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To simulate large\u2010to\u2010massive tears, rats were managed with free cage activity for 6 weeks after tear creation. A total of 18 rats were randomly allocated to repair\u2010only (control), repair with pericardial patch augmentation (patch), or repair with MSC loaded pericardial patch augmentation (patch\u2010MSC). Each group had 6 rats (one shoulder of each rat was used for histological evaluation and another for biomechanical evaluation). MSCs seeded on the pericardial patches were traced on four shoulders from 2 other rats at 4 weeks after surgery. Histological evaluation for bone\u2010to\u2010tendon healing and biomechanical testing was carried out at 8 weeks after repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MSCs tagged with a green fluorescent protein were observed in the repair site 4 weeks after the repair. One shoulder each in the control and patch groups showed complete discontinuity between the bone and tendon. One shoulder in the control group showed attenuation with only a tenuous connection. Fibrocartilage and tidemark formation at the bone\u2010to\u2010tendon interface (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .002) and collagen fiber density (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .040) and orientation (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .003) were better in the patch\u2010MSC group than in the control or patch group. Load\u2010to\u2010failure in the patch\u2010MSC and patch groups was higher than that in the control group (\n                      <jats:italic>P\u00a0=<\/jats:italic>\n                      .001 and .009, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Decellularized bovine pericardial patches loaded with adipose\u2010derived and cultured mesenchymal stromal cells enhanced healing in terms of both histology and mechanical strength at 8 weeks following rotator cuff repair in a rat model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Large\u2010to\u2010massive rotator tears need a strategy to prevent retear and enhance healing. The addition of decellularized bovine pericardial patch loaded with MSCs can enhance bone\u2010to\u2010tendon healing and improve biomechanical healing of large\u2010to\u2010massive rotator cuff tears following repair.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2022.06.004","type":"journal-article","created":{"date-parts":[[2022,6,15]],"date-time":"2022-06-15T21:48:34Z","timestamp":1655329714000},"page":"2987-3000","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":24,"title":["Decellularized Bovine Pericardial Patch Loaded With Mesenchymal Stromal Cells Enhance the Mechanical Strength and Biological Healing of Large\u2010to\u2010Massive Rotator Cuff Tear in a Rat Model"],"prefix":"10.1002","volume":"38","author":[{"given":"In Kyong","family":"Shim","sequence":"first","affiliation":[{"name":"Asan Institute for Life Sciences Asan Medical Center University of Ulsan College of Medicine Seoul 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