JSES International (Jul 2025)

Combined arthroscopic rotator cuff repair with mesenchymal stem cell augmentation shows similar functional outcomes but a higher structural integrity rate compared with isolated repair: a meta-analysis of comparative studies

  • Erminia Cofano, MD, PhD,
  • Roberto Minici, MD,
  • Giovanna Spina, MD,
  • Domenico Laganà, MD,
  • Olimpio Galasso, MD,
  • Giorgio Gasparini, MD,
  • Michele Mercurio, MD

DOI
https://doi.org/10.1016/j.jseint.2025.03.017
Journal volume & issue
Vol. 9, no. 4
pp. 1191 – 1198

Abstract

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Background: Arthroscopic rotator cuff repair (RCR) has guaranteed satisfactory outcomes but remains associated with a significant rate of tendon-bone healing failure. Mesenchymal stem cells (MSCs) have been tested as a promising cell-based therapy for rotator cuff tear (RCT). MSC augmentation has been proposed as a therapy associated with surgical repair, potentially enhancing the overall surgical outcomes for patients with RCTs. The aim of this meta-analysis was to compare functional and structural outcomes between arthroscopic RCR combined with MSC augmentation vs. isolated RCR for RCT. Methods: The PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and 5 studies were included. The first author, journal name, year of publication, study design, patient demographics, type of surgery, and follow-up period were recorded. The data extracted for quantitative analysis included the visual analog scale, University of California at Los Angeles score, flexion, external rotation, and retear. Random and fixed effect models were used for the meta-analysis of pooled mean differences and odds ratios. Results: A total of 415 patients were identified, 203 of whom underwent combined RCR and MSC augmentation, and 212 underwent isolated RCR. The mean ages were 62.2 ± 6.2 and 61.6 ± 5.7 years in the combined RCR and MSC injection and isolated RCR groups, respectively. The mean follow-up was 17.5 ± 8.7 and 17.6 ± 8 months. Comparable postoperative visual analog scale score (P = .59), flexion (P = .68), external rotation (P = .42), and University of California at Los Angeles score (P = .92) were found between the groups. Significantly higher rotator cuff retear rate was found in the isolated RCR group (17.7% and 35% for the RCR and MSC injection and isolated RCR groups, respectively; odds ratio = −0.19, 95% confidence interval [−0.34, −0.04], P = .01). Conclusion: Arthroscopic surgical repair combined with MSC augmentation reported better structural outcomes compared to isolated surgical repair for RCT. Pain and functional outcomes were similar between the two groups.

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