Use of injectable collagen in partial-thickness tears of the supraspinatus tendon: a case report

Abstract

Management of partial-thickness rotator cuff tears is actually controversial. We treated a patient with a partial-thickness tear of the supraspinatus tendon by a series of four type I porcine collagen ultrasound-guided injections, at weekly intervals. At the same time the patient underwent physical therapy, consisting of motor re-education and proprioceptive exercises. The patient was assessed before the treatment and up to 18 months after the last injection by the Constant–Murley score, the Disability of Arm, Shoulder and Hand questionnaire and ultrasonography. Shoulder pain and functional limitation progressively improved and they almost completely disappeared at the last follow-up. Ultrasonography showed a gradual healing of the partial-thickness tear and a regeneration of the tendon structure. This is the first study on ultrasound-guided injections of type I porcine collagen for the treatment of partial-thickness rotator cuff tears. Future research should confirm the excellent result achieved in this case report.

An Update on the Clinical Efficacy and Safety of Collagen Injectables for Aesthetic and Regenerative Medicine Applications

“…The first prospective, randomized clinical trial has been conducted by Kim et al in 2020 and reported rotator cuff functional outcomes improvement and a decreased tear size in 37% of patients with a single collagen injection (0.5–1.0 mL) [ 141 ]. A case study confirmed how multiple intratendinous weekly injections of 2 mL of collagen are able to reduce the partial-thickness tear in three months and to completely heal tendon tear in 18 months, which in addition appeared quite regular and isoechoic [ 183 ]. Collagen injections were thus found to be effective to decrease tear size (50–77% complete recovery), pain, increase functional shoulder score and delay tear progression in partial-thickness rotator cuff tears [ 141 , 145 , 146 , 183 ].…”

“…A case study confirmed how multiple intratendinous weekly injections of 2 mL of collagen are able to reduce the partial-thickness tear in three months and to completely heal tendon tear in 18 months, which in addition appeared quite regular and isoechoic [ 183 ]. Collagen injections were thus found to be effective to decrease tear size (50–77% complete recovery), pain, increase functional shoulder score and delay tear progression in partial-thickness rotator cuff tears [ 141 , 145 , 146 , 183 ]. The precise mechanism of tendon healing after injection of collagen is still unknown.…”

“…Collagen-based formulations are mainly used for the treatment of several kind of diseases belonging mainly to the musculoskeletal (i.e., hip or knee osteoarthritis [ 112 , 131 , 133 , 140 , 142 , 144 , 182 ], sprained knee pain [ 143 ], injured cartilage [ 138 , 141 ], piriformis syndrome [ 136 ], ankle and hindfoot arthritis [ 103 ] or fusion [ 100 , 106 , 107 , 108 , 109 ], lumbar spinal fusion [ 99 ], myofascial pain syndrome [ 130 , 137 ], chronic pain [ 132 ], acute lumbar spine pain [ 134 ], partial-thickness rotator cuff tears [ 141 , 146 , 183 ], plantar fasciitis [ 184 ], calcific supraspinatus tendinitis [ 145 ], pain [ 130 , 132 , 134 , 137 ]), urogenital (i.e., urinary incontinence [ 122 , 124 , 125 , 185 , 186 , 187 , 188 , 189 ], neurogenic urinary incontinence [ 190 ], lichens sclerosus [ 165 ], intrinsic sphincter deficiency [ 191 , 192 , 193 ], post-prostatectomy incontinence [ 65 , 123 , 194 ,…”

“…Thus, musculoskeletal apparatus-related medical treatments and costs increase with population age (numbers over 50 years). Among invasive and non-invasive currently available treatments, collagen injections are revealed to be quite effective for the treatment of several musculoskeletal diseases such as hip [ 131 ] or knee osteoarthritis [ 112 , 133 , 140 , 142 , 144 , 182 ], sprained knee pain [ 143 ], injured cartilage [ 138 , 141 ], piriformis syndrome [ 134 ], ankle and hindfoot arthritis [ 103 ] or fusion [ 100 , 106 , 107 , 108 , 109 ], lumbar spinal fusion [ 99 ], myofascial pain syndrome [ 130 , 137 ], chronic pain [ 132 ], acute lumbar spine pain [ 134 ] and in partial-thickness rotator cuff tears [ 141 , 144 , 183 ], plantar fasciitis [ 184 ], and calcific supraspinatus tendinitis [ 145 ] and pain [ 130 , 132 , 134 , 137 ].…”

“…Only recently the efficacy of collagen injections (RegenSeal ® , MD-Shoulder ® , MD-Muscle ® ) for the treatment of tendon tear have been clinically investigated [ 141 , 183 , 184 ]. The first prospective, randomized clinical trial has been conducted by Kim et al in 2020 and reported rotator cuff functional outcomes improvement and a decreased tear size in 37% of patients with a single collagen injection (0.5–1.0 mL) [ 141 ].…”