Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections

Our institute has published research on the treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow derived stem cells. The research appears in the peer-reviewed journal Cogent Medicine. The study can be found here in its entirety:

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections with a June 20, 2019 publication date.

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections Marc Darrow, Brent Shaw, Nicholas Schmidt, Gabrielle Boeger & Saskia Budgett | Udo Schumacher (Reviewing editor) Article: 1628883 | Received 02 Jan 2019, Accepted 30 May 2019, Accepted author version posted online: 18 Jun 2019, Published online: 20 Jun 2019

Below is a summary of our findings: Background: Human bone marrow has shown promise as a minimally invasive approach in treating a variety of musculoskeletal conditions due to the presence of stem cells, platelets, and growth factors in solution. This study examines the clinical effect of whole bone marrow (WBM) and bone marrow concentrate (BMC) injections in patients who were diagnosed with rotator cuff tears or shoulder osteoarthritis.

• Forty-seven patients and fifty shoulders (Three patients had both shoulders treated) with rotator cuff tears or shoulder osteoarthritis underwent one or two BMC or WBM treatments.
• The patients who were injected twice received the injections approximately 22 days apart.
• We measured outcomes for resting pain, active pain, upper extremity functionality scale and overall improvement percentage. The outcomes were compared to baseline in both groups.

Results:

• Patients who received either one and two treatments reported significant improvements in resting pain, active pain, and functionality score when compared to baseline.
• These groups also experienced a 42.25% and 50.17% overall improvement respectively.
• The group that received two treatments experienced statistically significant improvements in active pain when compared to the group that received one injection.
• There were no significant outcome differences between rotator cuff tear and osteoarthritis patients.

Conclusions: Our study demonstrated that patients diagnosed with shoulder osteoarthritis or rotator cuff tears experienced symptomatic improvements in pain and functionality when injected with bone marrow concentrate (BMC) or whole bone marrow (WBM) . Further randomized control studies are needed to validate these findings. Explanations of research:

• This study was performed to identify the effectiveness of one or two treatments of bone marrow concentrate injections (bone marrow is extracted from your iliac crest, the bone marrow is “spun” to concentrate the growth factors) and whole bone marrow (bone marrow is extracted from your iliac crest, the bone marrow is not concentrated)
• In many patients we see, one or two treatments will provide significant improvement, as we have documented. For other patients, the severity of their condition would require more treatment and significant results would be achieved with more than 2 treatments. This is discussed with patients at the initial consultation, examination, and assessment of a treatment plan.
• When a patient at our clinic is recommended to multiple treatments, we advise them to receive injections approximately fourteen days apart. However scheduling conflicts often cause greater injection intervals. The reasoning behind this fourteen-day interval is that this is the time period when there is growth factor secretion from various cell types that participate in the late phases of wound healing .
• In addition, patients were instructed not to perform any strenuous exercise, and instructed to perform a series of shoulder stretches each day to improve joint mobility and reduce the possibility of adhesive capsulitis.

Patient results of note: The outcomes of interest for this study were changes to pain (resting and active), overall improvement (percentage scale), and a joint function questionnaire. Data were collected at baseline, preceding each treatment, at 1 month, at 3 months, at 6 months, and annually after treatment. The functionality portion of the questionnaire, assessed degree of difficulty in performing daily activities, was based on 10 of 20 activities assessed in the Upper Extremity Functional Index, These included such activities as:

1. The difficulty or ability to open a door
2. The difficulty or ability to wash dishes
3. The difficulty or ability to comb or brush hair
4. The difficulty or ability to raise your hand above your head
5. The difficulty or ability to carry a heavy object
6. The difficulty or ability to roll over in bed
7. The difficulty or ability to do a job or household chores
8. The difficulty or ability to put on or take off a shirt
9. The difficulty or ability to wash dishes
10. The difficulty or ability to perform sports or hobbies.

Both Groups 1 and 2 showed statistical significance in terms of pain and functionality when compared to baseline.

• The single treatment group decreased in resting pain of 33.33% and a 28.13% decrease in active pain. These patients also experienced a mean 42.25% total overall improvement and a 15.81% increase in functionality score.
• The two treatment group experienced a 47.31% decrease in resting pain and 42.92% decrease in active pain. These patients also experienced a 50.17% total overall improvement and a 36.89% increase in functionality score Patients in group 2 experienced substantial improvement in active pain when compared to patients who only received one injection.