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Background: The objective of the study was to demonstrate the effect of concentrated bone marrow stem cells (MSCs) to the healing of sutured tendon of the supraspinatus muscle in comparison to the same procedure performed without MSCs. We have postulated the hypothesis that MSCs enhance the healing of the sutured supraspinatus tendon to its humeral footprint. Methods and findings:None of the patients had to be excluded from our prospective randomized study. 50 patients met the indication criteria for isolated supraspinatus surgery. 25 patients (Group I) received MSCs into the supraspinatus footprint. 25 patients (Group II) was treated without the use of MSCs. Patients were examined pre-operatively, 6, 12 and 24 months after the surgery and assessment included physical examination, visual analogue scale (VAS), ASES (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form) and Constant score. Patients underwent MRI 2 years postoperatively. Findings were compared with the preoperative results.We have found no statistically significant differences between both groups pre-operatively. After a 24-month follow-up period there were significant differences observed in all clinical outcomes. When compared results between both groups two years postoperatively, p-value (p=0.05) for the VAS score was 0.0176 and for the Constant score 0.0355. The only statistically non-significant was p-value for the ASES score comparing results from both groups at two years follow-up (p=0.085). The MRI findings at 2 years showed fully healed tissue of the rotator cuff tendon in 17 patients in the Group I, but only in 9 patients in the Group II. Conclusions:We have accepted the hypothesis that MSCs enhance the healing of the sutured supraspinatus tendon to its humeral footprint.

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PURPOSE OF THE STUDYGrowth factors produced by platelets enhance tissue healing. The aim of this study was to confirm or disprove the hypothesis that, in anterior cruciate ligament (ACL) reconstruction, the application of platelet-rich plasma (PRP) into the tibial and femoral tunnels and in the graft enhances graft maturation and graft-bone interface healing and thus improves knee function at 3 and 12 months post-operatively in comparison with the control group. MATERIAL AND METHODSA total of 40 patient had the surgery; 20 underwent single-bundle hamstring reconstruction with PRP application (PRP group) and 20 had the same surgery without PRP addition (control group). A 5 ml amount of PRP was obtained from the patient's peripheral blood. A graft inserted in the bone tunnels was fixed with interference screws and, after intra-articular fluid aspiration, 1 ml of PRP was injected into each tunnel and 3 ml were evenly applied to the intra-articular portion of the graft. The patients were examined by MRI at 3 and 12 months after surgery. The subsidence of swelling in the tunnelsurrounding tissues was taken as a sign of graft-bone interface healing, and increased signal intensity of the graft was considered as a result of its ligamentisation. The knee functional status was evaluated at 3 and 12 post-operative months, using the scoring systems (Cincinnati score, IKDC score). RESULTSBone swelling was found at 3 post-operative months in 18 of 20 patients in both the PRP and the control group. Graft signal intensity was increased in most patients (19 of the PRP group; 18 control patients; p = 0.949). The Cincinnati score at 3 months had an average value of 72.7 (34-100; SO, 18.7) in the PRP group and 73.4 (42-99; SO, 16.3) in the control group (p = 0.793).The functional score after 12 months improved to 97.5 (75-100; SO, 12.8) in the PRP group and to 95.1 (66-100; SO, 13.1) in the control group; there was no significant difference between the groups (p = 0.885) at either 3 or 12 months. The IKDC score showed similar results.At 12 months bone swelling was recorded in seven out of 20 patients in the PRP group and in nine patients in the control group (p = 0.751). Graft signal intensity was increased in three and four patients of the PRP and control groups, respectively (p = 0.681). There was a statistical difference between the findings at 3 and 12 months within each group, but no difference between the groups. DISCUSSIONIn ACL reconstruction, the process of tendon graft-to-bone healing has several stages involving inflammation, cell proliferation and graft ligamentisation. At each stage, an important role is played by growth factors produced by thrombocytes, and therefore their potential use in the treatment of injuries to ligaments and tendons has recently come into focus. A number of experimental studies dealing with the effect of platelet-rich plasma on soft tissue healing has been published. Therefore, the method of using PRP to enhance graft healing in ACL reconstruction in humans is still being studied. CONSLUSIONSThe...

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