Summary

Bio-Ravioli is a novel surgical technique that enhances arthroscopic rotator cuff repair by using autologous mesenchymal stem cells from the subacromial bursa and biceps tendon to improve healing outcomes.

Abstract

Objectives: Rotator cuff pathology presents a significant healthcare challenge with substantial economic implications. Although rotator cuff repair (RCR) is a common procedure, healing failure remains a persistent issue, particularly in chronic injuries. To address this challenge, various biological augmentation strategies, including the use of stromal cells derived from the subacromial bursa, have been proposed to enhance tendon healing. The main technical limitation in these strategies lies in the method of cell delivery. This study aims to introduce the Bio-Ravioli technique, a novel surgical approach designed to augment the healing potential of arthroscopic RCR.

Methods

Candidates included those with repairable full-thickness posterosuperior rotator cuff tears and a moderate-to-high risk of healing failure, asssessed using Rotator Cuff Healing Index (RoHI) score and various preoperative variables such as age, tear size, retraction, fatty infiltration, bone mineral density and level of work activity: The surgical procedure involved preparing a biceps patch graft by harvesting a portion of the biceps tendon, compressing it within a dedicated tray, and covering it with subacromial bursal tissue to form an envelope. The graft was then fixed using soft anchors at the bone-tendon interface. RCR was performed according to the tear pattern.

Conclusions

Bio-Ravioli represents an innovative, promising and cost-effective surgical approach for augmenting the healing potential of arthroscopic RCR. This technique utilizes autologous mesenchymal stem cells (MSCs) from two distinct sources, the subacromial bursa and long head of the biceps tendon, within a stable graft construct, potentially improving clinical outcomes in patients with rotator cuff injuries.