Fuente
Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pubmed/25908113
http://ajs.sagepub.com/content/43/7/1775.long
Wang A1, Mackie K2, Breidahl W3, Wang T2, Zheng MH4.
Am J Sports Med. 2015 Jul;43(7):1775-83. doi: 10.1177/0363546515579185. Epub 2015 Apr 23.
Todos los derechos reservados para:
© 2015 The Author(s).
Abstract
BACKGROUND:
Chronic lateral epicondylitis (LE) induces cell apoptosis and autophagy, which lead to the reduction of tendon-derived cells in the torn tendon. Our previous study has shown that ultrasound-guided autologous tenocyte injection (ATI) to the torn tendon in patients with chronic resistant LE significantly improves pain, function, and structural repair at 1 year. This report is the continued assessment of the clinical outcomes of these patients at mean 4.5-year follow-up.
HYPOTHESIS:
Improvements in LE clinical function and structural repair after ATI will be maintained at mean 4.5-year follow-up.
STUDY DESIGN:
Case series; Level of evidence, 4.
METHODS:
Patients with severe refractory LE underwent clinical evaluation and MRI before intervention. A patellar tendon needle biopsy was performed under local anesthetic, and tendon cells were expanded by in vitro culture. Autologous tenocytes were injected into the central tendinopathy identified at the common extensor tendon origin under ultrasound guidance on a single occasion. Patients underwent serial clinical evaluations for up to 5 years after ATI, including the visual analog scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Upper Extremity Functional Scale (UEFS), and grip strength. Post-ATI MRI scanning was performed at 1 year and final follow-up.
RESULTS:
A total of 16 patients (9 male, 7 female), aged between 37 and 63 years, were included in the study. The mean duration of symptoms before study recruitment was 29.24 months (range, 6-240 months). One patient elected to proceed to surgery 3 months after ATI due to reinjury at work, and 1 patient died of prostate cancer with metastases during the follow-up period. The mean final follow-up time for the remaining 15 patients was 4.51 years (range, 3.08-5.17 years). No complications were observed at the patellar tendon biopsy site for any patient. No adverse events, infection, or excessive fibroblastic reactions were observed in any patient at the injection site. Clinical evaluation revealed significant (P < .001) improvement in mean VAS pain score from 5.73 at initial assessment to 1.21 (78% improvement) at final follow-up. Mean QuickDASH, UEFS, and grip strength scores also significantly (P < .001) improved from initial assessment to final follow-up (from 45.88 to 6.61 [84%], from 31.73 to 9.20 [64%], and from 19.85 to 46.60 [208%], respectively). There was no difference in mean QuickDASH and UEFS scores at 1 year and final follow-up (P > .05); however, grip strength continued to improve (P < .001). A validated MRI scoring system indicated that the mean grade of tendinopathy at the common extensor origin improved significantly (P < .001) from initial assessment (4.31) to 1 year (2.88) and was maintained (P > .05) at final follow-up (2.87). At final follow-up, 93% of patients were either highly satisfied or satisfied with their ATI treatment.
CONCLUSION:
ATI significantly improved clinical function and MRI tendinopathy scores for up to 5 years in patients with chronic resistant LE who had previously undergone unsuccessful nonsurgical treatment. This study provides evidence for the midterm durability of ATI for treatment of LE tendinopathy.
© 2015 The Author(s).
KEYWORDS:
autologous tenocyte injection; elbow; lateral epicondylitis
- PMID:25908113 [PubMed – in process]
Inyecciones de tenocitos autólogos para el codo de tenista
La inyección de tenocitos autólogos (ATI) representa una técnica y enfoque relativamente nuevos para el tratamiento de patologías tendinosas recalcitrantes que han fracasado al tratamiento conservador. En un primer estudio publicado en el 2013 por Wang y cols. se definió este nuevo procedimiento y se demostró una mejora significativa en todos los resultados al cabo de 12 meses. El presente documento analiza los resultados de un seguimiento de los mismos tópicos a 4 años post-inyección y encontró que se mantuvieron los resultados de manera exitosa.
La epicondilalgia lateral crónica se caracteriza por un aumento de la matriz extracelular, lesión de la fibra de colágeno, apoptosis (muerte celular) y autofagia (degradación celular) de los tenocitos. En el estudio inicial realizado por Wang y cols. que describe una inyección de tenocitos autólogos a través de una biopsia con aguja del tendón rotuliano, las células del tendón se expanden mediante un cultivo in vitro. Los tenocitos se inyectan en una sola ocasión en el tendón del músculo extensor radial corto del carpo.
Entre el 3er y 5to año post-inyección ya estaban disponibles los datos de seguimiento de 15 de los 17 pacientes (1 se sometió a cirugía y 1 murió de causas no relacionadas). El dolor mejoró en un 86% al cabo de 1 año de seguimiento y el 78% a final del periodo de seguimiento. La fuerza de agarre mejoró en un 132% al cabo de 1 año y 208% al final del seguimiento. La ATI es un tratamiento prometedor para las tendinopatías recalcitrantes. Los futuros estudios deben incluir a un grupo control y las medidas de costo-efectividad en otros tendones.
> De: Wang et al., Am J Sports Med 43 (2015) 1775-1783(Publ. antes de impresión). Todos los derechos reservados: Los Autores.Pincha aquí para acceder al resumen de Pubmed.. Traducido por Vicente Mauri.
