Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study
The Regenerative Clinic's view on this research
Mr Ali Noorani “A study on rotator cuff tears was carried out and published in 2014. This is a case-controlled study with level 3 data. The patients were divided into two groups, one that received mesenchymal stem cells from bone marrow aspirate during arthroscopy and the other group that just had the arthroscopy. There was a total of 45 patients in each group and the rotator cuff tear sizes were between 1.4-2.5cm. In this study, when bone marrow aspirate was injected, a total of 150CCs of aspiration was carried out delivering 51,000 MSCs (4,300 CFU/ml) 8CC was injected into the greater tuberosity and 4CC at the repair site. The patients were followed up for 10 years and they had MRIs post operatively at 3 months, 6 months, 1 year, 2 years and at the most recent follow up (minimum 10 years). 100% of the patients in the bone marrow group had healed at 6 months versus 67% of the patients treated without bone marrow. At the 10 year follow up, in the bone marrow group 87% of the patients still had intact rotator cuffs whereas those who did not receive bone marrow treatment only 44% had intact rotator cuffs in the MRI scan. The study concluded that bone marrow aspirate MSCs was the most important variable in determining outcomes in these groups of patients.”
PURPOSE: The purpose of this study was to evaluate the efficiency of biologic augmentation of rotator cuff repair with iliac crest bone marrow-derived mesenchymal stem cells (MSCs). The prevalence of healing and prevention of re-tears were correlated with the number of MSCs received at the tendon-to-bone interface.
METHODS: Forty-five patients in the study group received concentrated bone marrow-derived MSCs as an adjunct to single-row rotator cuff repair at the time of arthroscopy. The average number of MSCs returned to the patient was 51,000 ± 25,000. Outcomes of patients receiving MSCs during their repair were compared to those of a matched control group of 45 patients who did not receive MSCs. All patients underwent imaging studies of the shoulder with iterative ultrasound performed every month from the first postoperative month to the 24th month. The rotator cuff healing or re-tear was confirmed with MRI postoperatively at three and six months, one and two years and at the most recent follow up MRI (minimum ten-year follow-up).
RESULTS: Bone marrow-derived MSC injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the quality of the repaired surface as determined by ultrasound and MRI. Forty-five (100 %) of the 45 repairs with MSC augmentation had healed by six months, versus 30 (67 %) of the 45 repairs without MSC treatment by six months. Bone marrow concentrate (BMC) injection also prevented further ruptures during the next ten years. At the most recent follow-up of ten years, intact rotator cuffs were found in 39 (87 %) of the 45 patients in the MSC-treated group, but just 20 (44 %) of the 45 patients in the control group. The number of transplanted MSCs was determined to be the most relevant to the outcome in the study group, since patients with a loss of tendon integrity at any time up to the ten-year follow-up milestone received fewer MSCs as compared with those who had maintained a successful repair during the same interval.
CONCLUSION: This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.