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Bone marrow aspirate concentrate after rotator cuff repair improved tendon quality
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NEW YORK — Results presented at the American Shoulder and Elbow Surgeons Annual Meeting showed improved tendon quality at 1 year among patients who received bone marrow aspirate concentrate injection at the time of rotator cuff repair.
Brian J. Cole, MD, and colleagues randomly assigned patients with single tendon tears to receive either a bone marrow aspirate concentrate injection at the rotator cuff repair site after surgery or a sham incision at the iliac crest. Researchers assessed physical exam and patient-reported outcomes preoperatively and at 3 and 6 months and 1 year and 2 years postoperatively. At 1 year postoperatively, researchers performed MRI and graded in accordance with the Sugaya classification system.
“Essentially, all of our [patient-reported outcomes] PROs improved but the main ones, the ASES, improved in both groups but they were not different at the end points of follow-up,” Cole said in his presentation here.
Compared with the control group, Cole noted the bone marrow aspirate concentrate group had higher baseline simple shoulder test scores. He added simple shoulder test scores significantly improved in both groups at all time points.
“The mean Sugaya score was 3.5 [for the control group, and for the bone marrow concentrate] BMC group was 2.6,” Cole said. “Chi-squared analysis showed a strong association between the treatment with bone marrow concentrate vs. those that did not.” – by Casey Tingle
Reference:
Cole BJ, et al. Paper 6. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Cole reports he receives research support from Aesculap/B.Braun, Arthrex Inc., NIH (NIAMS & NICHD) and Regentis; is on the editorial or governing board for the American Journal of Orthopedics, American Journal of Sports Medicine and Cartilage; receives IP royalties from Arthrex Inc. and Elsevier Publishing; is a paid consultant for Arthrex Inc. and Regentis; is a board or committee member for the Arthroscopy Association of North American and International Cartilage Repair Society; receives other financial or material support from Athletico, JRF Ortho and Smith & Nephew; is on the editorial board for the Journal of Shoulder and Elbow Surgery and the Journal of the American Academy of Orthopaedic Surgeons; receives publishing royalties, financial or material support from Operative Techniques in Sports Medicine; and has stock or stock options for Ossio and Regentis.
Perspective
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Richard K.N. Ryu, MD
The study by Brian J. Cole, MD, and colleagues is a good first step as we try to determine where orthobiologics fit into our practices. The results are appealing because we want to believe that biologics will enhance our outcomes, and Cole’s study indicates that the use of mesenchymal stem cells (MSCs) in the final construct led to superior healing compared to placebo based on postoperative imaging after 1 year. Strengths of the study include the prospective, randomized parameters and the inclusion criteria limiting the population to single-tendon pathology and consistent surgical technique.
The primary concern is the working definition of the MSCs that were injected into the repair site. Determining the number and characteristics of the MSCs is difficult to ascertain, and it may be more accurate to name the biologic component “medicinal signaling cells.” Without some method by which we can accurately assess the bone marrow aspirate concentration, namely quality and quantity, ascribing causation may be challenging. That said, the overarching message in Cole’s research focuses on the favorable role that MSCs may play in rotator cuff healing. At the basic science level, I don’t think we have all of the details sorted out; but from the standpoint of answering the question of whether or not to utilize orthobiologics, this study represents a positive first step.
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