Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up
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Although platelet-rich plasma (PRP) injection has shown controversial results for the treatment of Achilles tendinopathy, it remains the most used biological treatment. Recent findings seem to demonstrate that the stromal vascular fraction (SVF) within adipose tissue may counteract the impaired tendon homeostasis. The aim of this study was to prospectively compare the efficacy of PRP and SVF injection for the treatment of non-insertional Achilles tendinopathy.
Fourty-four patients were recruited in the study; 23 of them were assigned to the PRP group whereas 21 to the SVF group, treated unilaterally or bilaterally for a total of 28 tendons per group. All patients (age 18–55 years) were clinically assessed pre-operatively and at 15, 30, 60, 120 and 180 days from treatment, using the VAS pain scale, the VISA-A, the AOFAS Ankle-Hindfoot Score and the SF-36 form. The patients were also evaluated by ultrasound and magnetic resonance before treatment and after 4 (US only) and 6 months.
Both treatments allowed for a significant improvement with respect to baseline. Comparing the two groups, VAS, AOFAS and VISA-A scored significantly better at 15 and 30 days in the SVF in comparison to PRP group (p < 0.05). At the following time points the scores were not significantly different between the two groups. No correlation has been found between clinical and radiological findings.
Both PRP and SVF were safe, effective treatments for recalcitrant Achilles tendinopathy. The patients treated with SVF obtained faster results, thus suggesting that such a treatment should be taken into consideration for those patients who require an earlier return to daily activities or sport.
Level of evidence
Randomized Controlled Clinical Trial, Level 1.
KeywordsAchilles tendon Achilles tendinopathy PRP Adipose-derived mesenchymal stem cells Stromal vascular fraction (SVF)
- 6.Crisan M, Yap S, Casteilla L, Chen CW, Corselli M, Park TS, Andriolo G, Sun B, Zheng B, Zhang L, Norotte C, Teng PN, Traas J, Schugar R, Deasy BM, Badylak S, Buhring HJ, Giacobino JP, Lazzari L, Huard J, Péault B (2008) A perivascular origin for mesenchymal stem cells in multiple human organs. Cell Stem Cell 3:301–313CrossRefPubMedGoogle Scholar
- 7.Dallaudière B, Pesquer L, Meyer P, Silvestre A, Perozziello A, Peuchant A, Durieux MH, Loriaut P, Hummel V, Boyer P, Schouman-Claeys E, Serfaty JM (2014) Intratendinous injection of platelet-rich plasma under US guidance to treat tendinopathy: a long-term pilot study. J Vasc Interv Radiol 25:717–723CrossRefPubMedGoogle Scholar
- 8.de Girolamo L, Lopa S, Arrigoni E, Sartori MF, Baruffaldi Preis FW, Brini AT (2009) hASCs (human Adipose-derived Stem Cells) isolated from young and elderly women: study on their differentiation potential and scaffold interaction during osteogenic differentiation. CytoTherapy 11:793–803CrossRefPubMedGoogle Scholar
- 21.LaPrade RF, Geeslin AG, Murray IR, Musahl V, Zlotnicki JP, Petrigliano F, Mann BJ (2016) Biologic treatments for sports injuries II think tank-current concepts, future research, and barriers to advancement, part 1: biologics overview, ligament injury, tendinopathy. Am J Sports Med 44:3270–3283CrossRefPubMedGoogle Scholar
- 23.Michalek J, Moster R, Lukac L, Proefrock K, Petrasovic M, Rybar J, Capkova M, Chaloupka A, Darinskas A, Michalek J Sr, Kristek J, Travnik J, Jabandziev P, Cibulka M, Holek M, Jurik M, Skopalik J, Kristkova Z, Dudasova Z (2015) Autologous adipose tissue-derived stromal vascular fraction cells application in patients with osteoarthritis. Cell Transplant. doi: 10.3727/096368915X686760 PubMedCrossRefGoogle Scholar
- 28.Oloff L, Elmi E, Nelson J, Crain J (2015) Retrospective analysis of the effectiveness of platelet-rich plasma in the treatment of Achilles tendinopathy: pretreatment and posttreatment correlation of magnetic resonance imaging and clinical assessment. Foot Ankle Spec 8:490–497CrossRefPubMedGoogle Scholar
- 33.Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, Taunton JE, Khan KM (2001) Victorian Institute Of Sport Tendon Study Group. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med 35:335–341CrossRefPubMedPubMedCentralGoogle Scholar
- 34.Sanli I, Morgan B, van Tilborg F, Funk L, Gosens T (2014) Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. Knee Surg Sports Traumatol Arthrosc 24:2308–2312CrossRefPubMedGoogle Scholar
- 40.Wesner M, Defreitas T, Bredy H, Pothier L, Qin Z, McKillop AB, Gross DP (2016) A Pilot Study evaluating the effectiveness of platelet-rich plasma therapy for treating degenerative tendinopathies: a randomized control trial with synchronous observational cohort. PLoS One 11:e0147842CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Youngstrom DW, LaDow JE, Barrett JG (2016) Tenogenesis of bone marrow-, adipose-, and tendon-derived stem cells in a dynamic bioreactor. Connect Tissue Res 30:1–12Google Scholar