Short-term outcome after arthroscopic rotator cuff revision, augmented with an autologous fibrin scaffold and bone marrow cells from the proximal humerus
ESSKA Academy. Voss A. Nov 8, 2019; 286378
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Short-term outcome after arthroscopic rotator cuff revision, augmented with an autologous fibrin scaffold and bone marrow cells from the proximal humerus

ESA Free Oral Presentations

Topic: Biological Augmentation

Voss A.1,2, Divenere J.3, McCarthy M.B.3, Bellas N.3, Kellner R.4, Beitzel K.2,5, Imhoff A.B.2, Mazzocca A.D.3, Dyrna F.6
1Regensburg University Medical Center, Department of Trauma Surgery, Regensburg, Germany, 2Technical University of Munich
, Department of Orthopaedic Sports Medicine
, Munich, Germany, 3University of Connecticut Health Center, Department of Orthopaedic Surgery, Farmington, United States, 4Saarland University, Department of Quantitative Methods and Statistics,, Saarbrücken, Germany, 5ATOS Orthoparc Clinic, Department of Shoulder Surgery, Arthroscopy and Orthopaedic Sports Medicine,, Cologne, Germany, 6University of Münster, Department of Trauma, Plastic and Reconstructive Surgery, Münster, Germany

Introduction: The formation of a physiological enthesis after rotor cuff repair is still a relevant problem, resulting in high failure rates after reconstruction. Therefore, the purpose of this study was to clinically evaluate patients treated with revision rotator cuff surgery and the use of a biological augmentation Our hypothesis was that revision surgery augmented with an autologous scaffold and a high concentration of progenitor cells will improve shoulder function and reduce pain. Subsequently also reducing failure rates.
Material and methods: This is a retrospective review of prospectively collected data from 10 patients undergoing stem cell concentrated bone marrow aspirate (cBMA) in a single surgeon's practice. The group consisted of patients between 2014-15 that underwent revision rotator cuff repair surgery with biological augmentation (autologous fibrin clot and bone marrow cell concentrate) shuttled down on the footprint through an arthroscopic technique.
Inclusion criteria were patients with symptomatic rotator cuff re-tears. Exclusion criteria were set to advanced osteoarthritis, nerve injuries, tendon transfers, and fatty infiltration ≤ Goutallier Grade III. Outcome measures were collected preoperatively and post-operatively consisting of range of motion, ASES, SST, SANE, and VAS. Additionally, BMA from all patients has been examined for the number of nucleated cells and colony forming units. Regression analysis has been performed to investigated whether the amount of nucleated cells and CFUs had an influence on outcome and failure.
Results: The mean follow-up time was 30,7 (range: 11-49) months. Four patients have been revised at the final follow-up. Postoperative clinical scores increased significantly: ASES (p=0.005), SANE (p< 0.001) and VAS (p=0.006). SST showed no significant difference (p=0.144). Postoperative range of motion increased significantly with flexion (p=0.008) and abduction (p=0.038) but not with external rotation (p=0.164). Data analysis regarding the nucleated cells and CFU only revealed a significant correlation with less pain and increased nucleated cells (p=0.026), but no correlation could be found between failure rate and the amount of cells (p=0.430).
Conclusion: In revision rotator cuff surgery, patients receiving an autologous bone marrow cell concentrate implantation via a fibrin clot showed good clinical results. Never the less the overall revision rate for this procedure was 40%.
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