Examining the Potency of Subacromial Bursal Cells as a Potential Augmentation for Rotator Cuff Healing: An In Vitro Study

Daichi Morikawa; Jeremiah D Johnson; Cameron Kia; Mary Beth R McCarthy; Craig Macken; Nicholas Bellas; Joshua B Baldino; Mark P Cote; Augustus D Mazzocca

doi:10.1016/j.arthro.2019.05.024

Examining the Potency of Subacromial Bursal Cells as a Potential Augmentation for Rotator Cuff Healing: An In Vitro Study

Arthroscopy. 2019 Nov;35(11):2978-2988. doi: 10.1016/j.arthro.2019.05.024. Epub 2019 Oct 16.

Authors

Daichi Morikawa¹, Jeremiah D Johnson², Cameron Kia², Mary Beth R McCarthy², Craig Macken², Nicholas Bellas², Joshua B Baldino², Mark P Cote², Augustus D Mazzocca²

Affiliations

¹ Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan. Electronic address: dmorikaw@juntendo.ac.jp.
² Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.

PMID: 31629585
DOI: 10.1016/j.arthro.2019.05.024

Abstract

Purpose: To compare the potency of mesenchymal stem cells between the cells derived from the subacromial bursa to concentrated bone marrow aspirate (cBMA) taken from patients undergoing rotator cuff (RC) repair.

Methods: Subacromial bursa and cBMA were harvested arthroscopically from 13 patients (age 57.4 ± 5.2 years, mean ± standard deviation) undergoing arthroscopic primary RC repair. Bone marrow was aspirated from the proximal humerus and concentrated using an automated system (Angel System; Arthrex). Subacromial bursa was collected from 2 sites (over the RC tendon and muscle) and digested with collagenase to isolate a single cellular fraction. Proliferation, number of colony-forming units, differentiation potential, and gene expression were compared among the cells derived from each specimen.

Results: The cells derived from subacromial bursa showed significantly higher proliferation compared with the cells derived from cBMA after 5, 7, and 10 days (P = .018). Regarding colony-forming units, the subacromial bursa had significantly more colonies than cBMA (P = .002). Subacromial bursal cells over the RC tendon produced significantly more colonies than cells over both the RC muscle and cBMA (P = .033 and P = .028, respectively). Moreover, when compared with cBMA, cells derived from subacromial bursa showed significantly higher differentiation ability and higher gene expression indicative of chondrogenesis, osteogenesis, and adipogenesis.

Conclusion: The subacromial bursa is an easily accessible tissue that can be obtained during RC repair, with significant pluripotent stem cell potency for tendon healing. Compared with cBMA taken from the proximal humerus, bursal cells showed significantly increased differentiation ability and gene expression over time.

Clinical relevance: Failed RC repairs have been partly attributed to a poor healing environment. Biologic augmentation of the repair site may help increase healing potential and incorporation of the cuff at the tendon-bone interface.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Arthroscopy / methods*
Bursa, Synovial / pathology*
Cell Differentiation
Female
Humans
Male
Mesenchymal Stem Cells / cytology*
Middle Aged
Rotator Cuff / pathology
Rotator Cuff / surgery*
Rotator Cuff Injuries / diagnosis
Rotator Cuff Injuries / surgery*