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Stem cell use in rotator cuff tears

Robert J Gillespie, Derrick M Knapik, Ozan Akkus
Rotator cuff injuries are common in both young and elderly patients. Despite improvements in instrumentation and surgical techniques, the failure rates following tendon reconstruction remain unacceptably high. To improve outcomes, graft patches have been developed to provide mechanical strength and to furnish a scaffold for biologic growth across the delicate tendon-bone junction. Although no patch effectively re-creates the structured, highly organized system of prenatal tendon development, augmenting rotator cuff repair may help restore native tendon-to-bone attachment while reproducing the mechanical and biologic properties of native tendon...
October 20, 2016: Journal of the American Academy of Orthopaedic Surgeons
Tanujan Thangarajah, Shirin Shahbazi, Catherine J Pendegrass, Simon Lambert, Susan Alexander, Gordon W Blunn
BACKGROUND: Tendon-bone healing following rotator cuff repairs is mainly impaired by poor tissue quality. Demineralised bone matrix promotes healing of the tendon-bone interface but its role in the treatment of tendon tears with retraction has not been investigated. We hypothesized that cortical demineralised bone matrix used with minimally manipulated mesenchymal stem cells will result in improved function and restoration of the tendon-bone interface with no difference between xenogenic and allogenic scaffolds...
2016: PloS One
Gi-Young Park, Dong Rak Kwon, Sang Chul Lee
UNLABELLED: Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit's activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears...
November 2015: Stem Cells Translational Medicine
V Havlas, J Kotaška, P Koníček, T Trč, Š Konrádová, Z Kočí, E Syková
PURPOSE OF THE STUDY Rotator cuff tears are one of the most frequent shoulder disorders which are often associated with pain and interfere with proper arm function. In order to evaluate the safety and effectiveness of using cultured human autologous mesenchymal stem cells (MSC) applied to the suture site during arthroscopic repair of a rotator cuff tear, a prospective clinical study was designed and started recently at the authors' department. Its primary goal was to evaluate the safety of using cultured human MSCs, the secondary goal then was to study a therapeutic effect of their application...
2015: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Pilar Tornero-Esteban, José Antonio Hoyas, Esther Villafuertes, Cruz Rodríguez-Bobada, Yamila López-Gordillo, Francisco J Rojo, Gustavo V Guinea, Anna Paleczny, Yaiza Lópiz-Morales, Luis Rodriguez-Rodriguez, Fernando Marco, Benjamín Fernández-Gutiérrez
OBJECTIVES: Our main objective was to biologically improve rotator cuff healing in an elderly rat model using mesenchymal stem cells (MSCs) in combination with a collagen membrane and compared against other current techniques. METHODS: A chronic rotator cuff tear injury model was developed by unilaterally detaching the supraspinatus (SP) tendons of Sprague-Dawley rats. At 1 month postinjury, the tears were repaired using one of the following techniques: (a) classical surgery using sutures (n = 12), (b) type I collagen membranes (n = 15), and (c) type I collagen membranes + 1 × 106 allogeneic MSCs (n = 14)...
2015: Journal of Orthopaedic Surgery and Research
Jonathan P Gumucio, Michael D Flood, Stuart M Roche, Kristoffer B Sugg, Adeyiza O Momoh, Paul E Kosnik, Asheesh Bedi, Christopher L Mendias
PURPOSE: Rotator cuff injuries are associated with atrophy and fat infiltration into the muscle, commonly referred to as "fatty degeneration." As the poor function of chronically torn muscles may limit recovery after surgical repair, there is considerable interest in finding therapies to enhance muscle regeneration. Stromal vascular fraction stem cells (SVFCs) can improve muscle regeneration in other chronic injury states, and our objective was to evaluate the ability of SVFCs to reduce fibrosis and fat accumulation, and enhance muscle fibre specific force production after chronic rotator cuff tear...
April 2016: International Orthopaedics
Steven B Orr, Abby Chainani, Kirk J Hippensteel, Alysha Kishan, Christopher Gilchrist, N William Garrigues, David S Ruch, Farshid Guilak, Dianne Little
UNLABELLED: The rotator cuff consists of several tendons and muscles that provide stability and force transmission in the shoulder joint. Whereas most rotator cuff tears are amenable to suture repair, the overall success rate of repair is low, and massive tears are prone to re-tear. Extracellular matrix (ECM) patches are used to augment suture repair, but they have limitations. Tissue-engineered approaches provide a promising solution for massive rotator cuff tears. Previous studies have shown that, compared to nonaligned scaffolds, aligned electrospun polymer scaffolds exhibit greater anisotropy and exert a greater tenogenic effect...
September 2015: Acta Biomaterialia
Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Raul Barco Laakso, Ricardo Cuéllar, Mariano García Arranz
Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. 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. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair...
May 26, 2015: World Journal of Stem Cells
Philippe Hernigou, Guillaume Merouse, Pascal Duffiet, Nathalie Chevalier, Helene Rouard
PURPOSE: While the use of bone marrow concentrate (BMC) has been described in the treatment of rotator cuff tears, the impact of a rotator cuff injury on the mesenchymal stem cells (MSCs) content present in the human shoulder has not been determined, especially with regard to changes in the levels of MSCs at the tendon-bone interface. With the hypothesis that there was a decreased level of MSCs at the tendon-bone interface tuberosity in patients with rotator cuff tear, we assessed the level of MSCs in the tuberosity of the shoulder of patients undergoing a rotator cuff repair...
June 2015: International Orthopaedics
Xu Tao, Junpeng Liu, Lei Chen, You Zhou, Kanglai Tang
BACKGROUND/AIMS: The rate of healing failure after surgical repair of chronic rotator cuff tears is considerably high. The aim of this study was to investigate the function of the zinc finger transcription factor early growth response 1 (EGR1) in the differentiation of tendon stem cells (TSCs) and in tendon formation, healing, and tendon tear repair using an animal model of rotator cuff repair. METHODS: Tenocyte, adipocyte, osteocyte, and chondrocyte differentiation as well as the expression of related genes were determined in EGR1-overexpressing TSCs (EGR1-TSCs) using tissue-specific staining, immunofluorescence staining, quantitative PCR, and western blotting...
2015: Cellular Physiology and Biochemistry
Olaf Lorbach, Mike H Baums, Tanja Kostuj, Stephan Pauly, Markus Scheibel, Andrew Carr, Nasim Zargar, Maristella F Saccomanno, Giuseppe Milano
UNLABELLED: High initial fixation strength, mechanical stability and biological healing of the tendon-to-bone interface are the main goals after rotator cuff repair surgery. Advances in the understanding of rotator cuff biology and biomechanics as well as improvements in surgical techniques have led to the development of new strategies that may allow a tendon-to-bone interface healing process, rather than the formation of a fibrovascular scar tissue. Although single-row repair remains the most cost-effective technique to address a rotator cuff tear, some biological intervention has been recently introduced to improve tissue healing and clinical outcome of rotator cuff repair...
February 2015: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
J Gumucio, M Flood, J Harning, A Phan, S Roche, E Lynch, A Bedi, C Mendias
OBJECTIVES: Rotator cuff tears are among the most common and debilitating upper extremity injuries. Chronic cuff tears result in atrophy and an infiltration of fat into the muscle, a condition commonly referred to as 'fatty degeneration'. While stem cell therapies hold promise for the treatment of cuff tears, a suitable immunodeficient animal model that could be used to study human or other xenograft-based therapies for the treatment of rotator cuff injuries had not previously been identified...
September 2014: Bone & Joint Research
Pietro Randelli, Filippo Randelli, Vincenza Ragone, Alessandra Menon, Riccardo D'Ambrosi, Davide Cucchi, Paolo Cabitza, Giuseppe Banfi
Rotator cuff injuries are a common source of shoulder pathology and result in an important decrease in quality of patient life. Given the frequency of these injuries, as well as the relatively poor result of surgical intervention, it is not surprising that new and innovative strategies like tissue engineering have become more appealing. Tissue-engineering strategies involve the use of cells and/or bioactive factors to promote tendon regeneration via natural processes. The ability of numerous growth factors to affect tendon healing has been extensively analyzed in vitro and in animal models, showing promising results...
2014: BioMed Research International
Nicola Maffulli, Umile Giuseppe Longo, Mattia Loppini, Alessandra Berton, Filippo Spiezia, Vincenzo Denaro
The purpose of this systematic review was to address the treatment of rotator cuff tears by applying tissue engineering approaches to improve tendon healing, specifically platelet rich plasma (PRP) augmentation, stem cells, and scaffolds. Our systematic search was performed using the combination of the following terms: "rotator cuff", "shoulder", "PRP", "platelet rich plasma", "stemcells", "scaffold", "growth factors", and "tissue engineering". No level I or II studies were found on the use of scaffolds and stem cells for rotator cuff repair...
2012: Stem Cells International
Philippe Hernigou, Charles Henri Flouzat Lachaniette, Jerome Delambre, Sebastien Zilber, Pascal Duffiet, Nathalie Chevallier, Helene Rouard
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...
September 2014: International Orthopaedics
David Factor, Barry Dale
PURPOSE/BACKGROUND: Tendinopathies are a broad topic that can be examined from the lab to their impact upon function. Improved understanding will serve to bring this pathology to the forefront of discussion, whether in the clinic or the classroom. The purpose of this current concepts clinical commentary is to explore intrinsic and extrinsic mechanisms of rotator cuff (RC) tendinopathy in order to improve clinical and research understanding. METHODS: Pubmed, Medline, Cinahl, PEDro, and Cochrane databases were searched, limiting results to those published in the English language, between the years of 2005 and 2012...
April 2014: International Journal of Sports Physical Therapy
Leonardo Osti, Matteo Buda, Angelo Del Buono
Fatty degeneration is a degenerative condition of the tendon-muscle unit of rotator cuff muscles, characterized by atrophy of muscle fibers, fibrosis, and fatty accumulation within and around the muscles. Many classification may be useful to stage this pathology, especially on Computed Tomography (CT) and magnetic resonance imaging (Mari) findings. Stem cell-based therapies for repair and regeneration of tendons and muscles may be used to promote healing and to make this condition reversible. Diagnosis and management of this condition is mandatory as in patients undergoing rotator cuff repair, it may influence outcomes, increase the likelihood of re-tearing, and evolve negatively...
October 2013: Muscles, Ligaments and Tendons Journal
Joo Han Oh, Seok Won Chung, Sae Hoon Kim, Jin Young Chung, Joon Yub Kim
BACKGROUND: This study was conducted to verify the effects of adipose-derived stem cells (ADSCs) on tendon healing and reversal of fatty infiltration in a chronic rotator cuff tear model by using the rabbit subscapularis (SSC). METHODS: The SSC insertions in 32 rabbits were cut bilaterally. After 6 weeks, secondary procedures were performed bilaterally, dividing the rabbits into 4 groups of 8 rabbits each as follows: the ADSC+repair group, saline+repair group, ADSC-only group, and saline-only group...
April 2014: Journal of Shoulder and Elbow Surgery
Umile Giuseppe Longo, Giacomo Rizzello, Alessandra Berton, Ludovica Maltese, Caterina Fumo, Wasim S Khan, Vincenzo Denaro
Rotator cuff tear causes a high rate of morbidity. After surgical repair, the presence of a scar tissue reduces tendon biomechanical properties. Emerging strategies for enhancing tendon healing are growth factors, cytokines, gene therapy and tissue engineering. However their efficacy has to be proved. Growth factors help the process of tendon healing by aiding cells chemotaxis, differentiation and proliferation. Numerous growth factors, including the bone morphogenetic proteins and platelet-derived growth factor can be found during the early healing process of a rotator cuff repair...
November 2013: Current Stem Cell Research & Therapy
Guillermo Arce, Klaus Bak, Gregory Bain, Emilio Calvo, Benno Ejnisman, Giovanni Di Giacomo, Vicente Gutierrez, Dan Guttmann, Eiji Itoi, W Ben Kibler, Tom Ludvigsen, Augustus Mazzocca, Alberto de Castro Pochini, Felix Savoie, Hiroyuki Sugaya, John Uribe, Francisco Vergara, Jaap Willems, Yon Sik Yoo, John W McNeil, Matthew T Provencher
The goal of this article is to consolidate the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) Upper Extremity Committee's (UEC's) current knowledge on rotator cuff disease and management, as well as highlight key unresolved issues. The rotator cuff is an anatomically complex structure important for providing glenohumeral function and stability as part of a closed chain system. Current consensus suggests rotator cuff injuries are most accurately diagnosed, at levels similar to diagnosis by magnetic resonance imaging, with a combination of cuff- and impingement-specific clinical tests...
November 2013: Arthroscopy: the Journal of Arthroscopic & related Surgery
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