Purpose
To evaluate the ability of purified human bone marrow–derived mesenchymal stem cells
(MSCs) to augment healing of an acute small- to medium-sized rotator cuff repair in
a small-animal model, evaluating the structure and composition of the healing tendon-bone
interface with histologic and biomechanical analyses.
Methods
Fifty-two athymic rats underwent unilateral detachment and transosseous repair of
the supraspinatus tendon augmented with either fibrin glue (control group) or fibrin
glue with 106 human MSCs (experimental group) applied at the repair site. Flow cytometry verified
the stem cell phenotype of the cells as CD73+, CD90+, CD105+, CD14−, CD34−, and CD45−. Rats were killed at 2 and 4 weeks, with 10 from each group used for biomechanical
testing and 3 for histologic analysis.
Results
Safranin O staining identified increased fibrocartilage formation at the repair site
at 2 weeks in the human MSC group (18.6% ± 2.9% vs 9.1% ± 1.6%, P = .026). Picrosirius staining identified decreased energy (36.88 ± 4.99 J vs 54.97
± 8.33 J, P = .04) and increased coherence in the human MSC group (26.96% ± 15.32% vs 14.53%
± 4.10%, P = .05), indicating improved collagen orientation. Biomechanical testing showed a
significant increase in failure load (11.5 ± 2.4 N vs 8.5 ± 2.4 N, P = .002) and stiffness (7.1 ± 1.2 N/mm vs 5.7 ± 2.1 N/mm, P < .001) in the experimental group compared with the control group at 2 weeks. These
effects dissipated by 4 weeks, with no significant differences in fibrocartilage formation
(35% ± 5.0% vs 26.6% ± 0.6%, P = .172) or biomechanical load to failure (24.6 ± 7.1 N vs 21.5 ± 4.1 N, P = .361) or stiffness (13.5 ± 3.1 N/mm vs 16.1 ± 5.6 N/mm, P = .384). All failures occurred at the bone-tendon interface.
Conclusions
Rotator cuff repair augmentation with purified human MSCs improved early histologic
appearance and biomechanical strength of the repair at 2 weeks, although the effects
dissipated by 4 weeks with no significant differences between groups.
Clinical Relevance
Human MSCs may improve early rotator cuff healing during the first 2 weeks after repair.
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Article info
Publication history
Published online: June 07, 2016
Accepted:
April 19,
2016
Received:
December 5,
2015
Footnotes
The authors report the following potential conflict of interest or source of funding: S.A.R. receives support from Rotation Medical and Cayenne Medical. This study was supported in part by an Arthroscopy Association of North America research grant, awarded to Dr. Russell Warren at the Arthroscopy Association of North America Annual Meeting; Hollywood, Florida; May 3, 2014.
Identification
Copyright
© 2016 by the Arthroscopy Association of North America
