Fibrin Scaffold as a Carrier for Mesenchymal Stem Cells and Growth Factors in Shoulder Rotator Cuff Repair Andreas Voss, M.D., Mary Beth McCarthy, B.S.,

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Fibrin Scaffold as a Carrier for Mesenchymal Stem Cells and Growth Factors in Shoulder Rotator Cuff Repair Andreas Voss, M.D., Mary Beth McCarthy, B.S., Donald Allen, M.D., Mark P. Cote, P.T., D.P.T., Knut Beitzel, M.S., M.D., Andreas B. Imhoff, M.D., Augustus D. Mazzocca, M.S., M.D. Arthroscopy Techniques Volume 5, Issue 3, Pages e447-e451 (June 2016) DOI: 10.1016/j.eats.2016.01.029 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Aspiration of 17 mL bone marrow from the proximal humerus using a nonfenestrated trocar (*) with a 3 mL ACD-A prefilled 60-mL syringe. (B) Sterile autologous products used for scaffold forming (PPP, PRP, cBMA, and bovine thrombin) as well as heparin and ACD-A for instrument preparation. (C) Transferring autologous PPP, PRP, and cBMA from sterile cups by using a 1.0-mL tuberculin syringe into a sterile multiwell dish. (ACD-A, acid citrate dextrose–anticoagulant; cBMA, concentrated bone marrow aspirate; PPP, platelet-poor plasma; PRP, platelet-rich plasma.) Arthroscopy Techniques 2016 5, e447-e451DOI: (10.1016/j.eats.2016.01.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 (A) Customized PassPort cannula placed in a lateral portal to transfer the fibrin scaffold (clot) on the suture anchor used for rotator cuff repair. (B) The modified cannula and the customized clotting device. It is important to cut the cannula about 3 cm below the membrane. This allows for later clotting around the suture. Arthroscopy Techniques 2016 5, e447-e451DOI: (10.1016/j.eats.2016.01.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) Transferring the prepared mixture of PPP, PRP, and cBMA from the multiwell plate into the clotting device (*, prefilled with bovine thrombin) by using a 1.0-mL tuberculin syringe. Once the mixture is added, the clotting process is active and takes about 30 seconds. (B) By removing the clotting device distally, the clot remains on the suture. (C) The clot can now easily be transferred into the joint by using an arthroscopic knot pusher. (D) Arthroscopic view of clot at the bottom of a suture anchor placed onto the rotator cuff footprint. (cBMA, concentrated bone marrow aspirate; FP, footprint; PPP, platelet-poor plasma; PRP, platelet-rich plasma; SSP, supraspinatus tendon.) Arthroscopy Techniques 2016 5, e447-e451DOI: (10.1016/j.eats.2016.01.029) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions