Efficacy of supraspinatus tendon repair using mesenchymal stem cells along with a collagen I scaffold.
OBJECTIVE
Our main objective was to biologically improve rotator cuff healing in an elderly rat model using mesenchymal stem cells (MSCs) in combination with a collagen membrane and compared against other current techniques.


METHODS
A chronic rotator cuff tear injury model was developed by unilaterally detaching the supraspinatus (SP) tendons of Sprague-Dawley rats. At 1 month postinjury, the tears were repaired using one of the following techniques: (a) classical surgery using sutures (n = 12), (b) type I collagen membranes (n = 15), and (c) type I collagen membranes + 1 × 106 allogeneic MSCs (n = 14). Lesion restoration was evaluated at 1, 2, and 3 months postinjury based on biomechanical criteria. Continuous variables were described using mean and standard deviation (SD). To analyse the effect of the different surgical treatments in the repaired tendons' biomechanical capabilities (maximum load, stiffness, and deformity), a two-way ANOVA model was used, introducing an interaction between such factor and time (1, 2, and 3 months postinjury).


RESULTS
With regard to maximum load, we observed an almost significant interaction between treatment and time (F = 2.62, df = 4, p = 0.053). When we analysed how this biomechanical capability changed with time for each treatment, we observed that repair with OrthADAPT and MSCs was associated with a significant increase in maximum load (p = 0.04) between months 1 and 3. On the other hand, when we compared the different treatments among themselves at different time points, we observed that the repair with OrthADAPT and MSCs has associated with a significant higher maximum load, when compared with the use of suture, but only at 3 months (p = 0.014). With regard to stiffness and deformity, no significant interaction was observed (F = 1.68, df = 4, p = 0.18; F = 0.40, df = 4, p = 0.81; respectively).


CONCLUSIONS
The implantation of MSCs along with a collagen I scaffold into surgically created tendon defects is safe and effective. MSCs improved the tendon's maximum load over time, indicating that MSCs could help facilitate the dynamic process of tendon repair.
UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Pilar
P
Tornero-Esteban
UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
José Antonio
JA
Hoyas
UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Esther
E
Villafuertes
Dpto de Medicina y Cirugía Experimentales, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Cruz
C
Rodríguez-Bobada
Dpto de Anatomía y Embriología Humana I, Facultad de Medicina Universidad, Complutense de Madrid, Madrid, Spain.
Yamila
Y
López-Gordillo
Dpto de Ciencia de Materiales, Universidad Politécnica de Madrid, Madrid, Spain.
Francisco J
FJ
Rojo
Dpto de Ciencia de Materiales, Universidad Politécnica de Madrid, Madrid, Spain.|Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain.
Gustavo V
GV
Guinea
Dpto de Ciencia de Materiales, Universidad Politécnica de Madrid, Madrid, Spain.|Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Pozuelo de Alarcón, Madrid, Spain.
Anna
A
Paleczny
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Yaiza
Y
Lópiz-Morales
UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Luis
L
Rodriguez-Rodriguez
Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
Fernando
F
Marco
UGC de Reumatología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. benjamin.fernandez@salud.madrid.org.
Benjamín
B
Fernández-Gutiérrez
D000818:Animals; D024042:Collagen Type I / Q000008:administration & dosage*; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D051381:Rats; D017207:Rats, Sprague-Dawley; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000473:pathology / Q000628:therapy*; D054457:Tissue Scaffolds; D016896:Treatment Outcome
D024042:Collagen Type I