Promising improvement of chronic lateral elbow tendinopathy by using adipose derived mesenchymal stromal cells: a pilot study

Abstract

Purpose Study the effect of Adipose derived stromal cells (ASCs) injection as therapeutic procedure on the common extensor tendinopathy. Methods Eighteen Tennis players with chronic, recalcitrant LET (who have previously been unsuccessfully treated with nonoperative treatments) underwent clinical evaluation and magnetic resonance imaging (MRI) before intervention. Stromal vascular fraction cells (SVF) were expanded by in vitro culture and ASCs were obtained and characterized by flow cytometry. ASCs were injected into the site of tendinopathy (identified by ultrasound imaging at the origin of the common extensor tendon) on a single occasion followed by physiotherapy. Players underwent serial clinical evaluations during a 12-month period and repeated MRI at 6-month post-injection. Results At 6-month clinical evaluation revealed significant improvements compared to baseline in mean Visual Analog Scale (VAS) scores for: (1) maximum pain score (from 6.28 ± 1.65, to 1.0 ± 0.43; p < .001); (2) Mean quick Disabilities of the Arm, Shoulder and Hand (QuickDASH-Compulsory score: 51.38 ± 12.02 to 12.33 ± 4.66; p < .001); (3) QuickDASH-Sport score: 56.94 ± 15.44 to 8.68 ± 8.86; p < .001). Validated MRI scoring system grade of tendinopathy also improved significantly: 4.22 ± 0.26 to 2.22 ± 0.10 (p < .001). At 12-month from injection, VAS maximun pain score further decreased to 0.74 ± 0.44 (p < .001) and QuickDASH-Compulsory score to 5.56 ± 3.58 (p < .001). Average time to return to play tennis was 3,31 ± 0,61 month post-intervention. Conclusion Tennis players with recalcitrant LET showed significant clinical improvement and structural repair at the origin of the common tendon origin after injection of autologous ASCs. Results of this study are promising and open a new biological therapeutic modality to treat LET. Even if the results of this pilot study are positive, future well-designed studies, i.e. prospective randomized trials are needed to define the role of cell therapy in treating LET.

Expanded adipose derived mesenchymal stromal cells are effective in treating chronic insertional patellar tendinopathy: clinical and MRI evaluations of a pilot study

“…Clarke et al [9] using ultrasound-guided injection of expanded autologous skin-derived tendon-like cells concluded that they can be safely used to treat patellar tendinopathy with, in the short term, faster response of treatment and significantly greater improvement in pain and function than injection of plasma alone. The use of ASCs to treat lateral elbow tendinopathy with promising results has also been reported by our group [19]. It has been previously shown that the responsiveness of the VISA-P scale for patellar tendinopathy in athletes who showed an absolute change greater than 13 points in the VISA-P score (or 15.4-27% of relative change) achieved a 98% probability of a minimal important change (MICD) in their status.…”

ADSC-Based Cell Therapies for Musculoskeletal Disorders: A Review of Recent Clinical Trials

“…Another study where 18 tennis players were treated with approximately 8 × 10 6 autologous ADSCs for recalcitrant lateral elbow tendinopathy indicated that ADSC therapy significantly improved clinical parameters readily at one month following injection and structural repair of the origin of common extensor tendon at six months after injection [ 142 ], without any joint effusion or skin hypersensitivity reactions that had been observed in the previous similar study where allogeneic ADSCs were used [ 141 ].…”

Why Use Adipose-Derived Mesenchymal Stem Cells in Tendinopathic Patients: A Systematic Review

“…Among the seven studies included, three were performed in Korea [55][56][57], one in Italy [58], two in Argentina [59,60] and one in Australia [61]. In particular, two were classified as prospective longitudinal-case serious exploratory studies [59,60], one as cohort study [55], one as first-in human trial [56], one as randomized controlled clinical trial [58], one as open-label study [57] and one as case report [61].…”