Effect of Platelet-rich Plasma and Mesenchymal Stem Cells as Two Biological Alternatives in Rotator Cuff Injury Treatment: A Mini-review

Abstract

The rotator cuff injury introduces as significant damage of trauma and others factors, and currently recognized as a prevalent orthopedic problem. Thus, many clinical procedures have been demonstrated to reduce the complication of rotator cuff injury with varying degrees of success. Platelet-Rich Plasma (PRP) is being enchantingly agreed as one of the most effectiveness strategies for the symptomatic treatment of rotator cuff injury. Many confusing parameters can influence the result of PRP including size of rotator cuff injury, patient age, PRP producing strategy, and number and timing of PRP injections. However, there is some evidences which support beneficial effect PRP in term relieving pain and restoring function, along with minimal adverse effect, in compared with corticosteroids, and other nonsurgical methods. Besides platelet-rich plasma, Mesenchymal Stem Cells (MSCs) are another biological alternative that can be used to treat rotator cuff injuries. Due to lack of large clinical trials applicability, these biological cells have challenges fairly similar to PRP. In conclusion, there is a need for further research to understand the potential application of both of these alternatives as a safe and effective therapeutic option for rotator cuff injuries.

Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair

“… 29 , 33 , 36 While multiple animal studies have demonstrated BMAC’s ability to augment tendon repair by improving enthesis regeneration and repair quality, high-level human clinical studies are scarce. 29 , 38 Despite being scarce, the available clinical investigations have shown promise. 38 In one of the first clinical studies, Hernigou et al 15 investigated 90 matched patients who received a single-row RCR for small tears, half of whom received BMAC at the completion of the repair and the other half who did not.…”

“… 29 , 38 Despite being scarce, the available clinical investigations have shown promise. 38 In one of the first clinical studies, Hernigou et al 15 investigated 90 matched patients who received a single-row RCR for small tears, half of whom received BMAC at the completion of the repair and the other half who did not. At 6 months, all 45 patients who received BMAC had evidence of healed repairs on MRI compared with only 67% of patients who did not receive BMAC.…”

“…Thus far, human clinical studies have primarily focused on the impact that BMAC has on the MRI appearance of tendon-to-bone healing, and this is the first report on a difference in revision rates. 38 While it is important to report the effect that BMAC has on tendon healing as seen by MRI, it is well known that structural failure may not often manifest clinically. 21 The difference in revision rates shown in this study suggests that the differences seen on MRI may be a marker for higher failure rates and further support the consideration of insurer-covered cost of BMAC augmentation.…”

“…Overall, the majority of the clinical literature examining the application of biologics at the time of RCR has focused on PRP. 38 And although individual studies have produced promising results, pooled data from these studies have remained inconsistent. 7 , 16 , 37 Hurley et al 16 recently performed a meta-analysis of 18 RCTs and 1147 patients and reported that patients receiving PRP experienced significantly lower rates of incomplete healing, lower pain levels, and improved functional outcomes.…”

“…To our knowledge, few human clinical studies have sought to compare these 2 adjunctive therapies. 14 , 38 Liu et al 29 performed an in vivo animal study evaluating the influence of BMAC and PRP on tendon-to-bone healing in a rabbit chronic rotator cuff model. The group reported that rabbits treated with BMAC exhibited enhanced mechanical strength of the tendon-to-bone junction and histologically improved biologic healing compared with rabbits treated with PRP at the time of repair.…”