Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells

João L Ellera Gomes, Ricardo Canquerini da Silva, Lúcia M R Silla, Marcelo R Abreu, Roberto Pellanda, João L Ellera Gomes, Ricardo Canquerini da Silva, Lúcia M R Silla, Marcelo R Abreu, Roberto Pellanda

Abstract

Purpose: To investigate the behavior of rotator cuff tears treated with conventional repair technique with the aid of autologous bone marrow mononuclear cells (BMMC).

Methods: Fourteen consecutive patients (9 women, 5 men, mean age of 59.2 years) with complete rotator cuff tears (mean preoperative UCLA score of 12 ± 3.0) were fixed by transosseous stitches through mini-open incision, with subsequent injection of BMMC into the tendon borders, obtained from the iliac crest just prior to surgery. Magnetic resonance images (MRI) were acquired before and after surgery and evaluated by two musculoskeletal radiologists regarding new postoperative findings of patients treated with BMMC.

Results: After a minimum 12-month follow-up period, the UCLA score increased from 12 ± 3.0 to 31 ± 3.2. Clinical findings remained unaltered in the following year in all but one patient (13/14). MRI analysis after a 12-month follow-up period demonstrated tendon integrity in all cases (14/14), presence of low-signal intensity areas along the supraspinatus tendon and distal muscle belly in 8 cases (8/14), and high-intensity blooming small round artifact at the bursal and tendon topography in 11 cases (11/14). Six patients (6/14) showed formation of a high-signal intensity zone at the critical zone. Clinical findings remained unaltered in the following year in all but one patient, who relapsed into loss of strength and pain, being considered a bad result.

Conclusion: Implantation of BMMC in rotator cuff sutures appears to be a safe and promising alternative to other biological approaches currently used to enhance tissue quality in affected tendons.

Figures

Fig. 1
Fig. 1
Preoperative coronal T2-weighted magnetic resonance image (MRI) showing complete injury with a 3-cm retraction in 2 patients (a,b). Coronal T1-weighted (c) and T2-weighted (d) MRI sequences showing postoperative findings with tendons repaired, blooming artifacts at footprint, high-intensity tissue at the footprint (c), and high-intensity tissue at tendon–bursa interface (d)

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