Intraoperative Bone Marrow Concentrate for Rotator Cuff Repair:
The rotator cuff is composed of 4 muscles: Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. Three of the four muscles lie just behind the shoulder, on top of the shoulder blade and attach to a bone in the upper arm called the Humerus. This group of muscles is responsible for many movements of the shoulder as well as protection of the actual joint itself. One of the amazing features of the shoulder joint, in comparison to other joints in the body, is its wide variety of movements and large range of motion. The increased range of motion provides us with significant versatility in our arms and is crucial for performing many of our daily activities and weekend adventures. Although the rotator cuff muscles attempt to control and support the joint, the increased range of motion often combined with repetitive overuse, can predispose the rotator cuff tendons and muscles to injury. Which is why the rotator cuff is one of the most common injuries in athletes and weekend warriors alike. To make things more complicated, a rotator cuff injury is often times a nagging injury, and can become a chronic problem that seems to never quite heal properly, causing many people to result to surgery.
Significant research is emerging, investigating methods for noninvasive procedures as well as more efficient surgical techniques to help with rotator cuff injuries. Recently, the use of cellular concentrates has risen as a potentially viable option to enhance healing of this tricky area. Orthopedics this week recently wrote an article discussing one surgeon’s, Dr David Litner, method of using bone marrow derived stem cells inside the operating room, to enhance the healing of rotator cuff repair. Dr Litner extracts bone marrow from the patient and uses high-speed centrifugation to concentrate the cellular milieu. While he is repairing the injured rotator cuff in the operating room, he injects the concentrated mixture of stem cells, platelets, and growth factors into the joint. Dr Litner says, the mixture will act “like fertilizer”, and could potentially help to accelerate tissue repair.
The article went on to discuss a specific patient of Dr. Litner, who had 2 rotator cuff surgeries, the exact same procedure, performed by Dr. Litner himself, on each shoulder. The only difference between the two procedures was that one of the surgeries incorporated stem cells and the other did not. The surgery without stem cells required almost a 1-year recovery, while the procedure with stem cells resulted in complete range of motion by 3 months, and 100% recovery by 4 months. Although this is quite an unusual case, the significant difference in surgical outcomes does raise the question about the regenerative potential of stem cells in rotator cuff repair. Significantly more research and collaboration are needed to understand the potential mechanisms and specific treatment protocols for such surgical additions, but preliminary results are looking promising. Furthermore, nonsurgical application of such cellular concentrates is a rapidly evolving area of orthopedics, and the future may reveal exciting advancements in regenerative cellular therapies.
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