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Could Bone Marrow Aspirate Improve Tendon Healing in Rotator Cuff Repair?

A rotator cuff tear is a common shoulder injury that often necessitates surgical repair. Despite advances in techniques, poor tendon healing after surgery is a common problem. There has been increased interest in cell-based approaches to improve tendon healing, and a number of studies are under way at Hospital for Special Surgery (HSS). In the current pilot study, Scott Rodeo, MD, co-director of the Orthopaedic Soft Tissue Research Program at HSS, and colleagues set out to evaluate the use of bone marrow aspirate concentrate in arthroscopic rotator cuff repair.

Bone marrow aspirate, which is taken from fluid from a patient’s bone marrow, contains stem cells that may help in the healing of some bone and joint conditions. HSS orthopedic surgeons extracted the aspirate from the patient’s hip bone in a minimally invasive procedure at the time of arthroscopic rotator cuff repair.

The researchers evaluated patients one year after surgery and found similar outcomes between those who had received the bone marrow aspirate and those who did not. "Although the concept of improving rotator cuff tendon healing using bone marrow-derived cells is appealing, the preliminary data demonstrate no significant improvement in healing or clinical outcomes at 12 months after surgery," said Dr. Rodeo, who is also co-chief emeritus, Sports Medicine and Shoulder Service at HSS. "This may be due to an inadequate concentration of stem cells delivered to the repair site. There are significant limitations to the use of bone marrow aspirate, including the overall low number of stem cells present in bone marrow and variability among patients. The study points to the need to identify methods to improve the isolation and concentration of bone marrow-derived stem cells."

Dr. Rodeo’s lab continues to analyze study data to correlate the clinical and imaging outcomes with the composition and "biologic activity" of the implanted stem cells. "Further clinical studies are required to evaluate the optimal protocol for use of bone marrow aspirate to augment rotator cuff repair," he said.