Rotator cuff repair treatments – all but Vitamin D need a prescription
Pharmacologic Enhancement of Rotator Cuff Repair: A Narrative Review
Orthop Rev (Pavia). 2022 Sep 4;14(3):37782 doi: 10.52965/001c.37782. eCollection 2022.
Maksim Vaysman 1 , Matthew Alben 2 , Matthew Todd 3 , Charles Ruotolo 1
Introduction: As rotator cuff repairs (RCRs) are among the most common procedures in upper extremity orthopedics, healing augmentation using pharmacologic enhancement of the repaired rotator cuff muscle is of particular interest.
Objective: The purpose of this study is to review the current understanding of Matrix Metalloproteinases (MMPs), Doxycycline, Testosterone, Estrogen, Growth hormone/ IGF-1, Vitamin D, and Vitamin C as a means to mitigate deleterious effects and propagate factors that support healing following RCR.
Methods: A review of English language articles in PubMed and Medline was conducted in December of 2020. All articles describing the current understanding of the aforementioned therapies were reviewed. Studies were excluded if they were non-English or reported incomplete results.
Results: Matrix metalloproteinases (MMP's) are fundamental to the healing process after rotator cuff tears through a delicate balance of various proteases that can be modulated by doxycycline through inhibition. While testosterone has shown to induce replication and differentiation of the tendon stem-cells, estrogen agonists have been shown to decrease inflammation and muscle atrophy. Though growth hormone being associated with elevated collagen synthesis and decreased anoxic damage when present, clinical studies have shown inconclusive and adverse effects on rotator cuff healing. Patients with Vitamin D deficiency have shown to have increased fatty infiltration in rotator cuff muscle while Vitamin C functions as an antioxidant that increases collagen and fibroblast proliferation.
Conclusion: As manipulation of pharmacologic factors shows potential for enhancing healing following RCRs, future studies are needed to establish a viable augmentation strategy to improve patient outcomes.
📄 Download the PDF from VitaminDWiki
VitaminDWiki pages with ROTATOR in title (3 as of Sept 2022)
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Anecdote: Vitamin D loading dose BEFORE rotator cuff surgery was great
A friend of the founder of VitaminDWiki was going to have rotator cuff surgery (2013)
I suggested that he get a Vitamin D loading dose before his surgery - which he did
His doctor reported that the subsequent surgery had the fastest recovery he had ever seen.
VitaminDWiki - studies in both categories Trauma-Surgery and Loading Dose
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A few Vitamin D rotator cuff studies on the web
Vitamin D and the immunomodulation of rotator cuff injury - 2016;. doi: [10.2147/JIR.S106206] Free PDF
Preoperative Vitamin D Deficiency Is Associated With Higher Postoperative Complications in Arthroscopic Rotator Cuff Repair - 2019 doi: [10.5435/JAAOSGlobal-D-19-00075] - FREE PDF
Serum Vitamin D Correlates With Rotator Cuff Muscle Tissue Vitamin D And Muscle Performance Before And After Rotator Cuff Repair - 2022 DOI:https://doi.org/10.1016/j.jse.2022.01.028 Behind paywall
[Study on correlation between serum vitamin D level and the curative effect after repair of rotator cuff tears].- 2022 - DOI: 10.12200/j. Abstract is in English
VitaminDWiki - Trauma and surgery category contains
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