Abstract
PurposeStudy the effect of Adipose derived stromal cells (ASCs) injection as therapeutic procedure on the common extensor tendinopathy.MethodsEighteen 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.ResultsAt 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.ConclusionTennis 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.
Highlights
Lateral elbow tendinopathy or tennis elbow (LET) is related to microtrauma that causes degenerative conditions in wrist extensor tendons
All 18 tennis players returned to play at an average of 3.31 ± 0.61 months post-intervention
This study showed that Adipose derived stromal cells (ASCs) injections for recalcitrant LET, is possible, safe and of promising efficiency
Summary
Lateral elbow tendinopathy or tennis elbow (LET) is related to microtrauma that causes degenerative conditions in wrist extensor tendons. Despite the condition being commonly referred to as tennis elbow, tennis players make up only 10% of the patient population. Half of mature amateur tennis players develop pain around the elbow, of which 75% represent true tennis elbow. Individuals that play racket sports involving repetitive wrist extension, radial deviation, and/or forearm supination are prone to this injury. LET is more common in players older than 40 years of age and main complaints are pain, decreased grip strength and impairment of functional activities, which may cause significant disability to play. Most of players with LET spontaneously recover within one year, even without intervention, the remaining are difficult to manage successfully, and unresolved symptoms lead to chronic disease [18]
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