Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Minced Autologous Subacromial Bursa

Pancholi, Neel; Gregory, James M.

doi:10.1016/j.eats.2020.06.013

Cited by 13 publications

(14 citation statements)

References 16 publications

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“…A different approach describes the harvesting of bursa tissue and re-implantation of minced bursa tissue to the repair side. This is a further feasible method for bursa augmentation in rotator cuff repair, which can be used in combination with various surgical repair techniques [ 95 , 96 ]. In a preliminary study, the outcome after a more complex biological augmentation of rotator cuff repair using a stable clotted mixture of concentrated bone marrow, PRP, platelet-poor plasma (PPP), and subacromial bursa tissue was investigated.…”

Section: Clinical Strategies To Use the Augmentation Potential Of The...mentioning

confidence: 99%

“…We therefore speculate that mechanical forces are important triggers of inflammatory processes in the bursa and should be investigated in more detail in the future. The enrichment of stem cells, vasculature and growth factors at the tendon rupture site through bursal augmentation seems to be promising and easy and reliable surgical techniques for this augmentation were recently described [ 93 , 94 , 95 , 96 ]. However, functional follow-up results of clinical cohort studies comparing conventional rotator cuff repair to bursa-augmented strategies are needed to judge its effectivity.…”

Section: Future Perspectivesmentioning

confidence: 99%

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Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research

Klatte‐Schulz

Thiele

Scheibel

et al. 2022

Cells

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The subacromial bursa has long been demolded as friction-reducing tissue, which is often linked to shoulder pain and, therefore, partially removed during shoulder surgery. Currently, the discovery of the stem cell potential of resident bursa-derived cells shed a new light on the subacromial bursa. In the meanwhile, this neglected tissue is gaining more attention as to how it can augment the regenerative properties of adjacent tissues such as rotator cuff tendons. Specifically, the tight fibrovascular network, a high growth factor content, and the large progenitor potential of bursa-derived cells could complement the deficits that a nearby rotator cuff injury might experience due to the fact of its low endogenous regeneration potential. This review deals with the question of whether bursal inflammation is only a pain generator or could also be an initiator of healing. Furthermore, several experimental models highlight potential therapeutic targets to overcome bursal inflammation and, thus, pain. More evidence is needed to fully elucidate a direct interplay between subacromial bursa and rotator cuff tendons. Increasing attention to tendon repair will help to guide future research and answer open questions such that novel treatment strategies could harvest the subacromial bursa’s potential to support healing of nearby rotator cuff injuries.

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Section: Clinical Strategies To Use the Augmentation Potential Of The...mentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research

Klatte‐Schulz

Thiele

Scheibel

et al. 2022

Cells

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“…An easy and reliable arthroscopic surgical technique has already been described in which the RC tendons are covered with the subacromial bursa, using the highly vascularized bursa to augment RC repair [ 14 , 15 ]. Additionally, a recent technical note has reported on a method for re-implanting autologous minced bursa tissue obtained from bursectomy to the RC surface with the aim of supporting RC repair [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

Minkwitz

Thiele

Schmock

et al. 2021

BMC Musculoskelet Disord

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Background The role of the subacromial bursa in the development or healing of shoulder pathologies is unclear. Due to this limited knowledge, we aimed to understand specific reactions of the subacromial bursa according to rotator cuff (RC) pathologies compared to non-tendon defects of the shoulder. We hypothesized that the tissue composition and inflammatory status of the bursa are likely to vary between shoulder pathologies depending on the presence and the extent of RC lesion. Method Bursa samples from patients with either 1) shoulder instability with intact RC (healthy bursa, control), 2) osteochondral pathology with intact RC, 3) partial supraspinatus (SSP) tendon tear, or 4) full-thickness SSP tear were investigated histologically and on gene expression level. Result Bursae from SSP tears differed from non-tendon pathologies by exhibiting increased chondral metaplasia and TGFβ1 expression. MMP1 was not expressed in healthy bursa controls, but strongly increased with full-thickness SSP tears. Additionally, the expression of the inflammatory mediators IL1β, IL6, and COX2 increased with the extent of SSP tear as shown by correlation analysis. In contrast, increased angiogenesis and nerve fibers as well as significantly upregulated IL6 and COX2 expression were features of bursae from patients with osteochondral pathology. Using immunohistochemistry, CD45+ leukocytes were observed in all examined groups, which were identified in particular as CD68+ monocytes/macrophages. Conclusion In summary, besides the strong increase in MMP1 expression with SSP tear, molecular changes were minor between the investigated groups. However, expression of pro-inflammatory cytokines correlated with the severity of the SSP tear. Most pronounced tissue alterations occurred for the osteochondral pathology and full-thickness SSP tear group, which demonstrates that the bursal reaction is not exclusively dependent on the occurrence of an SSP tear rather than longstanding degenerative changes. The present bursa characterization contributes to the understanding of specific tissue alterations related to RC tears or non-tendon shoulder pathologies. This pilot study provides the basis for future studies elucidating the role of the subacromial bursa in the development or healing of shoulder pathologies.

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“…Recently, clinical translation of bursa-derived CTP therapeutics has progressed, with several studies detailing techniques for isolating proliferative CTPs that are superior to other common orthobiologic treatments [39][40][41][42][43] . Bursal tissue itself has also been delivered to the injured and repaired tendon in an animal model in order to localize CTPs to the site of healing; however, biological evidence of improved rotator cuff healing following this approach has not yet been established 44 . This budding interest in bursa-derived cells motivates additional investigation into whether the regenerative potential of the bursa may be harnessed with in situ manipulation in lieu of excision and ex vivo processing.…”

mentioning

confidence: 99%

“…This initiated a shift in the discussion around this tissue, from a focus on its theorized detriment to rotator cuff healing to a new focus on its potential supporting role in rotator cuff repair and regeneration. As a result, there recently has been an increase in studies characterizing the CTP population and/or delivering CTPs to the rotator cuff tendon repair (e.g., via direct injection, cell-seeded scaffolds, and bursal tissue affixed to the repair) 35,36,[38][39][40][41][42][43][44][45] . CTPs derived from both human and murine bursa have characteristics of mesenchymal stem cells (MSCs), demonstrating their potential for integration into regenerating tissues and immunomodulation, as has been shown in numerous previously published studies using MSCs 35,36,38,46 .…”

mentioning

confidence: 99%

The Role of the Subacromial Bursa in Rotator Cuff Healing

Marshall

Levine

Thomopoulos

2022

Journal of Bone and Joint Surgery

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Clinical Burden of Rotator Cuff DiseaseThe rotator cuff comprises the set of tendons that stabilize the glenohumeral joint (Fig. 1). Rotator cuff degeneration is a common pathology that results in pain, disability, lost productivity, and limitations to recreational activities 1 . Rotator cuff pathology carries a large clinical burden: in the United States, >4.5 million individuals suffer from rotator cuff tendinopathy, and >17 million individuals have a rotator cuff injury 2 . The incidence of rotator cuff pathology is high, with approximately 50% of the population who are ‡65 years of age experiencing a rotator cuff tear [3][4][5] . These injuries result in >500,000 rotator cuff repairs annually in the U.S. 1,3,[6][7][8] . Despite being one of the most common orthopaedic shoulder procedures, outcomes after rotator cuff repair are unpredictable and depend on factors such as tendon length, bone quality, and muscle quality, with failure rates ranging from 20% to 94% [9][10][11][12] . Repairs are typically performed arthroscopically and rely on sutures that are passed through the torn cuff tendon(s) and fixed to the humerus via suture anchors 13 . This serves to reapproximate the tendon to its native footprint in order to promote healing of the tendon to the bone. When the tendon is deemed irreparable due to irreversible degeneration and/or retraction, reconstruction may be recommended 14 .Before completing either repair or reconstruction, subacromial decompression often is performed (Fig. 1). This includes broadening of the subacromial space by resecting the subacromial bursa (subsequently referred to as the "bursa"), the coracoacromial ligament, and the inferior side of the acromion to varying degrees depending on the diagnosis and clinician preference 15,16 . Decompression is indicated in shoulders with or without refractory subacromial bursitis or subacromial impingement because it also improves visualization of the rotator cuff repair site 15,17,18 . However, decompression that includes subacromial bursectomy with acromioplasty has recently been shown to have no benefit over bursectomy alone, calling into question the necessity of acromioplasty 19 . Similarly, a systematic review of subacromial impingement treatment strategies revealed that bursectomy without acromioplasty is sufficient for treating symptoms of impingement 20 . Interestingly, subacromial decompression has been shown to impart no clinically meaningful improvement in patient outcomes 21,22 . Bursectomy has even been shown to be less effective in patients with subacromial pain syndrome if they also had degeneration in the shoulder 23 . Despite the judicious use of bursectomy, the impact that this procedure has on tendon-healing has not been established. Hence, investigating the involvement of the bursa in the tendon-healing response is critical for defining best surgical repair practices. Historical PerspectiveThe bursa was first discussed in the literature in 1906 when Codman reported its involvement in "stiff and painful shoulders." 24 The bursa...

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Biologic Augmentation of Arthroscopic Rotator Cuff Repair Using Minced Autologous Subacromial Bursa

Cited by 13 publications

References 16 publications

Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research

Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research

Histological and molecular features of the subacromial bursa of rotator cuff tears compared to non-tendon defects: a pilot study

The Role of the Subacromial Bursa in Rotator Cuff Healing

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