CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 271-278
DOI: 10.1055/s-0042-1750832
Artigo Original
Ombro e Cotovelo

Investigation the Effect of Human Recombinant Epidermal Growth Factor on Rotator Cuff Healing: An Experimental Model[*]

Article in several languages: português | English
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Alanya Alaaddin Keykubat, Alanya/Antalya, Turquia
,
2   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Hacettepe, Ankara, Turquia
,
1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Alanya Alaaddin Keykubat, Alanya/Antalya, Turquia
,
3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia
,
3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia
,
3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia
› Author Affiliations
Financial Support There was no financial support from public, commercial, or non-profit sources.

Abstract

Objective To investigate the effectiveness of human recombinant epidermal growth factor in the healing of rotator cuff tear in the rabbit shoulder.

Methods Rotator cuff tears (RCTs) were experimentally created on both shoulders of 20 New Zealand rabbits. The rabbits were divided into the following groups: RCT (sham group; n = 5), RCT + EGF (EGF group; n = 5), RCT + transosseous repair (repair group; n = 5), and RCT + EGF + transosseous repair (combined repair + EGF group; n = 5). All rabbits were then observed for 3 weeks, and biopsies were taken from the right shoulders in the third week. After three more weeks of observation, all rabbits were sacrificed, and a biopsy removed from their left shoulders. All biopsy material was stained with haematoxylin & eosin (H&E) and vascularity, cellularity, the proportion of fibers and the number of fibrocartilage cells were evaluated under light microscope.

Results The highest collagen amount and the most regular collagen sequence was detected in the combined repair + EGF group. The repair group and the EGF group showed higher fibroblastic activity and capillary formation when compared with the sham group, but the highest fibroblastic activity and capillary formation with highest vascularity was detected in the combined repair + EGF group (p < 0.001). EGF seems to improve wound healing in the repair of RCT. The EGF application alone, even without repair surgery, seems to be beneficial to RCT healing.

Conclusion In addition to rotator cuff tear repair, application of human recombinant epidermal growth factor has an effect on rotator cuff healing in rabbit shoulders.

Authors' Contributions

Each author contributed individually and significantly to the development of this article:

A. G.: Conceptualization (lead), data curation, application of the animal experiment, and application of surgery in an animal experiment.

E. T., A. A.: Methodology, project administration, planning of the project.

S. Ç., E. A., G. A.: Histology and embryology.


* Study developed at the Faculty of Medicine, Alanya Alaaddin Keykubat University, Alanya/Antalya, Turkey.




Publication History

Received: 13 November 2021

Accepted: 28 April 2022

Article published online:
06 July 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Maffulli N, Longo UG, Berton A, Loppini M, Denaro V. Biological factors in the pathogenesis of rotator cuff tears. Sports Med Arthrosc Rev 2011; 19 (03) 194-201
  • 2 Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 2007; 455 (455) 52-63
  • 3 Chillemi C, Petrozza V, Garro L. et al. Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthrosc 2011; 19 (09) 1588-1596
  • 4 Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia) 2012; 4 (02) e18
  • 5 VanBaak K, Aerni G. Shoulder Conditions: Rotator Cuff Injuries and Bursitis. FP Essent 2020; 491: 11-16
  • 6 Huang Y, He B, Wang L. et al. Bone marrow mesenchymal stem cell-derived exosomes promote rotator cuff tendon-bone healing by promoting angiogenesis and regulating M1 macrophages in rats. Stem Cell Res Ther 2020; 11 (01) 496
  • 7 Oliva F, Gatti S, Porcellini G, Forsyth NR, Maffulli N. Growth factors and tendon healing. Med Sport Sci 2012; 57: 53-64
  • 8 Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33 (05) 381-394
  • 9 Takahashi S, Nakajima M, Kobayashi M. et al. Effect of recombinant basic fibroblast growth factor (bFGF) on fibroblast-like cells from human rotator cuff tendon. Tohoku J Exp Med 2002; 198 (04) 207-214
  • 10 Bidder M, Towler DA, Gelberman RH, Boyer MI. Expression of mRNA for vascular endothelial growth factor at the repair site of healing canine flexor tendon. J Orthop Res 2000; 18 (02) 247-252
  • 11 Basal O, Atay T, Ciris İM, Baykal YB. Epidermal growth factor (EGF) promotes bone healing in surgically induced osteonecrosis of the femoral head (ONFH). Bosn J Basic Med Sci 2018; 18 (04) 352-360
  • 12 Plate JF, Brown PJ, Walters J. et al. Advanced age diminishes tendon-to-bone healing in a rat model of rotator cuff repair. Am J Sports Med 2014; 42 (04) 859-868
  • 13 Ide J, Kikukawa K, Hirose J. et al. The effect of a local application of fibroblast growth factor-2 on tendon-to-bone remodeling in rats with acute injury and repair of the supraspinatus tendon. J Shoulder Elbow Surg 2009; 18 (03) 391-398
  • 14 Kwon J, Kim YH, Rhee SM. et al. Effects of Allogenic Dermal Fibroblasts on Rotator Cuff Healing in a Rabbit Model of Chronic Tear. Am J Sports Med 2018; 46 (08) 1901-1908
  • 15 Benjamin M, Toumi H, Ralphs JR, Bydder G, Best TM, Milz S. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 2006; 208 (04) 471-490
  • 16 Honda H, Gotoh M, Kanazawa T. et al. Hyaluronic Acid Accelerates Tendon-to-Bone Healing After Rotator Cuff Repair. Am J Sports Med 2017; 45 (14) 3322-3330
  • 17 Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N. Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disabil Rehabil 2008; 30 (20-22): 1584-1589
  • 18 Vilchez-Cavazos F, Millán-Alanís JM, Blázquez-Saldaña J. et al. Comparison of the Clinical Effectiveness of Single Versus Multiple Injections of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis. Orthop J Sports Med 2019; 7 (12) 2325967119887116
  • 19 Middleton KK, Barro V, Muller B, Terada S, Fu FH. Evaluation of the effects of platelet-rich plasma (PRP) therapy involved in the healing of sports-related soft tissue injuries. Iowa Orthop J 2012; 32: 150-163
  • 20 Lindeboom JA, Mathura KR, Aartman IH, Kroon FH, Milstein DM, Ince C. Influence of the application of platelet-enriched plasma in oral mucosal wound healing. Clin Oral Implants Res 2007; 18 (01) 133-139
  • 21 Pandey V, Jaap Willems W. Rotator cuff tear: A detailed update. Asia Pac J Sports Med Arthrosc Rehabil Technol 2015; 2 (01) 1-14
  • 22 Sarıkaya B, Yumuşak N, Yigin A, Sipahioğlu S, Yavuz Ü, Altay MA. Comparison of the effects of human recombinant epidermal growth factor and platelet-rich plasma on healing of rabbit patellar tendon. Eklem Hastalik Cerrahisi 2017; 28 (02) 92-99
  • 23 Hardwicke J, Schmaljohann D, Boyce D, Thomas D. Epidermal growth factor therapy and wound healing–past, present and future perspectives. Surgeon 2008; 6 (03) 172-177
  • 24 Kocyigit I, Huri G, Yürüker S. et al. Epidermal Growth Factor Stimulates Rabbit Achilles Tendon Histologically and Biomechanically Healing. Muscles Ligaments Tendons J 2020; 10 (04) 589-602