Every month, I receive The American Academy of Orthopedic Surgeons News Magazine; in the Clinical News and Views Section, timely issues are reviewed. The November magazine devoted two pages to Surgical vs. Nonsurgical Treatment for Atraumatic Rotator Cuff Tears. The message is “The jury is still out on best course.” Basically, rotator cuff disease is increasing in an aging and active society but the orthopedic surgeon has a difficult time in clinical decision making. The benefits of conservative and surgical options are still controversial.
Our goal of treatment is to relieve pain, restore and maintain function, and provide lasting, durable relief. First of all, imaging studies continually document a high number of Rotator Cuff Tears in patients over 60; but most patients have no symptoms and thus need no treatment. Although the clinical management of Rotator Cuff Tears is highly successful in the short term, the repair often fails in those over 60.
The American Academy’s Clinical Practice Guidelines on “Optimizing the Management of Rotator Cuff Management” found a lack of definitive evidence. The number one recommendation is “exercise and anti-inflammatory medications may be useful in the management of rotator cuff symptoms in the absence of a full-thickness tear.” Highlighted and emphasized is the fact that surgical repair fails in 35% of cases.
An article that appeared in International Orthopaedics , (SICOT); 2014 reviewed Recent Data Showing the Positive Healing Effects from Augmenting a Rotator Cuff Repair (10 Year Follow up). The study documented that significant improvement in healing outcomes could be achieved by the use of Bone Marrow Aspirate Concentrate containing Mesenchymal Stem Cells. More important, studies by Regenexx demonstrated the healing of both symptomatic Atraumatic and Traumatic Rotator Cuff Tears with Bone Marrow Concentrate derived Stem Cells without surgery if the retraction of the torn tendon were minimal. The take home message, if you have shoulder problems, you need a physical examination, X-ray and MRI. For over half of the patient population with symptomatic rotator cuff tears, a BMAC/Stem Cell intervention may relieve symptoms and result in healing
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