Arthroscopic rotator cuff repair augmentation with autologous microfragmented lipospirate tissue improves short-term clinical and functional outcomes, according to a new study.
Could Adipose Tissue Improve Rotator Cuff Outcomes?
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The study, “Arthroscopic Rotator Cuff Repair Augmentation With Autologous Microfragmented Lipoaspirate Tissue Is Safe and Effectively Improves Short-term Clinical and Functional Results: A Prospective Randomized Controlled Trial With 24-Month Follow-up,” was published online on March 18, 2022 in The American Journal of Sports Medicine.
“Autologous microfragmented lipoaspirate tissue has been recently introduced in orthopaedics as an easily available source of nonexpanded adipose-derived mesenchymal stem cells. Autologous microfragmented lipoaspirate tissue is expected to create a suitable microenvironment for tendon repair and regeneration. Rotator cuff tears show a high incidence of re-rupture and represent an ideal target for nonexpanded mesenchymal stem cells,” the researchers wrote.
The purpose of this study was to evaluate the safety and efficacy of autologous lipoaspirate tissue in arthroscopic rotator cuff repair.
The study participants were randomized to receive a single-row arthroscopic rotator cuff repair followed by intraoperative injection of autologous microfragmented adipose tissue or just the surgery.
The researchers followed up with the patients at 3, 6, 12, 18, and 24 months. Magnetic resonance imaging of the operated shoulders was taken at 18 months to assess tendon integrity and re-rupture rate.
Overall, 177 patients were screened and 44 completed the 24-month follow-up. Improvements in Constant-Murley score were seen in the treatment group at the 6-month follow-up (mean ± SD; control group, 76.66 ± 10.77 points; treatment group, 82.78 ± 7.00 points; P = .0050).
However, the researchers found there were no significant differences in clinical outcome measures at other follow-up points. There were also no significant differences in re-rupture rate, complication rate, and number of adverse events.
“This prospective randomized controlled trial demonstrated that the intraoperative injection of autologous microfragmented adipose tissue is safe and effective in improving short-term clinical and functional results after single-row arthroscopic rotator cuff repair,” they wrote.
The study authors include Pietro S. Randelli, M.D., of the University of Milan, Davide Cucchi, M.D., Chiara Fossati, Ph.D., Linda Boerci, M.D., Elisabetta Nocerino, Federico Ambrogi, Ph.D., and Alessandra Menon, Ph.D., all of the University of Milan in Italy. Elisabetta Nocerino, M.D., of IRCCS Policlinico San Donato, San Donato Milanese also contributed to the study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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