Arthroscopic Rotator Cuff Repair Augmented with Autologous Subacromial Bursa Tissue, Concentrated Bone Marrow Aspirate, Platelet-Rich Plasma, Platelet-Poor Plasma, and Bovine Thrombin

Abstract

As recurrent rotator cuff tears following repair remain a significant problem, improving healing potential using biologic adjuvants, including concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP), or subacromial bursa tissue (SBT), has become increasingly popular in recent years. In an attempt to combine the benefits of these various biologic adjuvants and maximize the healing potential of the repaired tendon, an arthroscopic rotator cuff repair technique biologically augmented with autologous SBT, cBMA, PRP, platelet-poor plasma (PPP), and bovine thrombin has been developed. The created clot is used as a biologic scaffold for sufficient delivery, and it is stabilized using bovine thrombin in order to ensure maximum stability and retainment of the applied biologic augments at the repair site. Classifications I: shoulder; II: rotator cuff.

The effect of augmenting suture material with magnesium and platelet-rich plasma on the in vitro adhesion and proliferation potential of subacromial bursa-derived progenitor cells

“…These promising in vitro findings have led to the development of multiple surgical techniques regarding the use of SBDCs for biologic augmentation of rotator cuff repair. 6 , 11 , 30 , 32 While clinical evidence pertaining to postoperative functional improvement and repair integrity is yet to be provided, efforts to maximize the amount of SBDCs retained directly at the tear site may be critical to creating a sufficient healing environment regardless of the surgical augmentation technique performed. Recently, SBDCs were found to have the in vitro ability to adhere and proliferate on suture material commonly used in rotator cuff repair.…”

Editorial Commentary: Rotator Cuff Repairs Fail at an Alarmingly High Rate During Long-Term Follow-Up: Graft Augmentation and Biologics May Improve Future Outcomes

“…Investigations are ongoing into the role of bone marrow aspirate concentrate, 9 marrow stimulation, 10,11 platelet-rich plasma, 12,13 autologous microfragmented adipose tissue, 14 bursal tissue, [15][16][17][18] meshed biceps tendon autograft, 19 pulsed electromagnetic field therapy, 20 xenograft, 21 growth factors, 22 allograft, 23 or a combination of these augments. [24][25][26][27] Although many of these studies have reported early feasibility, few have investigated long-term outcomes. We truly need further studies of structural or biologic adjuncts with 5-and 10year follow-up to determine whether we can improve upon the sobering 43% failure rate over the long term.…”

Effectiveness of Bone Marrow–Derived Platelet-Rich Fibrin on Rotator Cuff Healing in a Rabbit Degenerative Model

“…8,58 RCR using BMAC combined with subacromial bursa and PRP has been reported to lead to good clinical outcome. 36 BMAC is liquid, 58 so it is ideal for use with a scaffold to prevent diffusion.…”