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Non-Responsive Shoulder Pain with Osteoarthritis and Rotator Cuff Tears Treated With Autologous, Micro-Fragmented and Minimally Manipulated Adipose Tissue Under Continuous Ultrasound Guidance
R.Striano, G. Malanga, J. Bowen, N. Bilbool, K. Azatullah, J. Hilado
Background: Orthopedic pain from osteoarthritis (OA) and rotator cuff disease affect a large portion of the adult population. The result is pain, reduced range of motion, impairment in activities of daily living and a worsening quality of life. Currently, there are limited treatments if non-operative care fails. In this context, the autologous fat graft is gaining interest. Fat is readily accessible and simple to harvest, to provide volume, cushion, structural support, repair and replacement of damaged tissues. In addition, fat graft is a heterogeneous mix of cellular and non-cellular elements that produce trophic cascades.
Objective: To study the safety and benefits of using an autologous, minimally manipulated adipose tissue graft for treating degenerative shoulder pathology with pain having failed conventional care.
Study description: To remove variables in assessing outcomes of the fat graft exclusively, no other biologics or pharmacologics were introduced with the treatment. 18 subjects (19 shoulders) reached one-year follow-up, which was part of an ongoing IRB study approved by IRCM (Institute of Regenerative and Cellular Medicine). Two subjects were lost to follow up prior to one year. The patients were ages: 39 – 89 with moderate to advanced degeneration. Tears (all confirmed on MRI): Glenohumeral Osteoarthritis: Severe n=10, moderate n=8. Acromio-clavicular arthrosis: n=8. Rotator Cuff: Supraspinatus: Full thickness tears n=8, complete tear n=2, partial thickness tears n=7, tendinosis n=8, fatty atrophy n=5. Infraspinatus: Tendinosis n=6, full thickness tear n=1. Subscapularis: Tendinosis n=4, intra-substance tear n=1. Labrum: Tear n=7. Bicep tendon: Tendinosis n=1, partial thickness tear n=4.
Material and Methods: An autologous, mircofragmented, fat graft was obtained using a minimal manipulation technology in a closed system, without the addition of enzymes or other additives.
The graft was injected in 1cc aliquots under continuous ultrasound guidance, into each joint and/or each tendon / soft tissue defect. Clinical outcomes are shown in Fig. 1-7.
Results: Other than pain consistent with multiple injections, no adverse events were reported. The improvement of the symptoms occurred within a few days after treatment and all measured scores (symptoms, signs, and function) showed significant improvement to one-year follow-up (NPS p<0.0001, ASES p<0.0002, Constant p< 0.0006. Figures 1-7).
Conclusion: Although more investigation is needed, these results show promise where other methods have failed. The injection of autologous, micro-fragmented, and minimally manipulated adipose tissue appears very effective in patients with shoulder disease that failed conventional treatments.