Continuing on this, on tendon, my friend and colleague from Milan, Italy, Pietro Ondele, who talked to us about cuff repair. Thanks, thanks a lot, Scott. Do you know what is the most spoken language all over the world? It's not Chinese, it's bad English, so I apologize for my English. Okay, that's my disclosure, nothing to disclose related to this lecture or the study containing this lecture. So let's start with PRP, you know, it's very famous and it was very important to start with PRP. Sorry, what's going on? Can you put again the slide on the screen? Oh, thank you. So we pioneered the study with PRP as a junked or rotator cuff repair in 2008, and it was a safe technique without complication, and then between 2010 and 2015, there was really a bunch of studies studying PRP in rotator cuff repair, but all of them, they were different level studies, PRP formulation, various surgical techniques were different, rehabilitation protocol, so the results, they were really contradictory. We did the randomized control trial with a two years and ten years follow-up, and we recorded a pain reduction in the early post-op phase, but we failed to demonstrate a reduction in the retired rate at two and ten years follow-up, and then a lot of studies, they come out in between 2015 and 2019, and those, they were negative. They were against PRP, so saying that it's not cost-effective and no clinical benefits and no structural improvements, but then things, they change again. In between 2019 and 2023, we had all very good reports from the studies, because probably the study were less biased, and so now we can really be enthusiastic regarding PRP, and saying that the recent literature support the effectiveness of PRP as a junked rotator cuff repair. PRP can reduce the post-operative pain and retire rate. It is not yet cost-effective. This is a small problem that still we have with PRP, but we need for sure more studies, despite it's 20 years that we are using PRP now, but we need more study respecting the MIBO, because all of the studies sometimes has some bias and problems. The other possibility that we have that is very appealing is the lipoaspirate. It's very appealing because it's very easy to use. You can do everything during one surgical step, so you do the harvesting, then you purify the product, and you can inject on top of your repair. Before using that in a clinical study, we did a lab test. We used calf tendon mesenchymal stem cells that were co-cultured with freshly obtained adipose cluster in a transfer cell plate to study the paracrine effect. So in this plate, the cells, they are not in contact with each other. Just the medium can drive any contact in between, so the cells, they don't touch, and so the results that were the micro-fragmented adipose cluster, they significantly increases the proliferation rate of stem cells from the rotator cuff. And even more, we saw that the expression of the vascular endothelial growth factors increased a lot, and so those are really positive effect of this lipoaspirate. After that, we decide to go on with a randomized controlled trial that has been recorded in the clinical trial. With that number, we enrolled the first patient, the first March 2016, and the last in April 2018. And finally, this study was published last year in the American Journal. So from a technical point of view, there is nothing to learn from this video. It's a single row repair. What is important is that you go after, in a dry condition, in the subacromial space, and then you inject the lipoaspirate in between the calf and the humeral head, and on top of the calf. And this video is very nice because it shows that the product, it stays there like a glue. It's not dissolving or going somewhere. So this is something that really can work. So the study has the primary outcome with a constant mileage score at six months, but then we did several scores of this patient with the MRI for all the patient-treated control group and treatment group. We had 44 patients at the final two years follow-up. And what about the primary outcome? The constant mileage score, we had an improvement, a significant difference in favor of the treatment group at six months, together with significant improvement in the shoulder test, simple shoulder test, the asses, and the strength near sternal rotation. In the MRI, we had less case of retail rate in the treatment group. Unfortunately, this was not statistically significant. No complication or adverse effect. And this is the first randomized control trial using this technology that is enzyme-free. We had significant improvements six months after the surgery. Maybe we had an accelerated repair in the treatment group. Maybe early return to work or support for this patient. Maybe. In conclusion, this lipoaspirate is an easily available source of autologous adipose-derived stem cells. It's a close and sterile system. It's safe and allows a faster recovery of shoulder function. I thank you very much for your attention.

platelet-rich plasma

lipoaspirate

rotator cuff repair

stem cell proliferation

shoulder function