A patient-friendly look at a peer-reviewed study of image-guided autologous bone-marrow-derived MSC treatment.
A partial rotator cuff tear can be deceptively disruptive. The tendon is not completely detached, yet pain, weakness, interrupted sleep, and difficulty lifting the arm can persist for months or years. Physical therapy, activity modification, and carefully selected medications or injections help many patients, but not everyone improves. Surgery may be appropriate in certain cases, although patients and physicians continue to look for less invasive options that may support tendon healing while preserving the shoulder’s native anatomy.
A peer-reviewed study published in Biomedicines in February 2026 adds important long-term information to that discussion. The research followed patients with imaging-confirmed partial-thickness rotator cuff tears who underwent ultrasound-guided treatment using their own culture-expanded bone-marrow-derived mesenchymal stem/stromal cells, or MSCs, along with platelet-based products.
The authors describe this as the longest known follow-up of intratendinous culture-expanded MSC treatment for partial-thickness rotator cuff tears. The results are encouraging, but the study was observational and had no untreated or surgical control group.
The rotator cuff is a group of four tendons that surround the shoulder and help stabilize and move the joint. A partial-thickness tear damages only part of a tendon’s depth. The supraspinatus tendon is most commonly affected, although the infraspinatus, subscapularis, and teres minor can also be involved.
Symptoms vary. Some tears are painless, while others cause pain with reaching or overhead activity, weakness, night pain, and loss of function. Ultrasound and MRI can both help confirm the diagnosis. Treatment should account not only for the tear, but also for associated problems, such as bursitis, labral injury, arthritis, or altered shoulder mechanics.
The investigators reviewed prospectively collected registry outcomes from 30 patients representing 37 treated shoulders. All patients had an MRI or ultrasound-confirmed partial-thickness tear and were treated between January 2018 and January 2020. Patients with a complete full-thickness tear, previous surgery on the treated shoulder, or severe glenohumeral arthritis were excluded.
Bone marrow was aspirated from the posterior pelvis under image guidance. Cells were isolated and expanded in culture using the patient’s own platelet lysate, then tested for cell count, viability, and endotoxin before treatment. The final cells were delivered under ultrasound guidance into one or more damaged rotator cuff tendons. Platelet lysate was used as the carrier, and some patients also received platelet-rich plasma. When clinically indicated, other injured shoulder structures – such as the joint, labrum, or acromioclavicular joint – were treated during the same procedure.
On average, 4.32 million MSCs were placed into the treated rotator cuff tendon or tendons, and 8.53 million MSCs were used across all treated areas of a shoulder. The supraspinatus was treated in 35 of the 37 shoulders.
The registry collected outcomes before treatment and at multiple intervals after treatment. Response rates decreased over time, so the longest follow-up results came from a much smaller group than the original cohort.
| Outcome | Starting point | Two years | Average change |
| Pain (NRS) | 3.00 | 0.75 | 2.25 points better |
| Disability (DASH) | 26.48 | 6.00 | 20.48 points better |
| Perceived improvement (modified SANE) | 17.32 at month 1 | 62.73 | 45.41 points better |
Source: Hooper et al., Biomedicines (2026). Two-year NRS and DASH changes were calculated from the means reported in Table 3. Modified SANE was compared with the one-month value, as specified by the study.
Pain and DASH disability scores improved significantly at most measured intervals from three months through two years. At two years, the average improvement in both measures exceeded the study’s cited thresholds for a minimally clinically important difference – meaning the changes were not only statistically detectable, but large enough to be considered meaningful to patients on average.
Modified SANE scores also improved at several intervals. Seven respondents provided six-year SANE data; their average score was 92.86, representing a 75.54-point increase from the one-month score. This suggests that some patients maintained substantial perceived benefit, although the very small number of six-year respondents prevents broad conclusions.
The authors reported no serious adverse events during the study’s four-year follow-up period. This is reassuring, especially because the cells and platelet products were autologous – derived from each patient’s own body – and the procedures were performed with imaging guidance. However, a 30-patient observational cohort cannot identify every uncommon complication or establish the safety profile of all MSC preparation and injection protocols.
The study supports a clinically important signal: patients with partial-thickness rotator cuff tears reported less pain and better upper-extremity function after a multifactorial, image-guided regenerative treatment that included culture-expanded autologous MSCs and platelet products. Improvement persisted for many respondents beyond the early recovery period, and a small subset continued to report benefit years later.
Just as important, the study does not prove that MSCs alone caused the improvement or that this approach is superior to physical therapy, PRP alone, surgery, or the natural course of the condition. Because several injured structures and different biologic products were often treated, the result reflects a comprehensive shoulder treatment strategy rather than an isolated injection into a single tendon.
For a patient with a symptomatic partial-thickness tear who has not reached acceptable function with a well-designed conservative program, an image-guided orthobiologic evaluation may be reasonable. The first step is a precise diagnosis. A rotator cuff tear may be only one part of the problem, and the treatment plan should consider tendon quality, tear depth, shoulder stability, arthritis, the labrum, the bursa, strength, and biomechanics.
A regenerative procedure is not a shortcut around rehabilitation. The biologic treatment, protection of the healing tissue, progressive loading, and correction of movement patterns should work together. A full-thickness tear, major tendon retraction, advanced muscle atrophy, severe arthritis, or progressive weakness may require a different strategy, including surgical consultation.
This 2026 study offers encouraging long-term evidence that a carefully performed, image-guided treatment using autologous culture-expanded bone-marrow-derived MSCs with platelet products may reduce pain and improve function in selected patients with partial rotator cuff tears. It also shows why the next step in the science must be larger, controlled trials with standardized dosing, consistent imaging follow-up, and direct comparisons with established treatments.
During the consultation, a physician should review your imaging, tear characteristics, prior treatment, functional goals, and the health of the entire shoulder. The goal is to choose the least invasive option that has a reasonable chance of restoring durable function – not simply to treat an MRI finding.For more information about our treatments or to schedule a consultation, please contact our team or call us on 1-877-211-3834 (US Toll-free).
Hooper N, Alhusen A, Siddiqui H, Pitts J, Jayaram P, Williams CJ. Safety and Efficacy of Autologous Bone-Marrow-Derived Mesenchymal Stem Cells for Treating Partial Rotator Cuff Tears: Observational Study with 4-Year Follow-Up. Biomedicines. 2026;14(2):382. doi:10.3390/biomedicines14020382
Medical note: Educational only; not medical advice or a guarantee of outcome. Individual evaluation is required.
Written by Christopher J. Williams, MD, at Interventional Orthopedics of Atlanta.
