1
|
Muench LN, Tamburini L, Kriscenski D, Berthold DP, Rupp MC, Cote MP, McCarthy MB, Mazzocca AD. The effect of augmenting suture material with magnesium and platelet-rich plasma on the in vitro adhesion and proliferation potential of subacromial bursa-derived progenitor cells. JSES Int 2023; 7:2367-2372. [PMID: 37969491 PMCID: PMC10638578 DOI: 10.1016/j.jseint.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Connective tissue subacromial bursa-derived progenitor cells (SBDCs) have been suggested as a potent biologic augment to promote healing of the repaired rotator cuff tendon. Maximizing the amount of retained progenitor cells at the tendon repair site is essential for ensuring an optimal healing environment, warranting a search for proadhesive and proliferative adjuvants. The purpose was to evaluate the effect of magnesium (Mg), platelet-rich plasma (PRP), and a combination of both adjuvants on the in vitro cellular adhesion and proliferation potential of SBDCs on suture material commonly used in rotator cuff surgery. Methods SBDCs were isolated from subacromial bursa samples harvested during rotator cuff repair and cultured in growth media. Commercially available collagen-coated nonabsorbable flat-braided suture was cut into 1-inch pieces, placed into 48-well culture dishes, and sterilized under ultraviolet light. Either a one-time dose of 5 mM sterile Mg, 0.2 mL of PRP, or a combination of both adjuvants was added, while a group without treatment served as a negative control. Cellular proliferation and adhesion assays on suture material were performed for each treatment condition. Results Augmenting the suture with Mg resulted in a significantly increased cellular adhesion (total number of attached cells) of SBDCs compared to PRP alone (31,527 ± 19,884 vs. 13,619 ± 8808; P < .001), no treatment (31,527 ± 19,884 vs. 21,643 ± 8194; P = .016), and combination of both adjuvants (31,527 ± 19,884 vs. 17,121 ± 11,935; P < .001). Further, augmentation with Mg achieved a significant increase in cellular proliferation (absorbance) of SBDCs on suture material when compared to the PRP (0.516 ± 0.207 vs. 0.424 ± 0.131; P = .001) and no treatment (0.516 ± 0.207 vs. 0.383 ± 0.094; P < .001) group. The combination of Mg and PRP showed a significantly higher proliferation potential compared to PRP alone (0.512 ± 0.194 vs. 0.424 ± 0.131; P = .001) and no treatment (0.512 ± 0.194 vs. 0.383 ± 0.094; P < .001). There were no significant differences in the remaining intergroup comparisons (P > .05, respectively). Conclusion Augmenting suture material with Mg resulted in a significantly increased cellular adhesion of SBDCs compared to untreated suture material, as well as augmentation with PRP alone or a combination of both adjuvants. Further, Mg with or without PRP augmentation achieved a significant increase in the cellular proliferation of SBDCs on suture material compared to untreated sutures and augmentation with PRP alone. Application of Mg may be a clinically feasible approach to optimizing the use of SBDCs as a biological augment in rotator cuff repair, while combined augmentation with PRP may harness the full potential for optimized tissue recovery due to the high concentration of PRP-derived growth factors.
Collapse
Affiliation(s)
- Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany
| | | | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Augustus D. Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Marshall BP, Levine WN, Thomopoulos S. The Role of the Subacromial Bursa in Rotator Cuff Healing: Friend or Foe? J Bone Joint Surg Am 2023; 105:417-425. [PMID: 36575165 PMCID: PMC10353884 DOI: 10.2106/jbjs.22.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
3
|
Klatte-Schulz F, Thiele K, Scheibel M, Duda GN, Wildemann B. Subacromial Bursa: A Neglected Tissue Is Gaining More and More Attention in Clinical and Experimental Research. Cells 2022; 11:cells11040663. [PMID: 35203311 PMCID: PMC8870132 DOI: 10.3390/cells11040663] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 01/27/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Franka Klatte-Schulz
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- BIH-Center for Regenerative Therapies, Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (K.T.); (M.S.)
| | - Markus Scheibel
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (K.T.); (M.S.)
- Department Shoulder and Elbow Surgery, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- BIH-Center for Regenerative Therapies, Berlin Institute of Health, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany
| | - Britt Wildemann
- Julius Wolff Institute, Berlin Institute of Health at Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany; (G.N.D.); (B.W.)
- Experimental Trauma Surgery, Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747 Jena, Germany
| |
Collapse
|
4
|
Significant Improvement in Shoulder Function and Pain in Patients Following Biologic Augmentation of Revision Arthroscopic Rotator Cuff Repair Using an Autologous Fibrin Scaffold and Bone Marrow Aspirate Derived From the Proximal Humerus. Arthrosc Sports Med Rehabil 2021; 3:e1819-e1825. [PMID: 34977636 PMCID: PMC8689277 DOI: 10.1016/j.asmr.2021.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose To clinically evaluate patients who underwent a biologic augmentation technique in revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated stem cells isolated from bone marrow aspirate (BMA) obtained from the proximal humerus. Methods This is a retrospective review of prospectively collected data from patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and BMA obtained from the proximal humerus between 2014 and 2015. Minimum follow-up was 12 months. Outcome measures were collected preoperatively and postoperatively including range of motion as well as American Shoulder and Elbow Surgeons Shoulder Form, Simple Shoulder Test, single assessment numeric evaluation, and visual analog score. In addition, BMA samples of each patient were assessed for the number of nucleated cells and colony-forming units. Regression analysis was performed to investigate whether the number of nucleated cells and colony-forming units had an influence on outcome and failure. Results Ten patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA obtained from the proximal humerus between 2014 and 2015 were included. The mean follow-up time was 30.7 (range: 12-49) months. Four patients were revised at final follow-up. Postoperative clinical scores improved significantly: American Shoulder and Elbow Surgeons (28.1 ± 5.4 to 60.9 ± 9.0; P < .01), single assessment numeric evaluation (6.6 ± 2.3 to 65.1 ± 10.9; P < .01), visual analog scale (7.2 ± 0.9 to 3.1 ± 0.9; P < .01), and Simple Shoulder Test (1.6 ± 0.5 to 10.3 ± 5.7; P < .01). Postoperative range of motion increased significantly with regard to flexion (97.0 ± 13.6 to 151.0 ± 12.2; P < .01) and abduction (88.0 ± 14.0 to 134.0 ± 15.1; P = .038) but not with external rotation (38.0 ± 5.7 to 50.5 ± 6.5; P = .16). Less pain was correlated to an increased number of nucleated cells (P = .026); however, there was no correlation between failure rate and number of nucleated cells (P = .430). Conclusions Patients who underwent biologic augmentation of revision arthroscopic rotator cuff repair using an autologous fibrin scaffold and concentrated BMA demonstrated a significant improvement in shoulder function along with reduction of pain. However, the overall revision rate for this procedure was 40%. Level of Evidence Level IV, therapeutic case series.
Collapse
|
5
|
LeVasseur MR, Hawthorne BC, Mancini MR, McCarthy MBR, Wellington IJ, Cote MP, Solovyova O, Williams VJ, Mazzocca AD. Trochanteric Bursa Is a Source of Connective Tissue Progenitor Cells. Arthrosc Sports Med Rehabil 2021; 3:e1661-e1670. [PMID: 34977618 PMCID: PMC8689227 DOI: 10.1016/j.asmr.2021.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/25/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose To investigate the presence of connective tissue progenitor cells (CTPs) in the trochanteric bursa harvested over the gluteus medius muscle belly and tendon during open hip procedures. Methods Trochanteric bursa samples from nine patients (63.1 ± 8.6 years) undergoing total hip arthroplasty for primary osteoarthritis were obtained from 2 sites: over the gluteus medius tendon at the greater trochanter and over the muscle belly. Bursal tissue was digested with collagenase and grown in culture. The nucleated cell count, cellular concentration, cellular proliferation, fluorescence-activated cell sorting (FACS) analysis, and differentiation using immunostaining and quantitative polymerase chain reaction (PCR) were used to determine and quantify the presence of CTPs. Results Bursa-derived CTPs were identified in all harvested samples. At t = 0, there was no difference in nucleated cell count over muscle and tendon (1.69 ± 1.26 × 108 and 1.41 ± 1.12 × 108 cells/g, respectively; P = .162). Similarly, the cellular concentration at 3 weeks was not significantly different between bursa harvested over muscle and tendon (6.61 ± 5.14 × 106 and 5.58 ± 4.70 × 106 cells/g, respectively; P = .532). High cellular proliferation was identified for both bursal tissue overlying muscle and tendon (2.28 ± .95 and 1.66 ± 1.05, respectively; P = .194). FACS analysis revealed high positivity rates (>95%) of CTP-specific surface epitopes (CD105, CD90, and CD73) and low positivity rates (<1.3%) of negative markers (CD45, CD31). Osteogenic, adipogenic, and chondrogenic differentiation potential was demonstrated with immunostaining and quantitative PCR for gene expression. Conclusions Connective tissue progenitor cells are found in the trochanteric bursa overlying the muscle and tendon of the hip abductors. Clinical Relevance During open hip procedures, the trochanteric bursa is often partially excised to identify muscular boundaries and tissue planes for surgical exposure. The function of the trochanteric bursa remains largely unknown. However, this tissue is a source of connective tissue progenitor cells, which may be important in the healing response of surgically repaired abductor tendons.
Collapse
Affiliation(s)
- Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Benjamin C Hawthorne
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth R McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Ian J Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Olga Solovyova
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Vincent J Williams
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| |
Collapse
|
6
|
Muench LN, Kriscenski D, Tamburini L, Berthold DP, Rupp MC, Mancini MR, Cote MP, McCarthy MB, Mazzocca AD. Augmenting Suture Tape Used in Rotator Cuff Surgery With Magnesium Increases in Vitro Cellular Adhesion of Human Subacromial Bursal Tissue. Arthrosc Sports Med Rehabil 2021; 3:e1975-e1980. [PMID: 34977656 PMCID: PMC8689267 DOI: 10.1016/j.asmr.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/23/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Lukas N. Muench
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
- Address correspondence to Lukas N. Muench, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Danielle Kriscenski
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Lisa Tamburini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Daniel P. Berthold
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | | | - Michael R. Mancini
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mark P. Cote
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| |
Collapse
|
7
|
Morikawa D, LeVasseur MR, Luczak SB, Mancini MR, Bellas N, McCarthy MBR, Cote MP, Berthold DP, Muench LN, Mazzocca AD. Decreased Colony-Forming Ability of Subacromial Bursa-Derived Cells During Revision Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2021; 3:e1047-e1054. [PMID: 34430884 PMCID: PMC8365201 DOI: 10.1016/j.asmr.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose To compare the cellular viability and differentiation potential of subacromial bursa-derived cells (SBDCs) located over the rotator cuff muscle and tendon of patients undergoing primary versus revision arthroscopic rotator cuff repair (ARCR). Methods Subacromial bursa was harvested from 18 primary (57.1 ± 4.6 years) and 12 revision ARCRs (57.3 ± 6.7 years). Bursa was collected from 2 sites (over rotator cuff tendon and muscle), digested with collagenase, and grown in culture. The number of nucleated cells, colony-forming units (CFUs), differentiation potential, and mesenchymal stem cell surface markers were compared in primary and revision cases. Results There was no difference in the number of nucleated cells between primary and revision ARCR harvested from the subacromial bursa overlying the tendon (3019.3 ± 1420.6 cells/mg and 3541.7 ± 2244.2 cells/mg, respectively; P = .912) or muscle (2753.5 ± 1547.1 cells/mg and 2989.0 ± 2231.4 cells/mg, respectively; P = .777). There was no difference in the number of CFUs between primary and revision ARCR over the rotator cuff tendon (81.5 ± 49.5 CFUs and 53.0 ± 36.9 CFUs, respectively; P = .138), but there were significantly fewer CFUs over the muscle in revision cases (28.1 ± 22.7 CFUs) compared with primary cases (55.7 ± 34.5 CFUs) (P = .031). SBDCs from revision ARCR expressed characteristic mesenchymal stem cell surface epitopes and had multidifferentiation potentials for chondrogenesis, osteogenesis, and adipogenesis. Conclusions SBDCs harvested over the rotator cuff muscle demonstrated significantly decreased colony-forming abilities in revision arthroscopic rotator cuff repairs compared with primary repairs. However, the subacromial bursa retains its pluripotent differentiation potential for chondrogenic, osteogenic, and adipogenic lineages in the revision setting. Clinical Relevance The subacromial bursa may play a role in the healing response of the repaired rotator cuff. This capacity is not necessarily diminished in the revision setting and may be harnessed as an orthobiologic.
Collapse
Affiliation(s)
- Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
| | - Matthew R LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - S Brandon Luczak
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Michael R Mancini
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Nicholas Bellas
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth R McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| |
Collapse
|
8
|
Muench LN, Uyeki CL, Mancini MR, Berthold DP, McCarthy MB, Mazzocca AD. Arthroscopic Rotator Cuff Repair Augmented with Autologous Subacromial Bursa Tissue, Concentrated Bone Marrow Aspirate, Platelet-Rich Plasma, Platelet-Poor Plasma, and Bovine Thrombin. Arthrosc Tech 2021; 10:e2053-e2059. [PMID: 34504743 PMCID: PMC8417132 DOI: 10.1016/j.eats.2021.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/11/2021] [Indexed: 02/03/2023] Open
Abstract
UNLABELLED As recurrent rotator cuff tears following repair remain a significant problem, improving healing potential using biologic adjuvants, including concentrated bone marrow aspirate (cBMA), platelet-rich plasma (PRP), or subacromial bursa tissue (SBT), has become increasingly popular in recent years. In an attempt to combine the benefits of these various biologic adjuvants and maximize the healing potential of the repaired tendon, an arthroscopic rotator cuff repair technique biologically augmented with autologous SBT, cBMA, PRP, platelet-poor plasma (PPP), and bovine thrombin has been developed. The created clot is used as a biologic scaffold for sufficient delivery, and it is stabilized using bovine thrombin in order to ensure maximum stability and retainment of the applied biologic augments at the repair site. CLASSIFICATIONS I: shoulder; II: rotator cuff.
Collapse
Affiliation(s)
- Lukas N. Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A.,Address correspondence to Lukas N. Muench, M.D., Dept. of Orthopaedic Sports Medicine, Technical University of Munich, Germany.
| | - Colin L. Uyeki
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Michael R. Mancini
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Daniel P. Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut 06030 U.S.A
| |
Collapse
|
9
|
Muench LN, Berthold DP, Kia C, Otto A, Cote MP, McCarthy MB, Mazzocca AD, Mehl J. Nucleated Cell Count Has Negligible Predictive Value for the Number of Colony-Forming Units for Connective Tissue Progenitor Cells (Stem Cells) in Bone Marrow Aspirate Harvested From the Proximal Humerus During Arthroscopic Rotator Cuff Repair. Arthroscopy 2021; 37:2043-2052. [PMID: 33581306 DOI: 10.1016/j.arthro.2021.01.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether nucleated cell count (NCC) could serve as an approximation for the number of colony-forming units (CFUs) in concentrated bone marrow aspirate (cBMA) obtained from the proximal humerus. METHODS Bone marrow aspirate (BMA) was harvested from the proximal humerus in 96 patients (mean age 56.2 ± 7.0 years) during arthroscopic rotator cuff repair. Following concentration of the aspirate, nucleated cells of each sample were counted. The total number of CFUs was evaluated under the microscope at their first appearance, usually after 5 to 10 days in culture. Fluorescence-activated cell sorting analysis and assays for osteogenic, adipogenic, and chondrogenic differentiation were performed. Linear regression was assessed to predict the number of CFUs by using NCC. Age, sex, and body mass index (BMI) were evaluated as independent variables. RESULTS The average volume of the obtained BMA was 86.7 ± 35.2 mL. The cBMA contained a mean of 26.3 ± 6.8 × 106 nucleated cells per mL, which yielded a mean of 1421.7 ± 802.7 CFUs in cell culture. There were no significant differences in NCC or number of CFUs when sex, volume of BMA, age, or BMI was examined independently (P >.05, respectively). Linear regression found that NCC was of limited predictive value for the total number of CFUs being yielded after cell culture (r2 = 0.28 with a root mean square error of 679.4). CONCLUSION NCC was of negligible predictive value for the total number of CFUs for connective tissue progenitor cells in BMA harvested from the proximal humerus during arthroscopic rotator cuff repair. CLINICAL RELEVANCE NCC is often used to assess the quality of cBMA samples for biological augmentation during surgery. The limited predictive value of this measurement tool is of clinical importance, because effectiveness of BMA applications has been suggested to depend on the concentration of progenitor cells within the sample.
Collapse
Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany.
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Alexander Otto
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Julian Mehl
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University, Munich, Germany
| |
Collapse
|
10
|
Muench LN, Tamburini L, Kriscenski D, Landry A, Berthold DP, Kia C, Cote MP, McCarthy MB, Mazzocca AD. The Effect of Insulin and Insulin-like Growth Factor 1 (IGF-1) on Cellular Proliferation and Migration of Human Subacromial Bursa Tissue. Arthrosc Sports Med Rehabil 2021; 3:e781-e789. [PMID: 34195645 PMCID: PMC8220627 DOI: 10.1016/j.asmr.2021.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/25/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose To evaluate the effect of a one-time dose of insulin or insulin-like growth factor 1 (IGF-1) on cellular proliferation and migration of subacromial bursa tissue (SBT) over time. Methods SBT was harvested from over the rotator cuff tendon in 4 consecutive patients undergoing primary arthroscopic rotator cuff repair. SBT was cultured for 3 weeks in complete media until reaching confluence. The culture dishes were stored in a humidified, low oxygen tension (5% CO2) incubator at 37°C. SBT of each patient underwent treatment with a one-time dose of insulin or IGF-1, whereas nontreated SBT served as a negative control. Cellular proliferation and migration were evaluated after 24, 48, 72, and 96 hours of incubation. SBT-derived cells migrated in the detection field were visualized using fluorescent microscopy. Results Cellular proliferation at 24, 48, 72, and 96 hours was 1.40 ± 0.27, 1.00 ± 0.20, 1.47 ± 0.31, and 1.68 ± 0.28 for IGF-1; 1.44 ± 0.24, 1.15 ± 0.27, 1.60 ± 0.36, and 1.61 ± 0.32 for insulin; and 1.51 ± 0.35, 1.29 ± 0.33, 1.53 ± 0.35, and 1.57 ± 0.38 for nontreated SBT. Untreated SBT demonstrated a significantly greater proliferation when compared with IGF-1 and insulin within the first 48 hours, although this effect was found to subside by 96 hours. Cellular migration at 24, 48, 72, and 96 hours was 575.7 ± 45.0, 641.6 ± 77.7, 728.3 ± 122.9, and 752.3 ± 114.5 for IGF-1; 528.4 ± 31.3, 592.5 ± 69.8, 664.2 ± 115.2, and 695.6 ± 148.2 for insulin; and 524.4 ± 41.9, 564.4 ± 49.8, 653.2 ± 81.5, and 685.7 ± 115.5 for nontreated SBT. Insulin showed no difference in migration at each timepoint compared to nontreated SBT (P > .05, respectively). Conclusions Insulin and IGF-1 initially inhibit cellular proliferation of human SBT, although this effect was found to subside by 96 hours. Further, neither insulin nor IGF-1 changed the slope of cellular migration over time. However, each treatment group demonstrated a significant increase in cellular proliferation and migration. Clinical Relevance In the setting of biologic augmentation of rotator cuff repair, the compatibility and synergistic effect of insulin on human SBT is highly limited.
Collapse
Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lisa Tamburini
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Danielle Kriscenski
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Arthur Landry
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington Connecticut, U.S.A
| |
Collapse
|