Cell Therapy in Tendon Disorders

What Is the Current Evidence?

1. Haron Obaid, MBChB, FRCS, FRCR*† and
2. David Connell, MBBS, MMed, FRANZCR‡

+Author Affiliations

1. ^†Doncaster Royal Infirmary, Doncaster, United Kingdom
2. ^‡Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, United Kingdom

1. *Haron Obaid, MBChB, FRCS, FRCR, Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada (e-mail: haron@doctors.org.uk).

Abstract

Background: Various types of tissue-derived cells are being experimented with for the treatment of tendinopathy, tendon repair, and use in tissue engineering.

Purpose: The aim of this systematic review is to explore the current evidence with a view to evaluate the potential of this therapeutic intervention.

Study Design: Systematic review.

Methods: A review of the literature was conducted using PubMed. Search criteria included keywords “tendinopathy,” “tendinitis,” “tendinosis,” “epicondylitis,” “stem cell,” and “cell therapy.” Articles not written in English language were excluded.

Results: A total number of 379 articles were identified and a critical appraisal of the relevant articles was undertaken, which encompassed human and animal research. The review included articles related to various tissue-derived cells such as tendon progenitors, adipose tissue, synovium, muscle, bone marrow, and skin. The utility of cell therapy in tissue engineering and rotator cuff repair was also assessed.

Conclusion: With the limitation of the available evidence, the literature suggests that cell therapy is applicable and may be effective for the treatment of tendinopathy. However, further research into the precise biological mechanisms, long-term implications, and cost-effectiveness is needed.

Very interesting! Here is the link to the full article

Full Article

Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconst

Biomechanical Measures During Landing and Postural

Stability Predict Second Anterior Cruciate Ligament

Injury After Anterior Cruciate Ligament Reconstruction

and Return to Sport

1. Mark V. Paterno, PT, MS, SCS, ATC*†‡§‖¶,
2. Laura C. Schmitt, PT, PhD†‡§#,
3. Kevin R. Ford, PhD, FACSM†‡‖,
4. Mitchell J. Rauh, PT, PhD, MPH, FACSM¶,
5. Gregory D. Myer, MS, CSCS†‡,a,
6. Bin Huang, PhD†,b and
7. Timothy E. Hewett, PhD, FACSM†‡‖,c

+Author Affiliations

1. ^†Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
2. ^‡Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio
3. ^§Division of Occupational Therapy and Physical Therapy, Cincinnati, Ohio
4. ^‖Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
5. ^¶Graduate Program in Orthopaedic and Sports Sciences, Rocky Mountain University of Health Professions, Provo, Utah
6. ^#Department of Physical Therapy, Ohio State University, Columbus, Ohio
7. ^aGraduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah
8. ^bDepartment of Epidemiology and Biostatistics, Cincinnati, Ohio
9. ^cDepartments of Orthopaedic Surgery, College of Medicine and the Department of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio and The Ohio State University

1. *Mark V. Paterno, PT, MS, SCS, ATC, Cincinnati Children’s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229 (e-mail: mark.paterno@cchmc.org).

Abstract

Background: Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes.

Hypotheses: Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.

Study Design: Cohort study (prognosis); Level of evidence, 2.

Methods: Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury.

Results: Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81).

Conclusion: Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.

Keywords:

• anterior cruciate ligament reconstruction
• kinetics
• kinematics
• postural stability