All patients saw a sustained benefit throughout 12 months for fat injections in shoulder
The use of Micro- Fragmented Adipose Tissue in treating Refractory Osteoarthritis shoulder pain and Rotator Cuff Tears Chronic shoulder pain and rotator cuff abnormalities affect a large number of the population, and can result in a serious loss of function and movement which can have an adverse and debilitating effect on the quality of a patient’s life.
One of the most common causes of shoulder pain is osteoarthritis and it is the third most common musculoskeletal disorder after lower back and neck pain.
Rotator cuff pain is most commonly caused by an inflamed tendon (tendinitis) or a torn tendon. The pain can range from a dull aching sensation to a sharp pain moving down the upper arm. Tendons can become frayed or worn down as a result of increasing age and wear and tear through engaging in physical activity with repetitive arm motion. As we age there is a decreased blood supply to the rotator cuff and tendons and as a result when stressed or injured, they do not repair and recover well.
If current standard non operative methods fail, there are few viable options available for treatment other than shoulder replacement surgery which can be invasive, complex, and risky.
Mesenchymal Stem Cell and Lipogems Treatment– the potential for regeneration The treatment for shoulder pain presents a significant clinical challenge for effective non surgical methods.
Recently biological treatments such as using adult stem cell treatments, Mesenchymal Stem Cells (MSCs) have been shown to have potential benefits when used in orthopaedic processes.
One such source of regenerative cellular tissue is adipose (fat), which is known to be a robust source of stem cells.
Adipose tissue, or fat, is an anatomical term for loose connective tissue composed of Adipocytes. It is known to be a very important and active endocrine organ and plays a vital role in the storage and release of energy. Adipose tissue is readily accessible, easily harvested, and there are few complications arising from its use.
Lipogems adipose tissue stem cell therapy is when small amounts of fatty (adipose ) tissue are taken from areas of the body such as the stomach and thighs. Using a special process, cells are then extracted from this tissue and then injected into the area of the body that has been damaged through wear and tear, injury or disease.
A study was carried out to investigate the safety, efficacy, and long term benefits from an ultrasound guided injection of an autologous, minimally manipulated, and micro fragmented adipose tissue on the shoulder.
For the trial, the micro fragmented adipose tissue was obtained with minimal manipulation using the Lipogems system. Adipose tissue has the ease of accessibility and is minimally invasive to acquire and use. The Lipogems process enables the MSCs taken from the patients’ own fatty tissue to be injected directly into the sites of tissue damage, aiding recovery and helping regeneration. MSCs include important proteins to help healing and the study with Lipogems was to investigate the effects on rotator cuff tears affected by chronic lesions which cause degenerative changes and near irreparable damage, to see if they had positive results.
The trial used 18 patients and was to investigate the long term benefits of the adipose tissue treatment on shoulder pain. The average age of patient was 65 years of age all with an average BMI.
Each patient had chronic progressive shoulder pain and a loss of useful function that included a restriction in range of motion, pain elevating the arm, an inability to raise the arm above 90 degrees, pain when sleeping on the affected side, weakness, and a reduced quality of life.
Each patient had pain exceeding 1 year and already failed with prior treatments such as physical therapy, cortisone injections, home exercise, platelet rich plasma, and other supplements. Patients who were not included had pain lasting less than a year, who had undergone cortisone injections in the last 60 days or who had rheumatoid arthritis, infectious disease or cancer.
All patients underwent an MRI and Ultrasound to investigate the pathology prior to treatment.
The scans helped to map out the treatment plan and determine the volume of adipose tissue required to treat the abnormalities in the shoulder. The adipose tissue was then collected from the abdomen. The harvested fat was then introduced to the Lipogems processing kit consisting of a disposable kit for aspiration, processing, and reinjection of autologous adipose tissue.
The technique is gentle and provides minimally manipulated and micro fragmented fat in a short time (60-90 minutes). The following sites could then be targeted for the patients : the glenohumeral joint, the rotator cuff and bicep tendons, and the acromioclavicular joint.
Clinical outcomes were measured immediately following the treatment and at weeks 1 and 5, and months 3, 6, and 12.
Significant improvement was noted through all time points to the one year marker and there were no procedural complications or adverse effects. The pre treatment scores were taken and compared to the post treatment scores using both the Numeric Pain Score (NPS) and the American Shoulder and Elbow Surgeon Scale on a 1-100 scale with 100 being perfect.
A significant improvement was found in all patients throughout the 12 months in all of the measured scores, with the most significant improvement occurring within the first 24 hours.
All patients then saw a sustained benefit throughout the whole 12 months.
The limitations of this study may have been the low number of subjects used, but it is vital to note the length of time each patient was then monitored and followed up post surgery and the fact that there were consistent and continual improvements in both function, and movement, and a significant reduction in pain.
Indeed the trial offered an improved quality of life for these patients as shown in all the positive outcomes and all measured scores with absolutely no adverse or complex side effects or risks. The autologous, minimally manipulated, and micro fragmented adipose tissue administered under continuous ultrasound guidance has proven to be safe and effective whilst providing a non surgical invasive alternative which produces long term results and benefits in the treatment of complex shoulder pain.