Mladen Miskulin, Josip Savic, Andrej Radic and Prim O Dulic
Background: Rotator cuff tears can be associated with significant shoulder dysfunction and pain. Despite improved surgical techniques and new methods for the rotator cuff reconstruction, there are still problems connected to the coverage of the humeral head caused by the tendon insufficiency due to degeneration or retraction and late/or inadequate tendon-to-bone healing. For that reason, innovative approaches for enhanced tendon healing are required. The potential of the biological treatment enchasing tendon healing has not been sufficiently explored so far. Biological augmentation may be an option to improve the healing process. One of the possibilities for augmentation is the subacromial bursa, easily accessible tissue during rotator cuff repair, highly proliferative rich in mesenchymal stem cells that are capable of differentiating into various cell lines. In this article, we describe the harvesting technique and application of the subacromial bursal stem cells mixed with platelet-rich plasma during the arthroscopic rotator cuff reconstruction, aiming at postoperative pain alleviation, the improvement of the tendon-to-bone and tendon-to-tendon healing. The goal is enhance healing, to reduce recovery process and to increase patient’s satisfaction with the outcome of the rotator cuff reconstruction.
Case: Authors present augmentation technique of the rotator cuff reconstruct using the nearby subacromial bursa tissue rich in stem cells and mixed whit platelet-rich plasma during arthroscopic rotator cuff repair. It is an advanced surgical technique in which we combine the best of proven surgical techniques for the rotator cuff reconstruction with the best of the regenerative medicine-mesenchymal stem cells from the subacromial bursa and platelet reach plasma. The surgical technique is easy to apprehend, it does not extend time of the surgery and, according to our preliminary data, decreases time of recovery.
Results: The use of subacromial bursal stem cells mixed whit platelet-rich plasma in arthroscopic rotator cuff repair seems to be effective in reducing recovery time in the short term follow up
Conclusion: The presented augmenting technique can be used in every procedure, especially in the elderly patients where issues of tendon to tendon and tendon to bone healing may be expected. Further investigation is necessary
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