Hernigou Philippe, Flouzat Lachaniette Charles Henri, Delambre Jerome, Zilber Sebastien, Duffiet Pascal, Chevallier Nathalie, Rouard Helene
Orthopaedic Surgery, Hopital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France,
Int Orthop. 2014 Sep;38(9):1811-8. doi: 10.1007/s00264-014-2391-1. Epub 2014 Jun 7.
The purpose of this study was to evaluate the efficiency of biologic augmentation of rotator cuff repair with iliac crest bone marrow-derived mesenchymal stem cells (MSCs). The prevalence of healing and prevention of re-tears were correlated with the number of MSCs received at the tendon-to-bone interface.
Forty-five patients in the study group received concentrated bone marrow-derived MSCs as an adjunct to single-row rotator cuff repair at the time of arthroscopy. The average number of MSCs returned to the patient was 51,000 ± 25,000. Outcomes of patients receiving MSCs during their repair were compared to those of a matched control group of 45 patients who did not receive MSCs. All patients underwent imaging studies of the shoulder with iterative ultrasound performed every month from the first postoperative month to the 24th month. The rotator cuff healing or re-tear was confirmed with MRI postoperatively at three and six months, one and two years and at the most recent follow up MRI (minimum ten-year follow-up).
Bone marrow-derived MSC injection as an adjunctive therapy during rotator cuff repair enhanced the healing rate and improved the quality of the repaired surface as determined by ultrasound and MRI. Forty-five (100 %) of the 45 repairs with MSC augmentation had healed by six months, versus 30 (67 %) of the 45 repairs without MSC treatment by six months. Bone marrow concentrate (BMC) injection also prevented further ruptures during the next ten years. At the most recent follow-up of ten years, intact rotator cuffs were found in 39 (87 %) of the 45 patients in the MSC-treated group, but just 20 (44 %) of the 45 patients in the control group. The number of transplanted MSCs was determined to be the most relevant to the outcome in the study group, since patients with a loss of tendon integrity at any time up to the ten-year follow-up milestone received fewer MSCs as compared with those who had maintained a successful repair during the same interval.
This study showed that significant improvement in healing outcomes could be achieved by the use of BMC containing MSC as an adjunct therapy in standard of care rotator cuff repair. Furthermore, our study showed a substantial improvement in the level of tendon integrity present at the ten-year milestone between the MSC-treated group and the control patients. These results support the use of bone marrow-derived MSC augmentation in rotator cuff repair, especially due to the enhanced rate of healing and the reduced number of re-tears observed over time in the MSC-treated patients.
本研究旨在评估使用髂嵴骨髓间充质干细胞（MSCs）对肩袖修复进行生物增强的效果。愈合率及预防再次撕裂与在肌腱-骨界面处接受的MSCs数量相关。
研究组的45例患者在关节镜检查时接受浓缩骨髓来源的MSCs作为单排肩袖修复的辅助治疗。回输给患者的MSCs平均数量为51,000±25,000。将接受MSCs修复的患者的结果与45例未接受MSCs的匹配对照组患者的结果进行比较。所有患者均接受肩部影像学检查，从术后第一个月至第24个月每月进行一次迭代超声检查。术后3个月、6个月、1年、2年及最近一次随访MRI（最短10年随访）时通过MRI确认肩袖愈合或再次撕裂情况。
在肩袖修复过程中，将骨髓来源的MSCs注射作为辅助治疗可提高愈合率，并改善由超声和MRI确定的修复表面质量。接受MSCs增强修复的45例患者中有45例（100%）在6个月时愈合，而未接受MSCs治疗的45例患者中有30例（67%）在6个月时愈合。骨髓浓缩液（BMC）注射还可预防未来十年内的进一步撕裂。在最近的10年随访中，MSCs治疗组的45例患者中有39例（87%）肩袖完整，而对照组的45例患者中只有20例（44%）。在研究组中，确定移植的MSCs数量与结果最相关，因为在长达10年随访里程碑的任何时间出现肌腱完整性丧失的患者与在同一时间段内维持成功修复的患者相比，接受的MSCs较少。
本研究表明，在标准治疗的肩袖修复中，使用含有MSCs的BMC作为辅助治疗可显著改善愈合结果。此外，我们的研究表明，在10年里程碑时，MSCs治疗组和对照患者之间的肌腱完整性水平有显著改善。这些结果支持在肩袖修复中使用骨髓来源的MSCs增强，特别是由于在接受MSCs治疗的患者中观察到随着时间推移愈合率提高且再次撕裂数量减少。
