Published online May 26, 2015. doi: 10.4252/wjsc.v7.i4.691
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.
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.