![stem cell treatment for shoulders stem cell treatment for shoulders](https://losalgodonescelltherapy.com/content/6-blog/20190103-stem-cell-therapy-for-shoulder-pain/return-to-play-standards-for-shoulder-injury-1.jpg)
The enthesis has been divided into four zones: tendon, non-mineralized fibrocartilage, mineralized fibrocartilage and bone (Figure (Figure1 1 and Table Table1). The enthesis represents a transitional tissue that allows for efficient energy transmission due to the gradual changes that occur in its microstructure, its histological characteristics and its biomechanical behaviour. The stiffness difference between tendon and bone is responsible for significant mechanical stress in the regeneration zone. Tissue regeneration in the tendon-to-bone interphase is a complex process. The purpose of this paper is to outline the current knowledge on the role stem cell therapy might have in dealing with rotator cuff tears and the future implications of the ongoing research’s results.ĮNTHESIS: TENDON TO BONE HEALING IN THE ROTATOR CUFF However, several questions still remain before they can be used clinically for augmenting tendon to bone healing. Stem cells have demonstrated great potential in enhancing the biologic healing process based on their influence in angiogenesis and the inflammatory pattern. In this direction, isolated GF or platelet rich plasma has been recently used with variable results but stems cell are a more promising alternative. The hypothesis is that biological therapies might facilitate the regeneration of the normal tendon-to-bone insertion microarchitecture and limit the amount of scar tissue. This would include growth factors (GF), bone morphogenetic proteins (BMPs) as well as stem cells. Thus, the focus in research has changed from mechanical improvement of the repair techniques to finding ways to improve the biological environment around that repair. Standard tendon to bone repair techniques attain only a fibro-vascular scar tissue that has relatively poor mechanical properties. The main problem with failure in rotator cuff repair is probably biologic, as it is well known that the delicate and highly specialized fibro-cartilaginous transition zone between the rotator cuff and the bone does not regenerate after repair.
![stem cell treatment for shoulders stem cell treatment for shoulders](https://www.stemcelltherapy.directory/wp-content/uploads/2019/01/shoulder-stem-cell-therapy-300x300.png)
Despite these significant technical advances, several studies have shown a persistently high failure rate of tendon to bone rotator cuff repair that ranges from 30% to 94%. In an attempt to improve the strength of the surgical repair, new materials and surgical techniques that aim to reproduce the anatomical footprint of the rotator cuff have been proposed. However, most of the authors have found that tear recurrence determines lower functional scores and a decrease in patient satisfaction. Whether or not healing of the tear is a prognostic factor on function and pain after rotator cuff repair has been controversial. The objective of the treatment is the repair of the damaged tendons. Rotator cuff tears often require surgical treatment in order to increase function and decrease pain. However, it also affects athletes and active individuals regardless of age and activity level. Rotator cuff disease is the most common condition of the shoulder for which patients seek treatment and can be found in 30% to 50% of the population aged older than 50 years. The rotator cuff is a structure formed by the tendinous insertions of a group of muscles that dynamically stabilize the glenohumeral joint. Future directions include expanded stem cell therapy in combination with growth factors or different scaffolds as well as new stem cell types and gene therapy. However, animal research is still inconclusive and more experimental studies are needed before human application. All these changes lead to an increase in biomechanical strength. Promising results have been reported with the use of autologous MSC of different origins in animal studies: they have shown to have better healing properties, increasing the amount of fibrocartilage formation and improving the orientation of fibrocartilage fibers with less immunologic response and reduced lymphocyte infiltration.
![stem cell treatment for shoulders stem cell treatment for shoulders](https://img.youtube.com/vi/2mAHfFjJb9o/maxresdefault.jpg)
Stem cell therapy is thus a potentially effective therapy to enhance rotator cuff healing. Mesenchymal stem cells (MSC) can differentiate into different mesodermal tissues and have a strong paracrine, anti-inflammatory, immunoregulatory and angiogenic potential. The study of the molecular environment during embryogenesis and during normal healing after injury is key in devising strategies to get a successful repair. It is essential to understand the molecular mechanisms that determine this failure. Despite improved surgical techniques, the tendon-to-bone healing rate is unsatisfactory due to difficulties in restoring the delicate transitional tissue between bone and tendon. Rotator cuff tears are frequent shoulder problems that are usually dealt with surgical repair.