Regenerative Medicine in the Treatment of Rotator Cuff Injury

Despite advances in surgical reconstruction of chronic rotator cuff tears leading to improved clinical outcomes, failure rates of 13-94% have been reported after surgical reconstruction (1). Reasons for this high failure rate could be attributed to compromised healing at the area where the rotator cuff tendons attach to boneRotator cuff surgery is a traumatic, invasive procedure disrupting the intricate fibrocartilaginous transition area connecting the tendons of the rotator cuff to the bone resulting in failure to regenerate the new fibrocartilaginous tissue. In its place scar tissue is produced, which can lead to chronic pain and limited function. “Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon.” (4)

Regenerative medicine is an ideal therapy to heal and restore the fibrocartilaginous transition area and damage along the tendons. Regenerative injection therapies stimulate the body’s healing process by signaling growth factors, collagen building precursors, and stem cells to migrate to an area of injury. Stem cells have the ability to increase fibrocartilage formation. This is the tissue that helps make up ligaments, tendons, and cartilage.

 

There is a growing body of research demonstrating dextrose prolotherapy, platelet rich plasma and mesenchymal stem cell therapy are potentially effective therapies to enhance rotator cuff healing and preventing further damage and eventual arthritis.

 

A study published in the medical journal Orthopaedics & Traumatology, Surgery & Research, the study tested the effectiveness of Prolotherapy in difficult chronic refractory rotator cuff tears.

  • 120 patients with chronic rotator cuff lesions and symptoms that persisted for longer than 6 months were divided into two groups: one treated with exercise and the other treated with prolotherapy injections.
  • In the Prolotherapy group, ultrasound-guided prolotherapy injections were applied
  • In the exercise group, patients received a physiotherapy protocol three sessions weekly for 12 weeks.
  • Both groups were instructed to carry out a home exercise program.

Results:

  • Both the exercise group and the Prolotherapy group achieved significant improvements.
    • Prolotherapy group had significantly better pain relief scores at weeks 3, 6, and 12, and last follow-up.
    • Prolotherapy group had significantly better shoulder abduction and flexion at week 12 and last follow-up, and in internal rotation at last follow-up.
    • In the prolotherapy group, 53 patients (92.9%) reported excellent or good outcomes; in the control group, 25 patients (56.8%) reported excellent or good outcomes. (5)

A study published in the Journal of Clinical Imaging Science, investigated the effectiveness of treatment of pain using platelet rich plasma injections on partial rotator cuff tears.

  • 20 patients with symptomatic partial rotator cuff tears were treated with ultrasound guided platelet rich plasma injection.
  • PRP was prepared using standard techniques and PRP product was injected at the rotator cuff tear site under ultrasound guidance
  • Patients were evaluated at 8 weeks and 3 months for pain and

 

Results:

 

  • The difference between preinjection and postinjection VAS scores, visual analog scale for pain, was extremely statistically significant at 8 weeks and 3 months
  • After 3 months, 11 patients had excellent UCLA score which determines quality of shoulder function, 6 patients had good, 2 had fair, and one patient had poor score
  • The study demonstrated that there is conclusive benefit for reducing pain and improving shoulder function in partial rotator cuff tears with ultrasound-guided PRP (platelet rich plasma). (6)

 

Reference:

 

  1. Zumstein MA, Lädermann A, Raniga S, Schär MO. The biology of rotator cuff healing. Orthop Traumatol Surg Res. 2016 Dec 30. pii: S1877-0568(16)30191-8. doi: 10.1016/j.otsr.2016.11.003
  2. Kim SJ, Kim EK, Kim SJ. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. Journal of orthopaedic surgery and research. 2018 Dec;13(1):1
  3. Ficklscherer A, Pietschmann MF, Bendiks M, Roßbach BP, Müller PE. [Clinical management of rotator cuff tears: Current concepts in cell-based therapy strategies].Orthopade. 2016 Feb;45(2):143-8. doi: 10.1007/s00132-015-3213-x. German
  4. Mora MV, Ibán MA, Heredia JD, Laakso RB, Cuéllar R, Arranz MG. Stem cell therapy in the management of shoulder rotator cuff disorders. World J Stem Cells. 2015 May 26;7(4):691-9. doi: 10.4252/wjsc.v7.i4.691.
  5. Bencardino JT, Beltran LS. Pain related to rotator cuff abnormalities: MRI findings without clinical significance. J Magn Reson Imaging. 2010 Jun;31(6):1286-99
  6. Sengodan, V., Kurian, S., & Ramasamy, R. (2017). Treatment of Partial Rotator Cuff Tear with Ultrasound-guided Platelet-rich Plasma. Journal of Clinical Imaging Science,7(1), 32. doi:10.4103/jcis.jcis_26_17

 

 

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