A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis
The Regenerative Clinic's view on this research
Mr Ali Noorani “There is some evidence that bone marrow aspirate concentrate (BMAC) can work in shoulder pathology as well. One of the main studies is from the follow-up of prospective multi-side registries data from Christopher Centeno who looked at the use of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears as well as osteoarthritis. In total they had 115 patients in their registry and there was a 6-12 month follow up. This is a level three/four study published in 2015. Overall in the treatment group, the dash score decreased (improved) from 36.1 to 17.1 and this was statistically significant. In addition, the pain score (out of 10) decreased (improved) from an average of 4.3 to 2.4. More importantly there was a subjective improvement of the SANE (Single Assessment Numeric Evaluation) score of 50%. Although the study is encouraging for users of bone marrow aspirate in shoulder pathology, it does show a mixed pathology in this group. There is an expectation that the two groups (I.e. the osteoarthritis and rotator cuff) may respond differently and the results on expectation that repairing the mechanical problem of a cuff tear with an addition to bone marrow aspirate injections may be useful to improve healing rates. There is certainly a scope for further randomised controlled trials in this area.”
Introduction: Shoulder pain is a common musculoskeletal complaint in the general population. Bone marrow concentrate (BMC) injections offer promising potential as a minimally invasive approach for treatment of shoulder pain in degenerative disease. In this study, we investigated the clinical outcomes of the BMC injections for treatment of shoulder pain and disability due to osteoarthritis (OA) and rotator cuff tears in a treatment registry population.
Methods: A total of 115 shoulders in 102 patients were treated with autologous BMC injections for symptomatic OA at the glenohumeral joint and/or rotator cuff tears. Data were collected for factors potentially influencing outcome, including age, sex, body mass index, and the type of condition treated (ie, OA or rotator cuff tear). Clinical outcomes were assessed serially over time using the disabilities of the arm, shoulder and hand score (DASH), the numeric pain scale (NPS), and a subjective improvement rating scale. Baseline scores were compared to the most recent outcome scores at the time of the analysis and adjusted for demographic differences. We reported comparisons of pre- and post-treatment scores, the differences between osteoarthritis and rotator cuff groups, and the predictive effects on the clinical outcomes.
Results: At the most current follow-up assessment after treatment, the average DASH score decreased (improved) from 36.1 to 17.1 (P<0.001) and the average numeric pain scale value decreased (improved) from 4.3 to 2.4 (P<0.001). These changes were associated with an average subjective improvement of 48.8%. No differences were observed between outcomes among the shoulders treated for OA versus rotator cuff tears, nor did age, sex, or body mass index influence pain or functional outcomes. There were no significant treatment-related adverse events reported.
Discussion: We observed preliminarily encouraging results following BMC injections for shoulder OA and rotator cuff tears. These results serve as basis for the design of an adequately powered randomized controlled trial.