Download PDF
Open Access
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

Authors

  • Anil Gulcu 

    1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Alanya Alaaddin Keykubat, Alanya/Antalya, Turquia

  • Egemen Turhan 

    2   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Hacettepe, Ankara, Turquia

  • Ahmet Aslan 

    1   Departamento de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade Alanya Alaaddin Keykubat, Alanya/Antalya, Turquia

  • Sevil Çaylı 

    3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia

  • Ebru Alimogullari 

    3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia

  • Gülben Akcan 

    3   Departamento de Histologia e Embriologia, Faculdade de Medicina, Universidade Ankara Yıldırım Beyazıt, Ankara, Turquia


Financial Support There was no financial support from public, commercial, or non-profit sources.
Further Information
Also available at
  Permissions and Reprints
Preview

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.

Keywords

rotator cuff injuries - wound healing - epidermal growth factor

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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 4 Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthop Rev (Pavia) 2012; 4 (02) e18
    Search in Google Scholar
  • 5 VanBaak K, Aerni G. Shoulder Conditions: Rotator Cuff Injuries and Bursitis. FP Essent 2020; 491: 11-16
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 7 Oliva F, Gatti S, Porcellini G, Forsyth NR, Maffulli N. Growth factors and tendon healing. Med Sport Sci 2012; 57: 53-64
    Search in Google Scholar
  • 8 Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33 (05) 381-394
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar