To investigate the influence of patient demographics and rotator cuff tear characteristics on the cellular proliferation potential of subacromial bursa–derived cells (SBDCs).
Patients undergoing arthroscopic rotator cuff repair between December 2017 and February 2019 were considered for enrollment in the study. Basic demographic information as well as medical and surgical history were obtained for each patient. Subacromial bursa was harvested from over the rotator cuff tendon. Cellular proliferation was evaluated after 3 weeks of incubation by counting nucleated SBDCs. Fluorescence-activated cell sorting (FACS) analysis was performed to confirm the presence of mesenchymal stem cell (MSC) specific surface markers. Using preoperative radiographs and magnetic resonance imaging (MRI), acromiohumeral distance (AHD), severity of cuff tear arthropathy, and rotator cuff tear characteristics were evaluated.
Seventy-three patients (mean age: 57.2 ± 8.5 years) were included in the study. There was no significant difference in cellular proliferation of SBDCs when evaluating the influence of age, sex, body mass index (BMI), smoking status, and presence of systemic comorbidities (p > .05, respectively). Similarly, there was no significant difference in cellular proliferation of SBDCs when looking at rotator cuff tear characteristics (size, tendon retraction, fatty infiltration, muscle atrophy), AHD, or severity of cuff tear arthropathy (p > .05). FACS analysis confirmed nucleated SBDCs to have a high positive rate of MSC specific surface markers.
Subacromial bursa consistently demonstrated a high cellular proliferation potential regardless of patient demographics, rotator cuff tear characteristics, and severity of glenohumeral joint degeneration.
These findings may alleviate concerns that subacromial bursa might lose cellular proliferation potential when being used for biologic augmentation in massive and degenerated rotator cuff tears, thus assisting in predicting tendon healing and facilitating surgical decision-making.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Arthroscopy
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair.Knee Surg Sports Traumatol Arthrosc. 2015; 23: 376-385
- The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears.J Bone Joint Surg Am. 2004; 86: 219-224
- Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs.Am J Sports Med. 2014; 42: 1134-1142
- Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study.J Bone Joint Surg Am. 2007; 89: 953-960
- Vascularity of the supraspinatus tendon three months after repair: Characterization using contrast-enhanced ultrasound.J Shoulder Elbow Surg. 2010; 19: 73-80
- The biology of rotator cuff healing.Orthop Traumatol Surg Res. 2017; 103: S1-S10
- Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: A case-controlled study.Int Orthop. 2014; 38: 1811-1818
- A systematic review of the concept and clinical applications of bone marrow aspirate concentrate in tendon pathology.SICOT J. 2017; 3: 58
- The Holy Grail of orthopedic surgery: Mesenchymal stem cells—their current uses and potential applications.Stem Cells Int. 2017; 2017: 2638305
- Multipotent mesenchymal stem cells from human subacromial bursa: Potential for cell based tendon tissue engineering.Tissue Eng Part A. 2014; 20: 239-249
- Characterization of bursa subacromialis-derived mesenchymal stem cells.Stem Cell Res Ther. 2015; 6: 114
- Human subacromial bursal cells display superior engraftment versus bone marrow stromal cells in murine tendon repair.Am J Sports Med. 2018; 46: 3511-3520
- Isolation and characterization of human mesenchymal stem cells derived from shoulder tissues involved in rotator cuff tears.Am J Sports Med. 2013; 41: 657-668
- A systematic review of the clinical applications and complications of bone marrow aspirate concentrate in management of bone defects and nonunions.Int Orthop. 2017; 41: 2213-2220
- Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 373-377
- Examining the potency of subacromial bursal cells as a potential augmentation for rotator cuff healing: An in vitro study.Arthroscopy. 2019; 35: 2978-2988
- Comparison of preparation techniques for isolating subacromial bursa-derived cells as a potential augment for rotator cuff repair.Arthroscopy. 2019; 36: 80-85
- Reduced levels of mesenchymal stem cells at the tendon-bone interface tuberosity in patients with symptomatic rotator cuff tear.Int Orthop. 2015; 39: 1219-1225
- Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement.Cytotherapy. 2006; 8: 315-317
- Factors associated with poor active anterior elevation after reverse total shoulder arthroplasty.J Shoulder Elbow Surg. 2018; 27: 786-793
- A radiographic classification of massive rotator cuff tear arthritis.Clin Orthop Relat Res. 2011; 469: 2452-2460
- The results of repair of massive tears of the rotator cuff.J Bone Joint Surg Am. 2000; 82: 505-515
- Classification of rotator cuff lesions.Clin Orthop Relat Res. 1990; 254: 81-86
- Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan.Clin Orthop Relat Res. 1994; 304: 78-83
- Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology.Acta Orthop Scand. 1996; 67: 264-268
- The role of tendon and subacromial bursa in rotator cuff tear pain: A clinical and histopathological study.Knee Surg Sports Traumatol Arthrosc. 2015; 24: 3779-3786
- Rotator cuff re-tear or non-healing: Histopathological aspects and predictive factors.Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1588-1596
- Surgical repair of rotator cuff ruptures—The importance of the subacromial bursa.J Bone Joint Surg Br. 1991; 73: 399-401
- Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome.Am J Sports Med. 2007; 35: 719-728
- Biomechanical and biologic augmentation for the treatment of massive rotator cuff tears.Am J Sports Med. 2010; 38: 619-629
- Rotator cuff degeneration: Etiology and pathogenesis.Am J Sports Med. 2008; 36: 987-993
- Differential ubiquitin-proteasome and autophagy signaling following rotator cuff tears and suprascapular nerve injury.J Orthop Res. 2014; 32: 138-144
- mTOR regulates fatty infiltration through SREBP-1 and PPARgamma after a combined massive rotator cuff tear and suprascapular nerve injury in rats.J Orthop Res. 2013; 31: 724-730
- Evaluation of Akt/mTOR activity in muscle atrophy after rotator cuff tears in a rat model.J Orthop Res. 2012; 30: 1440-1446
- Lineage tracing of resident tendon progenitor cells during growth and natural healing.PLoS One. 2014; 9e96113
- Murine supraspinatus tendon injury model to identify the cellular origins of rotator cuff healing.Connect Tissue Res. 2016; 57: 507-515
- Regenerative biology of tendon: Mechanisms for renewal and repair.Curr Mol Biol Rep. 2015; 1: 124-131
- Spontaneous healing process of a supraspinatus tendon tear in rabbits.Arch Orthop Trauma Surg. 2004; 124: 374-377
- Rotator cuff tear arthropathy.J Am Acad Orthop Surg. 2007; 15: 340-349
Published online: June 14, 2020
Accepted: June 4, 2020
Received: December 8, 2019See commentary on page 2803
The authors report the following potential conflicts of interest or sources of funding: M.P.C. reports personal fees from the Arthroscopy Association of North America. A.D.M. receives research support from and is a consultant for Arthrex. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
© 2020 by the Arthroscopy Association of North America