IC 06-2025 Practical Surgical Augmentation of Rotator Cuff Repair Using Biologics (CME)-IC 06-2025 Practical Surgical Augmentation of Rotator Cuff Repair Using Biologics (CME)

Video Transcription

Video Summary

The symposium focused on biologic augmentation strategies to improve rotator cuff repair outcomes, highlighting challenges and emerging therapies. Dr. Brian Cole emphasized rotator cuff disease prevalence in older adults and the persistent issue of structural failure post-surgery due to inadequate regeneration at the tendon-bone interface (enthesis). He discussed biologic adjuncts like bone marrow concentrate (BMAC), platelet-rich plasma (PRP), and scaffolds, noting that BMAC shows promising long-term tendon integrity improvement, although economic and application complexities remain. Dr. Scott Rodeo underscored the importance of modulating inflammation, osteoinduction, cell therapy, and mechanical loading in healing. He presented animal studies demonstrating that selective inhibition of pro-inflammatory mediators (e.g., TNF-alpha) and matrix metalloproteinases (MMPs) can enhance tendon-to-bone healing. Vitamin D deficiency adversely affects healing, while agents like parathyroid hormone (PTH) show potential in improving tendon repair and muscle health. Dr. Pietro Randelli introduced adipose-derived stem cell therapy using microfragmented adipose tissue (MFAT), describing clinical trials where MFAT injection during repair accelerated functional recovery with trends toward reduced re-tear rates. Advantages include ease of harvest and intraoperative processing. Dr. James Gregory highlighted the subacromial bursa as a rich source of connective tissue progenitor cells suitable for biologic augmentation. He demonstrated techniques to harvest and apply bursal tissue during surgery, with early studies suggesting trends toward structural improvements and reduced re-tear rates, although optimal application strategies remain to be defined. The panel stressed the multifactorial nature of rotator cuff healing involving patient metabolic status—nutrition, vitamin D levels, diabetes, and cholesterol—playing crucial roles. Clinical practice increasingly incorporates metabolic optimization and biologic augmentation tailored to patient profiles. Despite variability and incomplete understanding of biologic mechanisms, leveraging local cell populations, modulating inflammation, and enhancing osteoinduction represent promising directions for enhancing rotator cuff repair success.

Keywords

rotator cuff repair

biologic augmentation

bone marrow concentrate (BMAC)

platelet-rich plasma (PRP)

scaffolds

inflammation modulation

adipose-derived stem cells

microfragmented adipose tissue (MFAT)

subacromial bursa progenitor cells

metabolic optimization