Biological Augmentation With Subacromial Bursa in Arthroscopic Rotator Cuff Repair

Abstract

Rotator cuff tears can be associated with significant shoulder dysfunction and pain. Despite improved surgical techniques and new materials for rotator cuff reconstruction, there is no significant reduction in the re-rupture rate. Innovative approaches for enhanced tendon healing are required. The potential of biologically optimized tendon integration has probably been insufficiently explored so far. The existing practice of debridement might eliminate repair tissue and a major source of cells and blood vessels necessary for tendon healing. Biological augmentation may be an option to improve the healing process. The subacromial bursa is a highly proliferative tissue with mesenchymal stem cells capable of differentiating into various cell lines and is easily accessible during rotator cuff repair. We describe the technique of bursal augmentation in arthroscopic double-row SutureBridge repair of a posterosuperior rotator cuff tear with the aim of improving tendon-to-bone healing.

Local Autologous Stem Cells Application in Rotator Cuff Repairs: “LASCA” Technique

“…This paper describes a simple and reproducible Technical Note called “LASCA” to be used for biological augmentation of rotator cuff repairs using subacromial bursa. The only similar paper was published recently by Freislederer et al., 6 in which the authors proposed a technique to sew the mobilized parietal sheet of the SB above a double-row rotator cuff repair. Frailty of the bursal tissue, which may result in the suture’s pull out, and potential formation of adhesions in the subdeltoid recess resulting in secondary stiffness were described as potential risks.…”

“…Frailty of the bursal tissue, which may result in the suture’s pull out, and potential formation of adhesions in the subdeltoid recess resulting in secondary stiffness were described as potential risks. 6 LASCA presents even less-specific risks and limitations. In a few cases, in fact, the SB tissue may be insufficient or absent, and the technique may require modification.…”

Surgical Technique for Arthroscopic Rotator Cuff Augmentation With Human Acellular Dermal Matrix

“…In an attempt to revert the high failure rates of rotator cuff repair and improve tendon healing, many types of reinforcement have been proposed with promising results, including dermal allografts, xenografts, synthetic grafts, and autografts such as biceps autograft augmentation, 20 fascia lata, 21 or subacromial bursa, 22 among others.…”

Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Minced Autologous Subacromial Bursa

“… 5 The subacromial bursa has traditionally been excised and discarded during rotator cuff repair to improve visualization. 6 However, this tissue may potentially serve an important role in rotator cuff healing, by acting as a reservoir of mesenchymal stem cells (MSCs). 7 The bursa has been found to contain large numbers of MSCs.…”

“…A technique of suturing autologous subacromial bursal tissue has previously been described. 6 However, mechanical cutting or chopping has been shown to improve MSC yield compared with use of a whole bursa sleeve. 10 We describe a technique for subacromial bursal tissue reimplantation that obviates the need of suturing a whole sleeve of bursal tissue while improving cell yield.…”