Purpose
To compare the potency of mesenchymal stem cells between the cells derived from the
subacromial bursa to concentrated bone marrow aspirate (cBMA) taken from patients
undergoing rotator cuff (RC) repair.
Methods
Subacromial bursa and cBMA were harvested arthroscopically from 13 patients (age 57.4
± 5.2 years, mean ± standard deviation) undergoing arthroscopic primary RC repair.
Bone marrow was aspirated from the proximal humerus and concentrated using an automated
system (Angel System; Arthrex). Subacromial bursa was collected from 2 sites (over
the RC tendon and muscle) and digested with collagenase to isolate a single cellular
fraction. Proliferation, number of colony-forming units, differentiation potential,
and gene expression were compared among the cells derived from each specimen.
Results
The cells derived from subacromial bursa showed significantly higher proliferation
compared with the cells derived from cBMA after 5, 7, and 10 days (P = .018). Regarding colony-forming units, the subacromial bursa had significantly
more colonies than cBMA (P = .002). Subacromial bursal cells over the RC tendon produced significantly more
colonies than cells over both the RC muscle and cBMA (P = .033 and P = .028, respectively). Moreover, when compared with cBMA, cells derived from subacromial
bursa showed significantly higher differentiation ability and higher gene expression
indicative of chondrogenesis, osteogenesis, and adipogenesis.
Conclusion
The subacromial bursa is an easily accessible tissue that can be obtained during RC
repair, with significant pluripotent stem cell potency for tendon healing. Compared
with cBMA taken from the proximal humerus, bursal cells showed significantly increased
differentiation ability and gene expression over time.
Clinical Relevance
Failed RC repairs have been partly attributed to a poor healing environment. Biologic
augmentation of the repair site may help increase healing potential and incorporation
of the cuff at the tendon–bone interface.
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Article info
Publication history
Published online: October 16, 2019
Accepted:
May 12,
2019
Received:
January 3,
2019
Footnotes
See commentary on page 2989
The authors report the following potential conflicts of interest or sources of funding: A.D.M. reports grants and personal fees from Arthrex. M.P.C. reports personal fees from Arthroscopy Association of North America. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
The University of Connecticut Health Center/UConn Musculoskeletal Institute has received direct funding and material support from Arthrex (Naples, Florida, U.S.A.). The company had no influence on study design, data collection or interpretation of the results or the final manuscript.
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
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Access this article on ScienceDirectLinked Article
- Editorial Commentary: Subacromial Bursa—Friend or Foe Within The Shoulder? An Old Debate With New InsightsArthroscopyVol. 35Issue 11
- PreviewThere is an ongoing debate about whether to resect or preserve the subacromial bursa during surgical treatment of rotator cuff tears. Neer was the first to systematically describe bursitis as a component of subacromial impingement syndrome that may extend to rotator cuff disease, often discussed as a point of controversy with Uhthoff who first identified the bursa as a contributor to rotator cuff healing, both experimentally and clinically. Because the subacromial bursa provides the gliding mechanism of the shoulder and regenerates itself after surgical removal, interest evolved on the role of the bursa in the healing of rotator cuff tears for evolution of regenerative therapies as a support of arthroscopic repair techniques.
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