Biological supplementation for the shoulder is certainly a hot topic. This expanding frontier of orthopedics is certainly intellectually interesting and promising for the future. Currently we do not have a lot of information regarding what promising new treatments (stem cells, platelet rich plasma or PRP) can do long term. There are also a lot of questions regarding efficacy which is why currently these therapies are usually cash pay.
Because they are cash pay, I really prefer that patients have done their due diligence and do not rely on a doctor promising anecdotal evidence with outlandish claims. This is also the reason that we could have had a clinic appointment and I would not even mention these choices to you; I desire to present medical evidence and provide state of the art surgical care. Some of the science, quoted below, can really muddy the waters so to speak, so I find it best to encourage patients to do their own research.
Bone Marrow Aspirate Concentrate or BMAC is a way to draw bone marrow out of a bone (it frankly just looks like really dense, viscous blood), and spin it down to isolate a concentrate of mesenchymal stem cells. These are stem cells within your own body that can differentiate into other tissue and help heal. After this concentrate is isolated, these are then injected at the surgical site of repair (where the tendon is repaired to the bone).
Bone Marrow Aspirate Concentrate or BMAC (which contains stem cells)
1. Prospective Randomized Trial Of Biologic Augmentation With Mesenchymal Stem Cells In Patients Undergoing Arthroscopic Rotator Cuff Repair. B Cole et al. Orthop J Sports Med. 2019 Jul; 7(7 suppl5).
MSCs (stem cells) injected into the shoulder at the time of rotator cuff repair show improved tendon quality on post-operative MRI at 1-year post-op. This means that the repaired tendon tissue is thicker, which implies it is healthier.
2. Enhanced Tendon-to-Bone Healing of Chronic Rotator Cuff Tears by Bone Marrow Aspirate Concentrate in a Rabbit Model. Clin Orthop Surg. 2018 Mar; 10(1): 99–110.
This study demonstrated again thicker tendon quality in the rabbit model, with higher biomechanical strength.
Platelet Rich Plasma
1. Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. Kim et al. J Orthop Surg Res. 2018 Jan 3;13(1):1.
Compared to a control group both BMAC and PRP injections helped increase shoulder scores (how you feel your shoulder feels in a written reproducible fashion), and trended to healed tendons compared to control. In general the authors concluded that BMAC-PRP improved pain and shoulder function in patients with partial tear of the rotator cuff tendon.
2. Use of Platelet-Rich Plasma for the Improvement of Pain and Function in Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias Assessment. Chen et al. Am J Sports Med. 2020 Jul;48(8):2028-2041.
Long-term retear rates were significantly decreased in patients with rotator cuff-related abnormalities who received PRP. Significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences. Overall, our results suggest that PRP may positively affect clinical outcomes, but limited data, study heterogeneity, and poor methodological quality hinder firm conclusions.
This literature is just the tip of the iceberg so to speak, but in general I do believe evidence is trending in the direction that these adjuvant treatments are useful. Again if you are interested in pursuing this please call my office at 206-860-5578 for an appointment.