Application of stem cells in arthroscopic reconstruction of shoulder tendons

event 08.02.2021.


An 82-year-old patient reports pain in his left shoulder for the past 5 months, which worsened over time. He performed physical therapy to reduce the pain, but without success. In parallel, the mobility of the injured shoulder decreased. A month ago, he underwent an MRI of the shoulder, which diagnosed a rupture of the tendon of the supraspinatus muscle in the left shoulder, as well as a strain and effusion around the tendon of the long head of the biceps.

During his stay at AKSIS Special Hospital, he underwent surgery for arthroscopic reconstruction of the supraspinatus tendon, tenodesis of the long head of the biceps muscle, and acromioplasty of the left shoulder.

For the first time in Southeastern Europe, and probably more widely, during this procedure we “reinforced” the reconstructed tendon with stem cells taken from the tissue of the mucous sac that normally covers healthy shoulder tendons.

The mucus sac located in the shoulder is rich in stem mesenchymal cells that enable and accelerate tissue regeneration because they have a high capacity for self-renewal, as well as an exceptional potential for differentiation into different types of tissue. Scientific research has pointed to the fact that stem cells, due to all their characteristics, play an essential role in all phases of the development of the human organism, including the healing of injuries. Because of their virtually unlimited potential for proliferation and self-renewal, they are considered immortal.

During surgery, the mucous bag is cleaned from part of the tendon and passed through a special filter for the extraction of mesenchymal stem cells from the mucous sac of the shoulder (GraftNet). The tissue prepared in this way is mixed with plasma enriched with platelets.

Healing after injury and surgery is a complex process involving many biological mechanisms. Platelets play a key role in hemostasis and tissue healing, i.e. their ability to release bioactive substances such as growth factors, cytokines and chemokines during the activation phase.

Thrombocytes or platelets are small colorless bodies in the blood that we know for their role in clotting. When they travel in the bloodstream, they are not active. In case of injury, they are activated by coming out of the blood vessels, gather at the site of the injury, branch out over the injured tissue and thus the healing process begins. In their active phase, they secrete active factors that participate in healing. They affect tissue repair, the reactivity of blood vessels and other blood cells in angiogenesis and inflammation.

Platelet-rich plasma is a volume of autologous plasma in which the concentration of platelets is above the normal level. Plasma is the liquid part of the blood that contains proteins, some lipids, and most of it is water. ACP is a therapy that has been increasingly used in recent years in the treatment of injuries of the bone and joint system, and currently represents one of the most effective ways of treating injuries of the bone and joint system in medicine. This method of treatment speeds up healing and shortens the time of treatment from an injury. Through its action, it improves muscle healing and increases effective strength, and especially accelerates the healing process after bone-joint surgery. It works effectively in cartilage injuries. Using a special needle, a sample of venous blood is extracted, which is then separated using a special centrifuge system. At the bottom is a layer of erythrocytes, in the middle of platelets and at the top is plasma. The thus obtained serum (plasma and erythrocytes) is applied to the site of pain. The whole procedure takes about 20 minutes. ACP is an autologous therapy, which means that there are no negative reactions because the preparation is obtained from one’s own blood.

The specificity of this surgery is that a mixture of mesenchymal stem cells and plasma rich in platelets is precisely applied to the site of tendon rupture, which was arthroscopically reattached, which promotes tendon healing from two aspect – by accelerating the healing and regeneration process of the tendon. as well as through the quality of the tendon in the region of the rupture or its reconstructed part.

Surgery ends with the removal of osteophytes – bony growths that over time reduce the space through which the sipraspinatus tendon passes, all with the aim of preventing re-injury of the shoulder tendon.

At the end of surgery, platelet-rich plasma (ACP) was applied to the area around the supraspinatus tendon in order to further reduce post-operative pain.

This technique enables faster and better healing of the tendon, and therefore faster recovery of our patients.