A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis

Abstract

IntroductionShoulder pain is a common musculoskeletal complaint in the general population. Bone marrow concentrate (BMC) injections offer promising potential as a minimally invasive approach for treatment of shoulder pain in degenerative disease. In this study, we investigated the clinical outcomes of the BMC injections for treatment of shoulder pain and disability due to osteoarthritis (OA) and rotator cuff tears in a treatment registry population.MethodsA total of 115 shoulders in 102 patients were treated with autologous BMC injections for symptomatic OA at the glenohumeral joint and/or rotator cuff tears. Data were collected for factors potentially influencing outcome, including age, sex, body mass index, and the type of condition treated (ie, OA or rotator cuff tear). Clinical outcomes were assessed serially over time using the disabilities of the arm, shoulder and hand score (DASH), the numeric pain scale (NPS), and a subjective improvement rating scale. Baseline scores were compared to the most recent outcome scores at the time of the analysis and adjusted for demographic differences. We reported comparisons of pre- and post-treatment scores, the differences between osteoarthritis and rotator cuff groups, and the predictive effects on the clinical outcomes.ResultsAt the most current follow-up assessment after treatment, the average DASH score decreased (improved) from 36.1 to 17.1 (P<0.001) and the average numeric pain scale value decreased (improved) from 4.3 to 2.4 (P<0.001). These changes were associated with an average subjective improvement of 48.8%. No differences were observed between outcomes among the shoulders treated for OA versus rotator cuff tears, nor did age, sex, or body mass index influence pain or functional outcomes. There were no significant treatment-related adverse events reported.DiscussionWe observed preliminarily encouraging results following BMC injections for shoulder OA and rotator cuff tears. These results serve as basis for the design of an adequately powered randomized controlled trial.

Bone marrow concentrate injections for the treatment of osteoarthritis: evidence from preclinical findings to the clinical application

“…However, five studies were excluded being congress abstracts, one study was excluded because it was a case report [25], and one study was excluded because it provided the same data of another included study [26]. Thus, a total of 22 studies were included in the qualitative data synthesis: 4 preclinical studies [27][28][29][30] and 18 clinical studies [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]. Since the first reports in 2014, the publication trend remarkably increased over time, especially for the clinical studies, with over 50% of the articles published from 2018 ( Fig.…”

“…Out of the 18 clinical articles found (Table 2), six were retrospective case series, five were retrospective comparative studies, four were randomized controlled trials (RCTs), and three were prospective case series. Eleven studies focused on knee OA [31][32][33][34][35][36][37][38][39][40][41], two focused on hip OA [42,43], two focused on shoulder OA [44,45], while the other three studies described several joints affected by OA [46][47][48]. Intra-articular BMAC injections were performed in 17 studies, while in one study [36], the injection was performed within the tibial and femoral subchondral bone of the knee.…”

A systematic review of the concept and clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics

“…A prospective multicentre study by Centeno et al [ 51 ] compared the use of BMAC for the treatment of osteoarthritis (OA) with and without rotator cuff pathology. A total of 115 shoulders were treated with BMAC injection principally for glenohumeral OA with or without a rotator cuff tear.…”

Analysis of Time to Form Colony Units for Connective Tissue Progenitor Cells (Stem Cells) Harvested From Concentrated Bone Marrow Aspirate and Subacromial Bursa Tissue in Patients Undergoing Rotator Cuff Repair

“… 6 For consistency, the pluripotent cells discussed for the remainder of this study will be referred to as “CTPs.” Intraoperative use of these cells has been described extensively via the harvesting of concentrated bone marrow aspirate (cBMA) for applications in orthopaedic surgery. 1 , 2 , 7 , 8 , 9 Donor sites include the anterior and posterior iliac crest, proximal humerus, and distal femur. 2 , 7 , 10 , 11 , 12 Additional work has discussed the presence of these cells in subacromial bursa tissue as well.…”

“… 1 , 2 , 7 , 8 , 9 Donor sites include the anterior and posterior iliac crest, proximal humerus, and distal femur. 2 , 7 , 10 , 11 , 12 Additional work has discussed the presence of these cells in subacromial bursa tissue as well. 13 , 14 , 15 , 16 , 17 These studies call into question the routine debridement and disposal of this tissue.…”