From the Guidelines
Stem cell therapy for rotator cuff surgery is not currently recommended as a standard treatment worth paying out of pocket for, as evidence supporting its effectiveness remains limited and preliminary. The potential benefits include enhanced tissue healing, reduced inflammation, and possibly improved recovery times, as stem cells may promote regeneration of tendon tissue and modulate the inflammatory response 1. However, significant drawbacks exist: costs typically range from $3,000-$7,000 per treatment without insurance coverage; results are inconsistent and unpredictable; the procedure lacks standardization across providers; and long-term outcomes remain largely unknown.
Key Considerations
- The therapy involves harvesting stem cells (typically from bone marrow or adipose tissue), processing them, and injecting them into the injured area, either during surgery or as a standalone procedure.
- While some patients report improvement, others experience minimal benefit.
- Traditional approaches like physical therapy, conventional surgery, and standard rehabilitation protocols remain the evidence-based standard of care for rotator cuff injuries, with a significant reduction in postoperative pain when using an arthroscopic approach 1.
- The science behind stem cell therapy is promising in laboratory settings, but clinical translation has not yet demonstrated consistent, superior outcomes compared to conventional treatments.
Burden of Disease and Cost
- Rotator cuff pathology is a major cause of musculoskeletal disability in the United States, with approximately 250,000 yearly rotator cuff repairs done in the United States 1.
- Despite the high cost of rotator cuff repair, it creates an increase in quality-adjusted life-years for all patients, irrespective of age.
- The estimated lifetime societal saving per annum due to rotator cuff repair is significant, highlighting the importance of effective treatment options.
Recommendation
Given the current state of evidence, patients should prioritize traditional, evidence-based treatments for rotator cuff injuries, and consider stem cell therapy only under the guidance of specialists with extensive experience in orthopedic regenerative medicine, and at academic medical centers tracking outcomes.
From the Research
Pros of Stem Cell Use in Rotator Cuff Surgery
- Enhancement of tendon-bone healing after rotator cuff injuries using combined therapy with mesenchymal stem cells and platelet rich plasma 2
- Biological therapies, including stem cells, facilitate the regeneration of the correct microarchitecture of the tendon attachment to the bone and reduce failures after surgical rotator cuff repair 3
- Menstrual blood-derived mesenchymal stem cells encapsulated in autologous platelet-rich gel facilitate rotator cuff healing in a rabbit model of chronic tears 4
- Ultrasound-guided autologous bone marrow concentrate with platelet-rich plasma and platelet lysate percutaneous injection treatment shows significant differences in patient-reported outcomes for pain and function compared to exercise therapy 5
Cons of Stem Cell Use in Rotator Cuff Surgery
- Limited self-regeneration abilities of the tendon-bone part, making rotator cuff injuries a clinical challenge 2
- Variable but significant risk of incomplete healing with conventional repair of rotator cuff tears 3
- Limited data, study heterogeneity, and poor methodological quality hinder firm conclusions on the efficacy of platelet-rich plasma for rotator cuff-related abnormalities 6
- High cost of stem cell therapy, which may not be covered by insurance, making it a significant out-of-pocket expense for patients
Considerations for Paying Out-of-Pocket
- Significant improvements in pain and functional outcomes with stem cell therapy, although results may vary depending on the individual and the specific treatment used 2, 3, 4, 5
- Potential for reduced risk of retears and improved healing rates with stem cell therapy 4, 5, 6
- Importance of consulting with a healthcare professional to discuss the potential benefits and risks of stem cell therapy and determine if it is a suitable treatment option for individual cases 2, 3, 4, 5, 6