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Adipose-derived stem cells for the treatment of Achilles tendinopathy: A randomized prospective trial
Foot and Ankle Surgery 22S (2016) 20–25
Contents lists available at ScienceDirect
Foot and Ankle Surgery journal homepage: www.elsevier.com/locate/fas
Abstract 5: Free Paper 31
32
FI2016_FreePaper_01 Corticosteroid injection into Achilles tendon in rabbits: Histology, biomechanics and biomolecular
FI2016_FreePaper_02 Adipose-derived stem cells for the treatment of Achilles tendinopathy: A randomized prospective trial
A.L. Godoy-Santos 1,*, K. Dinhane 2, A. Todorovic-Fabro 2, I. Depra´ 2, M.R. Moretto 2, W. Bonetti-Yoshida 2
F.G. Usuelli *, M. Grassi, U. Alfieri Montrasio, M. Boga, L. De Girolamo
1
University of Sa˜o Paulo, Brazil 2 UNESP, Brazil *Corresponding author. Background: There are clinical and experimental controversies regarding to benefits and complications of corticosteroid (CE) injections for management of tendons disorders. Objective: To evaluate the histology, biomechanics and expression of metalloproteinases and interleukins on normal rabbits; Achilles tendons treated with CE injections. Methods: 73 New Zealand rabbits were randomly divided into two groups: Test Group: 37 animals were underwent to one intratendinous injection of CE (0.2 ml of solution with 1.4 mg of betamethasone) into the Achilles tendon of the right pelvic limb; Control Group: 36 animals, in which right Achilles tendon underwent to one injection of saline solution (0.2 ml) (Placebo Control Group) and the left Achilles tendon without any procedure (Normal Control Group). Forty-eight hours after, the tendons were dissected and extracted at an extension of four centimeters from its insertion in the calcaneus bones. Expressions of metalloproteinases (MMP-1 and MMP-2) and interleukins (IL-1 and IL-6), biomechanical resistance (load x elongation parameters) and histomorphometric (HE, Picrosirius red) analysis were all performed by blinded observers. Results: Test Group presented a significant reduction in MMP-2 expression compared to the both pelvic limbs of Control Group (p = 0.027). No statistical differences were found in histological characteristics, biomechanical properties, and expressions of metalloproteinases 1, interleukins 1 and 6 between groups. Conclusions: Corticosteroid injection into Achilles tendon in rabbits did not show any statistical difference regarding to histology and biomechanics. We found a decrease of MMP-2 expression after a single intratendinous injection of CE in the Aquilles Tendon of rabbits compared with control.
USPeC – I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy *Corresponding author. Introduction: Achilles tendinopathy commonly occurs in both active and inactive people. It consists in pain and inflammation in the early phases, with the development of fibrotic tissue and degeneration of tendon matrix. Current conservative treatments do not provide satisfactory results, particularly in active patients. Aim: The aim of the present study is to demonstrate the therapeutic effect of adipose-derived mesenchymal stem cells (ASCs), either expanded or used directly within the stromal vascular fraction (SVF) in the treatment of tendinopathy. Method: 56 patients affected by non-insertional Achilles tendinopathy (18–55 y/o) were prospectively enrolled in this clinical study, and randomly assigned either to single PRP injection group (GPSIII kit, Biomet, USA) (n = 28 tendons) or single adipose tissue SVF (FastKit, Corios, Italy) (n = 28 tendons) injection group. All patients were assessed clinically preoperatively and at 15, 30, 60, 120 and 180 days from treatment, using VAS Pain, VISA-A, AOFAS and SF-36 forms, and by ultrasound and magnetic resonance before treatment and after 4 and 6 months. Results: Population background data and pre-operative scores were similar in the two groups. At final follow-up, both groups showed significantly improvements in all clinical scores. 15 days after treatment patients in the SVF group showed better results in the clinical outcomes. MR and ultrasounds showed an improvement of in both groups, without relevant differences. Conclusions: Both PRP and SVF are safe and effective treatments for Achilles tendinopathy. However, SVF allowed to obtain faster results, thus allowing to consider this treatment for patients requiring to come back to sport earlier. http://dx.doi.org/10.1016/j.fas.2016.05.037
http://dx.doi.org/10.1016/j.fas.2016.05.036
1268-7731/
Contents lists available at ScienceDirect
Foot and Ankle Surgery journal homepage: www.elsevier.com/locate/fas
Abstract 5: Free Paper 31
32
FI2016_FreePaper_01 Corticosteroid injection into Achilles tendon in rabbits: Histology, biomechanics and biomolecular
FI2016_FreePaper_02 Adipose-derived stem cells for the treatment of Achilles tendinopathy: A randomized prospective trial
A.L. Godoy-Santos 1,*, K. Dinhane 2, A. Todorovic-Fabro 2, I. Depra´ 2, M.R. Moretto 2, W. Bonetti-Yoshida 2
F.G. Usuelli *, M. Grassi, U. Alfieri Montrasio, M. Boga, L. De Girolamo
1
University of Sa˜o Paulo, Brazil 2 UNESP, Brazil *Corresponding author. Background: There are clinical and experimental controversies regarding to benefits and complications of corticosteroid (CE) injections for management of tendons disorders. Objective: To evaluate the histology, biomechanics and expression of metalloproteinases and interleukins on normal rabbits; Achilles tendons treated with CE injections. Methods: 73 New Zealand rabbits were randomly divided into two groups: Test Group: 37 animals were underwent to one intratendinous injection of CE (0.2 ml of solution with 1.4 mg of betamethasone) into the Achilles tendon of the right pelvic limb; Control Group: 36 animals, in which right Achilles tendon underwent to one injection of saline solution (0.2 ml) (Placebo Control Group) and the left Achilles tendon without any procedure (Normal Control Group). Forty-eight hours after, the tendons were dissected and extracted at an extension of four centimeters from its insertion in the calcaneus bones. Expressions of metalloproteinases (MMP-1 and MMP-2) and interleukins (IL-1 and IL-6), biomechanical resistance (load x elongation parameters) and histomorphometric (HE, Picrosirius red) analysis were all performed by blinded observers. Results: Test Group presented a significant reduction in MMP-2 expression compared to the both pelvic limbs of Control Group (p = 0.027). No statistical differences were found in histological characteristics, biomechanical properties, and expressions of metalloproteinases 1, interleukins 1 and 6 between groups. Conclusions: Corticosteroid injection into Achilles tendon in rabbits did not show any statistical difference regarding to histology and biomechanics. We found a decrease of MMP-2 expression after a single intratendinous injection of CE in the Aquilles Tendon of rabbits compared with control.
USPeC – I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy *Corresponding author. Introduction: Achilles tendinopathy commonly occurs in both active and inactive people. It consists in pain and inflammation in the early phases, with the development of fibrotic tissue and degeneration of tendon matrix. Current conservative treatments do not provide satisfactory results, particularly in active patients. Aim: The aim of the present study is to demonstrate the therapeutic effect of adipose-derived mesenchymal stem cells (ASCs), either expanded or used directly within the stromal vascular fraction (SVF) in the treatment of tendinopathy. Method: 56 patients affected by non-insertional Achilles tendinopathy (18–55 y/o) were prospectively enrolled in this clinical study, and randomly assigned either to single PRP injection group (GPSIII kit, Biomet, USA) (n = 28 tendons) or single adipose tissue SVF (FastKit, Corios, Italy) (n = 28 tendons) injection group. All patients were assessed clinically preoperatively and at 15, 30, 60, 120 and 180 days from treatment, using VAS Pain, VISA-A, AOFAS and SF-36 forms, and by ultrasound and magnetic resonance before treatment and after 4 and 6 months. Results: Population background data and pre-operative scores were similar in the two groups. At final follow-up, both groups showed significantly improvements in all clinical scores. 15 days after treatment patients in the SVF group showed better results in the clinical outcomes. MR and ultrasounds showed an improvement of in both groups, without relevant differences. Conclusions: Both PRP and SVF are safe and effective treatments for Achilles tendinopathy. However, SVF allowed to obtain faster results, thus allowing to consider this treatment for patients requiring to come back to sport earlier. http://dx.doi.org/10.1016/j.fas.2016.05.037
http://dx.doi.org/10.1016/j.fas.2016.05.036
1268-7731/