Arthroscopic Rotator Cuff Repair with a Fibrin Scaffold Containing Growth Factors and Autologous Progenitor Cells Derived From Humeral cBMA Improves Clinical Outcomes in High Risk Patients.

Otto, Alexander; LeVasseur, Matthew R; Baldino, Joshua B; Muench, Lukas N; Bellas, Nicholas; Uyeki, Colin; Trudeau, Maxwell T; Mancini, Michael R; McCarthy, Mary Beth R; Mazzocca, Augustus D

doi:10.1016/j.asmr.2022.06.006

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2022

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Title:: Arthroscopic Rotator Cuff Repair with a Fibrin Scaffold Containing Growth Factors and Autologous Progenitor Cells Derived From Humeral cBMA Improves Clinical Outcomes in High Risk Patients.
Document type:: Journal Article
Author(s):: Otto, Alexander; LeVasseur, Matthew R; Baldino, Joshua B; Muench, Lukas N; Bellas, Nicholas; Uyeki, Colin; Trudeau, Maxwell T; Mancini, Michael R; McCarthy, Mary Beth R; Mazzocca, Augustus D
Abstract:: PURPOSE: To report the clinical outcomes after biologically augmented rotator cuff repair (RCR) with a fibrin scaffold derived from autologous whole blood and supplemented with concentrated bone marrow aspirate (cBMA) harvested at the proximal humerus. METHODS: Patients who underwent arthroscopic RCR with biologic augmentation using a fibrin clot scaffold ("Mega- Clot") containing progenitor cells and growth factors from proximal humerus BMA and autologous whole blood between April 2015 and January 2018 were prospectively followed. Only high-risk patients in primary and revision cases that possessed relevant comorbidities or physically demanding occupation were included. Minimum follow-up for inclusion was 1 year. The visual analog score for pain (VAS), American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test (SST), Single Assessment Numerical Evaluation (SANE), and Constant-Murley scores were collected preoperatively and at final follow-up. In vitro analyses of the cBMA and fibrin clot using nucleated cell count, colony forming units, and live/dead assays were used to quantify the substrates. RESULTS: Thirteen patients (56.9 ± 7.7 years) were included. The mean follow-up was 26.9 ± 17.7 months (n = 13). There were significant improvements in all outcome scores from the preoperative to the postoperative state: VAS (5.6 ± 2.5 to 3.1 ± 3.2; P < .001), ASES (42.0 ± 17.1 to 65.5 ± 30.6; P < .001), SST (3.2 ± 2.8 to 6.5 ± 4.7; P = .002), SANE (11.5 ± 15.6 to 50.3 ± 36.5; P < .001), and Constant-Murley (38.9 ± 17.5 to 58.1 ± 26.3; P < .001). Six patients (46%) had retears on postoperative MRI, despite all having improvements in pain and function except one. All failures were chronic rotator cuff tears, and all were revision cases except one (1.6 ± 0.5 previous RCRs). The representative sample of harvested cBMA showed an average of 28.5 ± 9.1 × 106 nucleated cells per mL. CONCLUSIONS: Arthroscopic rotator cuff repairs that are biologically augmented with a fibrin scaffold containing growth factors and autologous progenitor cells derived from autologous whole blood and humeral cBMA can improve clinical outcomes in primary, as well as revision cases in high-risk patients. However, the incidence of retears remains a concern in this population, demanding further improvements in biologic augmentation. LEVEL OF EVIDENCE: IV, therapeutic case series.
Journal title abbreviation:: Arthrosc Sports Med Rehabil
Year:: 2022
Journal volume:: 4
Journal issue:: 5
Pages contribution:: e1629-e1637
Fulltext / DOI:: doi:10.1016/j.asmr.2022.06.006
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/36312725
TUM Institution:: Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)2022