groups. Complete anatomic watertight healing was found in 11 of 17 in the L-PRF+ group and in 11 of 18 in the L-PRP− group ( P = .73). The mean postoperative defect size (214 ± 130 mm 2 in the L-PRF+ group vs 161 ± 149 mm 2 in the L-PRF− group; P = .391) and the mean postoperative tendon quality according to Sugaya (L-PRF+ group: 3.0 ± 1.4, L-PRF− group: 3.0 ± 0.9) were similar in both groups at 12 months of follow-up. Conclusion Arthroscopic rotator cuff repair with application of L-PRF yields no beneficial effect in clinical outcome, anatomic healing rate, mean postoperative defect size, and tendon quality at 12 months of follow-up. [ABSTRACT FROM AUTHOR]

Hypothesis: We hypothesized that arthroscopic rotator cuff repairs using leukocyte- and platelet-rich fibrin (L-PRF) in a standardized, modified protocol is technically feasible and results in a higher vascularization response and watertight healing rate during early healing. Methods: Twenty patients with chronic rotator cuff tears were randomly assigned to 2 treatment groups. In the test group (N = 10), L-PRF was added in between the tendon and the bone during arthroscopic rotator cuff repair. The second group served as control (N = 10). They received the same arthroscopic treatment without the use of L-PRF. We used a double-row tension band technique. Clinical examinations including subjective shoulder value, visual analog scale, Constant, and Simple Shoulder Test scores and measurement of the vascularization with power Doppler ultrasonography were made at 6 and 12 weeks. Results: There have been no postoperative complications. At 6 and 12 weeks, there was no significant difference in the clinical scores between the test and the control groups. The mean vascularization index of the surgical tendon-to-bone insertions was always significantly higher in the L-PRF group than in the contralateral healthy shoulders at 6 and 12 weeks (P = .0001). Whereas the L-PRF group showed a higher vascularization compared with the control group at 6 weeks (P = .001), there was no difference after 12 weeks of follow-up (P = .889). Watertight healing was obtained in 89% of the repaired cuffs. Discussion/Conclusions: Arthroscopic rotator cuff repair with the application of L-PRF is technically feasible and yields higher early vascularization. Increased vascularization may potentially predispose to an increased and earlier cellular response and an increased healing rate. [Copyright &y& Elsevier]

Abstract: The shoulder is the most frequently dislocated joint in the human body, anterior dislocation being the most common variant. For stability, the glenohumeral joint relies on both static and dynamic restraints and dislocation often results in damage to these restraints. For example, antero-inferior capsulolabral complex damage often occurs as a result of anterior dislocations (a ‘Bankart lesion’) and impaction of the dislocated humeral head against the rim of the antero-inferior glenoid can result in a postero-lateral humeral head defect (the ‘Hill–Sachs lesion’). Prompt reduction of the dislocation is necessary to relieve pain and reduce the risk of complications, and should be performed as soon as possible in the emergency department, or in the operating theatre in cases with an associated shoulder fracture. Subsequent treatment of the dislocation is aimed at restoring function of the shoulder and minimizing the risk of recurrent instability. Non-surgical treatment is the conventional method of management after a successful closed reduction and involves immobilization of the affected shoulder for between 3 and 6 weeks coupled with, or followed by, physiotherapy. Young age at the time of the first anterior dislocation is associated with a high rate of recurrence and there is growing evidence that primary arthroscopic stabilization significantly reduces the rate of recurrent instability. This article outlines the current management strategies for dealing with this acute traumatic injury. [Copyright &y& Elsevier]

Tendons and ligaments are similar structures in terms of their composition, organisation and mechanical properties. The distinction between them stems from their anatomical location; tendons form a link between muscle and bone while ligaments link bones to bones. A range of overlapping functions can be assigned to tendon and ligaments and each structure has specific mechanical properties which appear to be suited for particular in vivo function. The extracellular matrix in tendon and ligament varies in accordance with function, providing appropriate mechanical properties. The most useful framework in which to consider extracellular matrix differences therefore is that of function rather than anatomical location. In this review we discuss what is known about the relationship between functional requirements, structural properties from molecular to gross level, cellular gene expression and matrix turnover. The relevance of this information is considered by reviewing clinical aspects of tendon and ligament repair and reconstructive procedures. [ABSTRACT FROM AUTHOR]