Purpose
To conduct a systematic review of the current evidence for the effects of stem cells
on tendon healing in preclinical studies and human studies.
Methods
A systematic search of the PubMed, CINAHL (Cumulative Index to Nursing and Allied
Health Literature), Cochrane, and Embase databases was performed for stem cells and
tendons with their associated terminology. Data validity was assessed, and data were
collected on the outcomes of trials.
Results
A total of 27 preclinical studies and 5 clinical studies met the inclusion criteria.
Preclinical studies have shown that stem cells are able to survive and differentiate
into tendon cells when placed into a new tendon environment, leading to regeneration
and biomechanical benefit to the tendon. Studies have been reported showing that stem
cell therapy can be enhanced by molecular signaling adjunct, mechanical stimulation
of cells, and the use of augmentation delivery devices. Studies have also shown alternatives
to the standard method of bone marrow–derived mesenchymal stem cell therapy. Of the
5 human studies, only 1 was a randomized controlled trial, which showed that skin-derived
tendon cells had a greater clinical benefit than autologous plasma. One cohort study
showed the benefit of stem cells in rotator cuff tears and another in lateral epicondylitis.
Two of the human studies showed how stem cells were successfully extracted from the
humerus and, when tagged with insulin, became tendon cells.
Conclusions
The current evidence shows that stem cells can have a positive effect on tendon healing.
This is most likely because stem cells have regeneration potential, producing tissue
that is similar to the preinjury state, but the results can be variable. The use of
adjuncts such as molecular signaling, mechanical stimulation, and augmentation devices
can potentially enhance stem cell therapy. Initial clinical trials are promising,
with adjuncts for stem cell therapy in development.
Level of Evidence
Level IV, systematic review of Level II-IV studies.
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Article info
Publication history
Published online: March 01, 2012
Accepted:
December 2,
2011
Received:
October 31,
2011
Footnotes
The authors report the following source of funding: the Technology Strategy Board and National Institute for Health Research.
Identification
Copyright
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
