Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. May 26, 2015; 7(4): 691-699
Published online May 26, 2015. doi: 10.4252/wjsc.v7.i4.691
Stem cell therapy in the management of shoulder rotator cuff disorders
Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Raul Barco Laakso, Ricardo Cuéllar, Mariano García Arranz
Maria Valencia Mora, Miguel A Ruiz Ibán, Jorge Díaz Heredia, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
Raul Barco Laakso, Hospital Universitario La Paz, 28046 Madrid, Spain
Ricardo Cuéllar, Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitario Donostia, 20080 San Sebastián, Spain
Mariano García Arranz, Instituto de Investigación Sanitaria Fundación Jiménez Diaz, 28040 Madrid, Spain
Mariano García Arranz, Departamento de Cirugía, Universidad Autónoma de Madrid, 28049 Madrid, Spain
Author contributions: All authors had contributed to the design, writing and reviewing of this original.
Conflict-of-interest: Mariano García Arranz has the following conflict of interest: MGA is inventor on 2 patents entitled “Identification and isolation of multipotent cells from non-osteochondral mesenchymal tissue” (10157355957US) and “Use of adipose tissue-derived stromal stem cells in treating fistula” (US11/167061). The Universidad Autónoma de Madrid (UAM) and Cellerix share patent rights. The rest of the authors do not have any conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Miguel A Ruiz Ibán, MD, PhD, Unidad de Hombro y Codo, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo km. 9, 100, 28034 Madrid, Spain.
Telephone: +34-91-3368000 Fax: +34-91-3368000
Received: September 7, 2014
Peer-review started: September 10, 2014
First decision: December 17, 2014
Revised: January 26, 2015
Accepted: February 4, 2015
Article in press: February 9, 2015
Published online: May 26, 2015

Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. It is essential to understand the molecular mechanisms that determine this failure. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration. All these changes lead to an increase in biomechanical strength. However, animal research is still inconclusive and more experimental studies are needed before human application. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy.

Keywords: Rotator cuff, Enthesis, Biologic, Stem cells

Core tip: Current surgical techniques in rotator cuff repair do not achieve good tendon-to-bone healing. The use of stem cells to improve healing is a promising alternative. Different in vivo animal studies have shown good results in achieving restoration of the native enthesis. However, human studies are scarce so the use of stem cell therapy in rotator cuff repair should still be considered and experimental technique. Further basic and clinical research is needed.