The Role of Mesenchymal Stem Cells in Augmenting Rotator Cuff Repairs

The prevalence of rotator cuff tears increases as patients age due to an attenuated biologic healing capacity. As mechanical advancements in rotator cuff arthroscopic repairs begin to slow, researchers have looked toward using mesenchymal stem cells (MSC) to optimize the shoulder's biologic environment as an alternative route for improvement.

This article aims to review the levels of evidence in clinical studies using an injection of MSC in the shoulder joint or obtaining MSC from sources in the shoulder joint to determine if they show promise in augmenting rotator cuff repairs (RCR). This review also aims to highlight the central tenets behind the arguments for and against the usage of MSC in the in vivo setting.

PubMed and Cochrane Review databases were queried for studies investigating the safety and efficacy of MSC in augmenting RCR published between 1980 and 2017. Clinical human studies were included if they investigated an injection of MSC during arthroscopic RCR or a technique for harvesting MSC from sources in the shoulder joint.

Two studies examined the efficacy of an injection of MSC in conjunction with an arthroscopic RCR. Seven studies demonstrated that harvesting MSC from the humeral head, the rotator cuff, subacromial bursa, and long head of the biceps is both feasible and safe.

While MSC hold promise in augmenting RCR, their clinical successes thus far are very limited. Furthermore, there are many barriers to their use in clinical practice including, but not limited to, lack of standardization and cost.