From the Guidelines
Stem cell therapy is not a recommended treatment for torn rotator cuff injuries due to limited evidence supporting its effectiveness, and conventional treatments such as physical therapy, anti-inflammatory medications, corticosteroid injections, and rest should be explored first. The use of biological augmentation of rotator cuff repair with platelet-derived products, including stem cells, has been studied, but strong evidence does not support its use in improving patient-reported outcomes (PROs) 1. However, limited evidence suggests that liquid platelet–rich plasma may be beneficial in decreasing retear rates.
Considerations for Treatment
When considering treatment options for a torn rotator cuff, it is essential to prioritize conventional treatments, including:
- Physical therapy
- Anti-inflammatory medications
- Corticosteroid injections
- Rest These treatments should be tried before considering surgical repair or experimental treatments like stem cell therapy.
Surgical Repair
For moderate to severe tears, surgical repair remains the gold standard treatment. Before considering surgery, a trial of non-surgical management for at least 3 months is recommended, unless specifically contraindicated 1.
Stem Cell Therapy
Stem cell therapy is still considered experimental, and its effectiveness in treating torn rotator cuff injuries is not well established. The procedure involves harvesting stem cells from the patient's own bone marrow or fat tissue and injecting them into the injured rotator cuff area. However, there is no standardized protocol for stem cell treatment of rotator cuff tears, and dosing, timing, and delivery methods vary across medical practices. Additionally, stem cell therapy can be expensive and is rarely covered by insurance.
Recommendation
Before considering stem cell therapy, patients should consult with an orthopedic specialist to evaluate their specific tear and discuss whether stem cell therapy might be appropriate for their situation. The specialist can help determine the best course of treatment based on the severity of the tear and the patient's overall health. The primary goal of treatment should be to decrease pain, increase function, and enhance activities of daily living while mitigating potential long-term adverse outcomes 1.
From the Research
Torn Rotator Cuff and Stem Cell Therapy
- Stem cell therapy has shown promise in promoting tendon remodeling and fibrocartilage formation, increasing biomechanical strength, and inhibiting inflammation and adhesion formation in rotator cuff injuries 2, 3, 4.
- The optimal source and dose of stem cells for rotator cuff tendinopathy need to be determined, and novel approaches are being explored to overcome cell population heterogeneity and standardize patient types for stem cell applications 3.
- Mesenchymal stem cells (MSC) have been found to have a strong paracrine, anti-inflammatory, immunoregulatory, and angiogenic potential, making them a potentially effective therapy to enhance rotator cuff healing 4.
- Stem cell-derived extracellular vesicles (EVs) can increase collagen synthesis and inhibit inflammation and adhesion formation by carrying regulatory proteins and microRNAs, which can promote rotator cuff healing 2.
- While some clinical trials have confirmed the effectiveness of stem cell therapy for rotator cuff tendinopathy, its application has not been widely promoted and approved due to various issues that need to be addressed 3.
Comparison with Other Treatments
- Perioperative acetaminophen has been found to decrease opioid consumption and improve overall pain control after primary arthroscopic rotator cuff repair, highlighting the importance of multimodal analgesia in shoulder surgery 5.
- Physical therapy and precision rehabilitation play a crucial role in the management of shoulder rotator cuff disease, with wearable devices emerging as a promising tool for movement and posture monitoring 6.
Future Directions
- Future studies need to explore stem cell therapy in combination with cellular factors, gene therapy, and novel biomaterial delivery systems to enhance rotator cuff healing 2, 4.
- Expanded stem cell therapy in combination with growth factors or different scaffolds, as well as new stem cell types and gene therapy, are potential future directions for the management of rotator cuff disorders 4.