Background

In the musculoskeletal system, bone, tendon, and muscle form highly integrated multi-tissue units such as the rotator cuff complex, which facilitates functional and dynamic movement of the shoulder joint. Understanding the intricate interplay among these tissues within clinical, biological, and engineering contexts is vital for addressing challenging issues in treatment of musculoskeletal disorders and injuries.

Methods

A wide-ranging literature search was performed, and findings related to the socioeconomic impact of rotator cuff tears, the structure-function relationship of rotator cuff bone-tendon-muscle units, pathophysiology of injury, current clinical treatments, recent state-of-the-art advances (stem cells, growth factors, and exosomes) as well as their regulatory approval, and future strategies aimed at engineering bone-tendon-muscle musculoskeletal units are outlined.

Results

Rotator cuff injuries are a significant socioeconomic burden on numerous healthcare systems that may be addressed by treating the rotator cuff as a single complex, given its highly integrated structure-function relationship as well as degenerative pathophysiology and limited healing in bone-tendon-muscle musculoskeletal tissues. Current clinical practices for treating rotator cuff injuries, including the use of commercially available devices and evolving trends in surgical management have benefited patients while advances in application of stem/progenitor cells, growth factors, and exosomes hold clinical potential. However, such efforts do not emphasize targeted regeneration of bone-tendon-muscle units. Strategies aimed at regenerating bone-tendon-muscle units are thus expected to address challenging issues in rotator cuff repair.

Conclusions

The rotator cuff is a highly integrated complex of bone-tendon-muscle units that when injured, has severe consequences for patients and healthcare systems. State-of-the-art clinical treatment as well as recent advances have resulted in improved patient outcome and may be further enhanced by engineering bone-tendon-muscle multi-tissue grafts as a potential strategy for rotator cuff injuries.

Translational Potential of this Article

This review aims to bridge clinical, tissue engineering, and biological aspects of rotator cuff repair and propose a novel therapeutic strategy by targeted regeneration of multi-tissue units. The presentation of these wide-ranging and multi-disciplinary concepts are broadly applicable to regenerative medicine applications for musculoskeletal and non-musculoskeletal tissues.

中文翻译：

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通过多组织再生方法修复肩袖损伤的临床前景

 背景

在肌肉骨骼系统中，骨骼、肌腱和肌肉形成高度集成的多组织单位，例如肩袖复合体，有利于肩关节的功能性和动态运动。了解这些组织在临床、生物和工程背景下复杂的相互作用对于解决肌肉骨骼疾病和损伤治疗中的挑战性问题至关重要。

 方法

我们进行了广泛的文献检索，结果涉及肩袖撕裂的社会经济影响、肩袖骨-肌腱-肌肉单元的结构-功能关系、损伤的病理生理学、当前的临床治疗、最新的状态-概述了技术进步（干细胞、生长因子和外泌体）及其监管批准，以及旨在工程骨-肌腱-肌肉肌肉骨骼单元的未来策略。

 结果

肩袖损伤对许多医疗保健系统来说是一个重大的社会经济负担，考虑到肩袖高度集成的结构-功能关系以及退行性病理生理学和骨-肌腱-肌肉肌肉骨骼组织的有限愈合，可以通过将肩袖视为单一复合体来解决这一负担。目前治疗肩袖损伤的临床实践，包括使用市售设备和手术治疗的发展趋势，使患者受益，而干/祖细胞、生长因子和外泌体应用的进展则具有临床潜力。然而，这些努力并不强调骨-肌腱-肌肉单位的有针对性的再生。因此，旨在再生骨-肌腱-肌肉单元的策略有望解决肩袖修复中的挑战性问题。

 结论

肩袖是骨-肌腱-肌肉单元的高度集成复合体，受伤时会对患者和医疗保健系统造成严重后果。最先进的临床治疗以及最新进展已经改善了患者的治疗效果，并且可以通过设计骨-肌腱-肌肉多组织移植物作为治疗肩袖损伤的潜在策略来进一步增强治疗效果。

本文的翻译潜力

本综述旨在弥合肩袖修复的临床、组织工程和生物学方面，并通过多组织单位的靶向再生提出一种新的治疗策略。这些广泛和多学科概念的提出广泛适用于肌肉骨骼和非肌肉骨骼组织的再生医学应用。