Our Summary

Rotator cuff tear (RCT) is a common cause of arm disability, leading to over 4.5 million doctor visits and more than 460,000 surgeries every year in the U.S. Despite surgery, a significant number of patients experience a re-tear, with rates ranging from about 30% to 94%. Current surgical grafts used in repair have mixed results, as they do not effectively support healing at the bone-tendon interface and do not prevent scar tissue that leaves the rotator cuff vulnerable to re-tearing.

Research in the field of tissue engineering has shown that using mesenchymal stem cells (MSCs) and growth factors (GFs) can significantly enhance the healing process in animal models, making the repaired tissue stronger and less likely to re-tear. These MSCs and GFs can be delivered in several ways, such as direct injection or being incorporated into repair materials.

The challenge now is to translate these promising animal study results to human clinical practice. The ideal rotator cuff repair graft should be easy to implant and fix in place, compatible with current arthroscopic techniques, and capable of delivering MSCs and/or GFs to enhance healing.

FAQs

  1. What is a rotator cuff tear and how common is it?
  2. What is the role of mesenchymal stem cells and growth factors in rotator cuff repair?
  3. What are the challenges in translating the results of animal studies to human clinical practice in rotator cuff repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about rotator cuff repair is to follow a personalized rehabilitation program post-surgery to ensure proper healing and prevent re-tearing. This program may include physical therapy exercises, rest, and lifestyle modifications to protect the repaired rotator cuff. It is important to follow the guidance of your healthcare provider and avoid activities that may put strain on the shoulder until fully healed. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can promote overall healing and reduce the risk of future injuries.

Suitable For

Patients who are typically recommended for rotator cuff repair surgery are those with:

  • Severe pain and limited function in the shoulder
  • Persistent symptoms despite conservative treatment (such as physical therapy, cortisone injections, and anti-inflammatory medications)
  • Large or complete tears of the rotator cuff
  • Tears that are causing weakness in the shoulder muscles
  • Tears in younger patients who are more likely to benefit from surgery and have a higher chance of successful healing

Patients who have failed previous rotator cuff repair surgeries or who have a high risk of re-tear may also be candidates for newer techniques using MSCs and GFs to enhance healing. These patients may benefit from a more advanced approach that incorporates tissue engineering principles to improve the outcomes of rotator cuff repair surgery.

Timeline

Timeline before and after rotator cuff repair:

Before Rotator Cuff Repair:

  1. Patient experiences pain, weakness, and limited range of motion in the shoulder.
  2. Patient undergoes physical examination, imaging tests (such as MRI), and possibly conservative treatments (such as physical therapy or corticosteroid injections).
  3. If conservative treatments are unsuccessful, patient may be recommended for surgery to repair the rotator cuff tear.

After Rotator Cuff Repair:

  1. Surgery is performed using arthroscopic techniques to repair the torn rotator cuff tendon.
  2. Mesenchymal stem cells (MSCs) and growth factors (GFs) may be incorporated into the repair material to enhance healing.
  3. Patient undergoes post-operative rehabilitation, including physical therapy to regain strength and range of motion in the shoulder.
  4. Over time, the repaired rotator cuff tendon heals and becomes stronger, reducing pain and improving function in the shoulder.
  5. Follow-up appointments with the surgeon are scheduled to monitor progress and address any complications.
  6. In some cases, despite successful initial healing, there may be a risk of re-tear in the future, requiring ongoing monitoring and possibly additional treatments.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with rotator cuff repair surgery?

  2. How long is the recovery process after rotator cuff repair surgery, and what can I expect in terms of pain and physical therapy?

  3. What type of graft material will be used for my rotator cuff repair, and how does it compare to other options in terms of success rates and re-tear prevention?

  4. Are there any alternatives to surgery for treating a rotator cuff tear, and how do they compare in terms of effectiveness?

  5. How will mesenchymal stem cells (MSCs) and growth factors (GFs) be incorporated into my rotator cuff repair, and what are the expected benefits of this approach?

  6. What is the success rate of using MSCs and GFs in rotator cuff repair, and are there any potential drawbacks or limitations to this treatment?

  7. Will I need any follow-up procedures or treatments after my rotator cuff repair surgery to ensure the best possible outcome?

  8. What is the long-term prognosis for my rotator cuff injury after surgery, and what steps can I take to prevent re-tears or further damage in the future?

  9. Are there any specific exercises or lifestyle changes I should make after surgery to promote healing and improve the strength and flexibility of my shoulder?

  10. How frequently will I need to follow up with my doctor after rotator cuff repair surgery, and what signs or symptoms should I watch for that may indicate a problem with the healing process?

Reference

Authors: Durtschi MS, Kim S, Li J, Kim C, Chu C, Cheung E, Safran M, Abrams G, Yang YP. Journal: Tissue Eng Part B Rev. 2024 Oct;30(5):559-569. doi: 10.1089/ten.TEB.2023.0320. Epub 2024 Apr 29. PMID: 38411502