Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation

Stein, Benjamin E.; Stroh, D. Alex; Schon, Lew C.

doi:10.1007/s00264-015-2725-7

Cited by 51 publications

(45 citation statements)

References 27 publications

(35 reference statements)

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“…In recent years, there was an increase re-rupture of Achilles tendon, which may be associated with increasing physical activity in modern societies [10, 16]. Therefore, the optimal treatment of both acute Achilles tendon ruptures and Achilles tendon re-ruptures also remains of great clinical importance [10, 18]. …”

Section: Introductionmentioning

confidence: 99%

Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis

et al. 2016

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PurposeAchilles tendinopathy is a significant clinical lower limb issue observed in recent years. Neither the location nor the mechanism behind the pain has yet been sufficiently explained. Patients frequently experience pain on the medial side of the calcaneal tendon, and between 2 and 7 cm above the calcaneal tuberosity, which may suggests that the plantaris tendon plays an important role. The purpose of this study was to determine the anatomical relationships between the course of the plantaris tendon and the calcaneal tendon, as well as the type of insertion of the plantaris tendon.MethodsThe tests were carried out on 50 randomized lower limbs (23 left and 27 right) fixed in 10 % formalin solution.ResultsFive insertion types of the plantaris tendon were identified in relation to the calcaneal tendon: four with their insertion on the calcaneal tuberosity (Types 1, 2, 3, 5), while the fifth (Type 4) had its insertion in the crural fascia. In addition, two variants of the course of the plantaris tendon were identified, the most common being termed Variant A, in which the tendon crosses the space between the gastrocnemius and the soleus muscles, thus reaching the medial crural region, and is located on the medial side of the calcaneal tendon (84 % cases). The course of the Variant B is similar to the course of the Variant A, but upon leaving the space located between the gastrocnemius and soleus muscle, it turned to the medial crural region and ran directly anterior to the calcaneal tendon (12 %). The plantaris muscle was found to be absent in two lower limbs (4 %). The most frequent insertion type of the plantaris tendon into the calcaneal tuberosity is fan-shaped, occurring on the medial side of the Achilles tendon (Type 1–44 % cases).ConclusionThe course of the plantaris tendon and its mobility range in relation to the calcaneal tendon may be likely to affect the occurrence of pains in the lower medial part of the leg (Achilles tendinopathy).

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Section: Introductionmentioning

confidence: 99%

Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis

et al. 2016

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“…Five studies evaluating cBMA in tendon repair were included and summarized in Table 5[34-38]. One study evaluated open Achilles tendon repair augmented with cBMA and reported excellent functional outcomes, early mobilization, normal range of motion, and no re-ruptures at a mean follow up of 29.7 mo[38].…”

Section: Resultsmentioning

confidence: 99%

“…One study evaluated open Achilles tendon repair augmented with cBMA and reported excellent functional outcomes, early mobilization, normal range of motion, and no re-ruptures at a mean follow up of 29.7 mo[38]. One study evaluated the use of cBMA during rotator cuff repair and reported enhanced healing rates, improved quality of the repair surface on ultrasound and MRI, and a decreased risk of re-rupture when compared to the control group[34].…”

Section: Resultsmentioning

confidence: 99%

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

Gianakos¹,

Sun²,

Patel³

et al. 2017

WJO

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AIMTo examine the evidence behind the use of concentrated bone marrow aspirate (cBMA) in cartilage, bone, and tendon repair; establish proof of concept for the use of cBMA in these biologic environments; and provide the level and quality of evidence substantiating the use of cBMA in the clinical setting.METHODSWe conducted a systematic review according to PRISMA guidelines. EMBASE, MEDLINE, and Web of Knowledge databases were screened for the use of cBMA in the repair of cartilage, bone, and tendon repair. We extracted data on tissue type, cBMA preparation, cBMA concentration, study methods, outcomes, and level of evidence and reported the results in tables and text.RESULTSA total of 36 studies met inclusion/exclusion criteria and were included in this review. Thirty-one of 36 (86%) studies reported the method of centrifugation and preparation of cBMA with 15 (42%) studies reporting either a cell concentration or an increase from baseline. Variation of cBMA application was seen amongst the studies evaluated. Twenty-one of 36 (58%) were level of evidence IV, 12/36 (33%) were level of evidence III, and 3/36 (8%) were level of evidence II. Studies evaluated full thickness chondral lesions (7 studies), osteochondral lesions (10 studies), osteoarthritis (5 studies), nonunion or fracture (9 studies), or tendon injuries (5 studies). Significant clinical improvement with the presence of hyaline-like values and lower incidence of fibrocartilage on T2 mapping was found in patients receiving cBMA in the treatment of cartilaginous lesions. Bone consolidation and time to bone union was improved in patients receiving cBMA. Enhanced healing rates, improved quality of the repair surface on ultrasound and magnetic resonance imaging, and a decreased risk of re-rupture was demonstrated in patients receiving cBMA as an adjunctive treatment in tendon repair.CONCLUSIONThe current literature demonstrates the potential benefits of utilizing cBMA for the repair of cartilaginous lesions, bony defects, and tendon injuries in the clinical setting. This study also demonstrates discrepancies between the literature with regards to various methods of centrifugation, variable cell count concentrations, and lack of standardized outcome measures. Future studies should attempt to examine the integral factors necessary for tissue regeneration and renewal including stem cells, growth factors and a biologic scaffold.

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“…After title and abstract selection seven articles34–40 were selected for full-text evaluation (figure 1). Two trials37 39 were excluded because we were unable to determine whether stem cells had actually been injected as no analyses were performed to investigate whether stem cells were actually present. One article was excluded40 because it was mostly in vitro and had no data of interest.…”

Section: Resultsmentioning

confidence: 99%

“…We excluded two trials37 39 that used bone marrow aspirates, and we discovered two other trials73 74 that made attempts to investigate stem cell efficacy in tendon disorders. All these trials were excluded because no analysis was performed to confirm the presence of potential stem cells in the intervention.…”

Section: Discussionmentioning

confidence: 99%

No evidence for the use of stem cell therapy for tendon disorders: a systematic review

Pas¹,

Moen²,

Haisma

et al. 2017

Br J Sports Med

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IntroductionStem cells have emerged as a new treatment option for tendon disorders. We systematically reviewed the current evidence for stem cell therapy in tendon disorders.MethodsRandomised and non-randomised controlled trials, cohort studies and case series with a minimum of 5 cases were searched in MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus. In addition, we searched grey literature databases and trial registers. Only human studies were included and no time or language restrictions were applied to our search. All references of included trials were checked for possibly eligible trials. Risk of bias assessment was performed using the Cochrane risk of bias tool for controlled trials and the Newcastle-Ottawa scale for case series. Levels of evidence were assigned according to the Oxford levels of evidence.Results4 published and three unpublished/pending trials were found with a total of 79 patients. No unpublished data were available. Two trials evaluated bone marrow-derived stem cells in rotator cuff repair surgery and found lower retear rates compared with historical controls or the literature. One trial used allogenic adipose-derived stem cells to treat lateral epicondylar tendinopathy. Improved Mayo Elbow Performance Index, Visual Analogue Pain scale and ultrasound findings after 1-year follow-up compared with baseline were found. Bone marrow-derived stem cell-treated patellar tendinopathy showed improved International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscales and Tegner scores after 5-year follow-up. One trial reported adverse events and found them to be mild (eg, swelling, effusion). All trials were at high risk of bias and only level 4 evidence was available.ConclusionsNo evidence (level 4) was found for the therapeutic use of stem cells for tendon disorders. The use of stem cell therapy for tendon disorders in clinical practice is currently not advised.

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Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation

Abstract: IV - Therapeutic.

Cited by 51 publications

References 27 publications

Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis

Anatomic study suggests that the morphology of the plantaris tendon may be related to Achilles tendonitis

Clinical application of concentrated bone marrow aspirate in orthopaedics: A systematic review

No evidence for the use of stem cell therapy for tendon disorders: a systematic review

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