Rotator Cuff Regeneration Post Expanded Stem Cell Therapy: Clinical Approach

This study aims to investigate if biological therapy can repair rotator cuff tears (RCTs) without surgery. RCT is primarily a disease of middle-aged and older patients. Observational data estimated a linear increment in RCTs frequency over time due to the degenerative process. Sport and non-sport Injuries can contribute to RCTs; however, asymptomatic tears do not require any intervention. Tears can be treated conservatively with anti-inflammatory medication, physical therapy, and steroid injections for symptomatic relief and restore shoulder strength and function. RCTs have limited ability to heal independently, and most often, surgical repair is the last resort when non-operative therapy fails. The recovery period following surgery can be lengthy, in addition to possible complications of surgery and general anaesthesia. There are no conclusive data to support the routine use of biological therapy of mesenchymal stem cells (MSCs) or platelet-rich plasma (PRP) in treating symptomatic RCTs. We report a case of a full-thickness supraspinatus (SST) tear in an older woman. The tear happened after frequent injuries; an ultrasound (USS) and MRI scan showed a tear in SST of 9 mm in length and 13 mm in width with 7mm retraction, unresponsive to anti-inflammatory medicines, rehabilitation, and steroid injections. She has had a significant clinical and radiological response to implantation with fat-derived autologous expanded MSCs combined with PRP. We performed USS-guided injections into the subacromial bursa, supraspinatus tendon substance and tendon insertion. After five months, USS revealed that the SST had healed. Eight months post-MSC therapy, she improved dramatically in symptoms. She significantly dropped the Disability of the Arm, Shoulder, and Hand (DASH) score from a baseline of 88.3 before the therapy to 16.3 at the final visit. A Follow-up MRI scan revealed complete healing and regeneration of the SST, with reattachment of the retracted tendon to the greater tuberosity of the humerus, indicating a successful outcome of MSC therapy as an alternative non-surgical treatment. We reviewed the relevant literature and found that no other non-surgical medical therapy produces world record full-thickness tendon repair.