Background:

Platelet-rich fibrin (PRF) is a second-generation platelet concentrate. Although peripheral blood–derived PRF (P-PRF) is commonly applied in biological augmentation, there is no report about the therapeutic effect of bone marrow–derived PRF (BM-PRF) for degenerative rotator cuff tears (RCTs).

Purpose/Hypothesis:

To examine the effects of platelet-rich plasma (PRP), P-PRF, and BM-PRF during rotator cuff repair (RCR) in degenerative RCTs in rabbits. We hypothesized that BM-PRF would accelerate the bone-tendon healing after RCR.

Study Design:

Controlled laboratory study.

Methods:

Degenerative RCT models were created 2 weeks before beginning the study, and 68 juvenile rabbits were divided into 4 groups: the control, PRP, P-PRF, and BM-PRF groups. RCR without augmentation was done in the control group. PRP was prepared by centrifuging peripheral blood twice using a plastic tube. P-PRF and BM-PRF were prepared by centrifuging peripheral blood and bone marrow, respectively, using a glass tube. Rabbits from PRP, P-PRF, and BM-PRF groups were administered the augmentation in a similar fashion for RCR, between the rotator cuff and the footprint of the humerus. At 4, 8, and 12 weeks, rabbits were euthanized and histologically assessed using hematoxylin and eosin staining, Alcian blue staining, and immunohistochemical staining for type I and III collagen. The sections were also evaluated with immunofluorescence staining of vascular endothelial growth factor (VEGF) at 4 weeks.

Results:

The continuity was significantly better in the BM-PRF group at 4 weeks (P < .05). Immunofluorescence staining demonstrated that VEGF-positive stained cells were significantly greater in the BM-PRF group than in the control group (P < .01). The modified tendon maturing score was significantly greater in the BM-PRF group than in the control and PRP groups at 12 weeks (P < .05). There was no significant difference in the modified tendon maturing score of the P-PRF group compared with the control group.

Conclusion:

The rabbit model of degenerative RCTs demonstrated that RCR combined with BM-PRF enhanced tendon-bone continuity and increased the VEGF-positive cells at 4 weeks and obtained preferable tendon-bone maturation at 12 weeks.

Clinical Relevance:

RCR augmented with BM-PRF has the potential to improve clinical outcomes for RCTs.

中文翻译：

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骨髓衍生的富含血小板的纤维蛋白对兔退行性模型中肩袖愈合的有效性

背景：

富血小板纤维蛋白 (PRF) 是第二代浓缩血小板。虽然外周血源性 PRF (P-PRF) 常用于生物增强，但没有关于骨髓源性 PRF (BM-PRF) 对退行性肩袖撕裂 (RCTs) 的治疗效果的报道。

目的/假设：

研究富血小板血浆 (PRP)、P-PRF 和 BM-PRF 在兔退行性随机对照试验中肩袖修复 (RCR) 过程中的作用。我们假设 BM-PRF 会加速 RCR 后的骨肌腱愈合。

学习规划：

受控实验室研究。

方法：

研究开始前 2 周建立退行性 RCT 模型，将 68 只幼兔分为 4 组：对照组、PRP、P-PRF 和 BM-PRF 组。在对照组中进行了没有增强的 RCR。通过使用塑料管将外周血离心两次来制备 PRP。P-PRF 和 BM-PRF 分别通过使用玻璃管离心外周血和骨髓来制备。来自 PRP、P-PRF 和 BM-PRF 组的兔子以类似的 RCR 方式在肩袖和肱骨足印之间进行了增强。在第 4、8 和 12 周，对兔子实施安乐死，并使用苏木精和伊红染色、阿新蓝染色和免疫组织化学染色对 I 型和 III 型胶原蛋白进行组织学评估。

结果：

BM-PRF 组在 4 周时的连续性明显更好（P < .05）。免疫荧光染色表明，BM-PRF 组的 VEGF 阳性染色细胞明显多于对照组（P < .01）。在 12 周时，BM-PRF 组的改良肌腱成熟评分显着高于对照组和 PRP 组（P < .05）。P-PRF组改良肌腱成熟评分与对照组相比无显着差异。

结论：

退行性随机对照试验的兔模型表明，RCR 联合 BM-PRF 在 4 周时增强了肌腱-骨连续性并增加了 VEGF 阳性细胞，并在 12 周时获得了较好的肌腱-骨成熟度。

临床相关性：

BM-PRF 增强的 RCR 有可能改善 RCT 的临床结果。