Artikel
Clinical outcomes after arthroscopic rotator cuff repair with a fibrin scaffold containing growth factors and autologous progenitor cells derived from cBMA
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Autoren
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Alexander Otto
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Joshua B. Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, United States
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Lukas Münch
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Germany
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Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, United States
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Augustus D. Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut Health Center, Farmington, United States
| Veröffentlicht: | 25. Oktober 2022 |
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Gliederung
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Objectives: 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: Thirteen patients (56.9 ± 7.7 years) at high-risk of RCR failure were prospectively followed after arthroscopic RCR with biologic augmentation using a fibrin clot scaffold ("Mega-Clot") containing progenitor cells and growth factors from proximal humerus bone marrow aspirate and autologous whole blood. The visual analogue 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 and conclusion: The mean follow-up was 26.9 ± 17.7 months (N=13). There were significant improvements in all outcome scores from the pre- to the postoperative state: VAS (5.6±2.5 to 3.1±3.2; p<0.001), ASES (42.0±17.1 to 65.5±30.6; p<0.001), SST (3.2±2.8 to 6.5±4.7; p=0.002), SANE (11.5±15.6 to 50.3±36.5; p<0.001), and Constant-Murley (38.9±17.5 to 58.1±26.3,(<0.001). Six patients (46%) had re-tears 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 x 106 nucleated cells per mL.
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 are a valid option to improve clinical outcomes in primary as well as revision cases in high-risk patients. However, the incidence of re-tears remains a concern in this population.
