Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleEffect of Recombinant Human Parathyroid Hormone on Rotator Cuff Healing After Arthroscopic Repair
Section snippets
Methods
This study was a prospective comparative case-control study with propensity matching of the control group. Data collection and all protocols were approved by the Seoul National University Bundang Hospital Institutional Review Board of the senior author's (J.H.O.) institution (IRB No. B-1802/450-111).
According to the power analysis, the sample size required 31 patients in the treatment group and 124 patients in the control group. Assuming a 20% dropout rate, 40 patients were needed in the group
Results
Figure 1 shows the total number of patients undergoing rotator cuff surgery in the study period and the number analyzed after exclusions. Patients’ demographic characteristics are shown in Table 1. The mean BMD was –1.6 ± 1.1 in group I and –1.6 ± 1.3 in group II (P = .959). Ten patients (32.3%) in group I and 40 patients (32.3%) in group II had osteoporosis (P = .975). None of the patients who had osteoporosis in group I had a treatment history of osteoporosis. Among the 40 patients who had
Discussion
The most important finding from the current data was that teriparatide had an effect on enhancing tendon-to-bone healing; in patients who had been treated with teriparatide, the rate of retear was significantly reduced compared with that of the control group (16.1% vs 33.9%; P = .037).
Several studies demonstrated the effect of teriparatide not only on treating osteoporosis but also on enhancing tendon-to-bone healing.16, 27, 28 Hettrich et al.16 reported that an rhPTH resulted in more
Conclusions
Teriparatide, an rhPTH, can be a systemic treatment option that significantly enhances the tendon-to-bone healing after arthroscopic rotator cuff repair for patients with rotator cuff tears >2 cm.
References (36)
- et al.
Massive rotator cuff tears: Debridement versus repair
Orthop Clin N Am
(1997) - et al.
Does footprint preparation influence tendon-to-bone healing after rotator cuff repair in an animal model?
Arthroscopy
(2014) - et al.
2013 Neer Award: Effect of the adipose-derived stem cell for the improvement of fatty degeneration and rotator cuff healing in rabbit model
J Shoulder Elbow Surg
(2014) - et al.
Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses
Arthroscopy
(2016) Skeletal actions of intermittent parathyroid hormone: effects on bone remodelling and structure
Bone
(2007)- et al.
Delayed administration of recombinant human parathyroid hormone improves early biomechanical strength in a rat rotator cuff repair model
J Shoulder Elbow Surg
(2016) - et al.
Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears
J Shoulder Elbow Surg
(2003) - et al.
Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation
Arthroscopy
(2005) - et al.
Goniometric assessment of shoulder range of motion: Comparison of testing in supine and sitting positions
Arch Phys Med Rehab
(1998) - et al.
PTHrP regulates growth plate chondrocyte differentiation and proliferation in a Gli3 dependent manner utilizing hedgehog ligand dependent and independent mechanisms
Devel Biol
(2007)
Contribution of PTHrP to mechanical strain-induced fibrochondrogenic differentiation in entheses of Achilles tendon of miniature pigs
J Biomechanics
Assessing compliance, acceptance, and tolerability of teriparatide in patients with osteoporosis who fractured while on antiresorptive treatment or were intolerant to previous antiresorptive treatment: An 18-month, multicenter, open-label, prospective study
Clin Ther
Outcome and structural integrity of rotator cuff after arthroscopic treatment of large and massive tears with double row technique: A 2-year followup
Advances Orthop
Arthroscopic repair of massive rotator cuff tears: Outcome and analysis of factors associated with healing failure or poor postoperative function
Am J Sports Med
The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears
J Bone Joint Surg Am
Factors affecting rotator cuff healing after arthroscopic repair: Osteoporosis as one of the independent risk factors
Am J Sports Med
Effect of platelet-rich plasma and porcine dermal collagen graft augmentation for rotator cuff healing in a rabbit model
Am J Sports Med
Effects of allogenic dermal fibroblasts on rotator cuff healing in a rabbit model of chronic tear
Am J Sports Med
Cited by (17)
Postoperative Antiosteoporotic Treatment with Zoledronic Acid Improves Rotator Cuff Healing but Does Not Improve Outcomes in Female Patients with Postmenopausal Osteoporosis: A Prospective, Single-Blinded, Randomized Study
2024, Arthroscopy - Journal of Arthroscopic and Related SurgeryIncreased HbA1c Levels in Diabetics During the Postoperative 3-6 Months After Rotator Cuff Repair Correlated With Increased Retear Rates
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryCitation Excerpt :The retear rate after rotator cuff repair (RCR) in patients with rotator cuff tears of ≥2 cm has been reported to be persistently high at 18.6%–75%.1,2 To reduce the retear rate, systemic approaches are being applied in addition to localized treatments, including repair methods and tissue regeneration.3 In relation to such approaches, hyperlipidemia and diabetes mellitus (DM) are known to be closely associated with rotator cuff diseases.4
Recombinant Human Parathyroid Hormone Biocomposite Promotes Bone-to-Tendon Interface Healing by Enhancing Tenogenesis, Chondrogenesis, and Osteogenesis in a Rabbit Model of Chronic Rotator Cuff Tears
2023, Arthroscopy - Journal of Arthroscopic and Related SurgeryThree-dimensionally printed recombinant human parathyroid hormone–soaked nanofiber sheet accelerates tendon-to-bone healing in a rabbit model of chronic rotator cuff tear
2022, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Daily subcutaneous rhPTH injections could improve the density of the bone and blood vessels and collagen fiber orientation from the day of repair in rats.23 Similarly, systemic rhPTH treatment could markedly enhance tendon-to-bone healing after arthroscopic rotator cuff repair in humans, especially with RCTs larger than 2 cm.44 Unfortunately, systemic rhPTH administration remains inconvenient and causes side effects in humans; therefore, topical rhPTH administration during surgical repair has gained attention.
Biologics in rotator cuff repair
2022, Surgical Techniques of the Shoulder, Elbow, and Knee in Sports Medicine, Third EditionConsiderations in spontaneous quadriceps tendon rupture repair in end-stage renal disease patients: A case report
2021, International Journal of Surgery Case ReportsCitation Excerpt :While Hasan, et al. reported a repair technique with 3 metallic anchor and an internal cerclage wiring for a case of SQTR in an ESRD patient [12]. Additionally, biological enhancements for tendon healing with stem cells, platelet-rich plasma, or local recombinant PTH injection might be worth looking into [13–15]. We did not add any biological enhancement due to the limited resources available in our facility.
See commentary on page 1072
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.