What's New in Shoulder and Elbow Surgery
Gary M. Gartsman, MD; Samer S. Hasan, MD, PhD


The sources for this annual update on shoulder and elbow surgery were presentations and symposia at meetings of the American Shoulder and Elbow Surgeons (October 8 through 11, 2003, and March 13, 2004), the Arthroscopy Association of North America (November 13 through 16, 2003; March 13, 2004; and April 23 through 25, 2004), the Orthopaedic Research Society (March 6 through 9, 2004), the American Academy of Orthopaedic Surgeons (March 9 through 13, 2004), the American Orthopaedic Society for Sports Medicine (March 13, 2004), and the American Orthopaedic Association (June 23 through 26, 2004).


Rotator Cuff

Basic Science

Zuckerman discussed the early work on cartilage-derived morphogenetic protein-2 (CDMP-2). Rat tendon repairs that had been treated with CDMP-2 were stronger than untreated repairs at four weeks. Dines discussed his initial investigations involving platelet-derived growth factor (PDGF) and insulin-like growth factor-1 (IGF-1). Studies at his laboratory demonstrated that cultured rat fibroblasts could be transduced with the genes from the growth factors and then seeded onto a polymer scaffold and cultured to form tissue-engineered tendon constructs. Fibroblasts apposed to the tissue engineered constructs containing the IGF gene demonstrated up to a tenfold stimulation of collagen synthesis compared with constructs with the gene. The author stated that he hopes that this research can lead to the development of biologically active patches capable of accelerating and modulating rotator cuff repair.

Kikugawa reported on the effects of synovial tissue and growth factors on rotator cuff healing. A supraspinatus tendon defect was created in forty-eight rats. In half of the rats, the defect was filled with synovial tissue. Compared with the specimens without synovial tissue-filled defects, specimens with filled defects appeared to be more mature, with more-intense staining for TGF-α and increased production of type-I and type-III procollagen. These findings suggest that synovial tissue plays an important role in modulating tendon-healing and …

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