Blood Clots Heal Rotator Cuff Tears (Biloine Young @ OTW)
Can a blood clot help heal a rotator cuff tear? Christopher S. Proctor, M.D., writing in Arthroscopy Techniques, believes it can. In his article he notes that a significant number of rotator cuff repairs re-tear in the first six months. To resolve this problem, Proctor refers to recent research that has focused on the use of platelet-rich plasma (PRP). Platelets contain and release a number of growth factors and studies indicate that these growth factors benefit tendon healing.
But not every time. Results of rotator cuff repairs that have been augmented by PRP have been mixed with some showing lower re-tear rates and others showing no change in the re-tear rate at all. Proctor acknowledges that part of the problem may that not all PRP preparation process are alike, appropriate dosing has not been established and techniques for applying PRP have not standardized. He proposes a new procedure.
Proctor urges the application of fibrin blood clots to the tendon, noting that the clots are a rich source of platelets and a reservoir of platelet-derived growth factor. He writes that clots can provide a scaffold for cell migration and proliferation and “may biologically affect the healing process in a much broader fashion than the simple application of PRP.” A final benefit is that a properly prepared fibrin clot has structural integrity and can hold sutures.
A Stowe, Vermont company, Pierce Surgical Corporation has devised the “ClotMaster Hula Cup” that will produce a blood clot in ten minutes. A technician in the operating room puts from 10 to 60 cc of blood or bone marrow aspirate into the container, closes the lid, adjusts a glass rod that runs through the center of the cup and swirls it for 10 minutes. This creates the blood clot and aligns the fibers so that the clot has sufficient structure that it can be sutured onto the tendon-bone repair site.
Proctor writes, “Using an endogenous fibrin clot to augment rotator cuff repair not only has the advantages of being reproducible, quick and inexpensive but also provides a method of securely fastening the biologic material at the repair site.”