2013 Neer Award: Effect of the adipose-derived stem cell for the improvement of fatty degeneration and rotator cuff healing in rabbit model

Background This study was conducted to verify the effects of adipose-derived stem cells (ADSCs) on tendon healing and reversal of fatty infiltration in a chronic rotator cuff tear model by using the rabbit subscapularis (SSC). Methods The SSC insertions in 32 rabbits were cut bilaterally. After 6 weeks, secondary procedures were performed bilaterally, dividing the rabbits into 4 groups of 8 rabbits each as follows: the ADSC+repair group, saline+repair group, ADSC-only group, and saline-only group. A fifth group of 8 rabbits served as normal controls (control group). Electromyographic, biomechanical, and histologic analyses were performed 6 weeks after the secondary procedures. Results All SSC tendons in the ADSC-only and saline-only groups failed to heal and were excluded from the electromyographic and biomechanical tests. On electromyographic evaluation, the ADSC+repair group exhibited a larger compound muscle action potential area than the saline+repair group (11.86 ± 2.97 ms · mV vs 9.42 ± 3.57 ms · mV, P = .029), and this response was almost at the level of the control group (13.17 ± 6.6 3 ms · mV, P = .456). Biomechanically, the load-to-failure of the ADSC+repair group (87.02 ± 29.81 N) was higher than that of the saline+repair group (59.85 ± 37.77 N), although this difference did not reach statistical significance ( P = .085). Histologically, the mean proportions of fatty infiltration in the SSC muscles were 29% ± 15%, 43% ± 9%, 51% ± 14%, 63% ± 10%, and 18% ± 9% for the ADSC+repair, saline+repair, ADSC-only, saline-only, and control groups, respectively ( P < .001). The degree of fat staining increased from the ADSC+repair group (unclear or weak) to the saline-only group (strongly present). Conclusion Local administration of ADSCs might have the possibility to improve muscle function and tendon healing and decrease fatty infiltration after cuff repair.