Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation
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Optimal treatment of acute Achilles tendon ruptures remains controversial. Positive results using stem-cell-bearing concentrates have been reported with other soft-tissue repairs, but no studies exist on outcomes of bone marrow aspirate concentrate (BMAC) augmentation in primary Achilles tendon repair.
We reviewed patients with sport-related Achilles tendon ruptures treated via open repair augmented with BMAC injection from 2009 to 2011. Data on operative complications, strength, range of motion, rerupture, calf circumference and functional improvement through progressive return to sport and the Achilles tendon Total Rupture Score (ATRS) were analysed.
A total of 27 patients (28 tendons) treated with open repair and BMAC injection were identified (mean age 38.3 ± 9.6 years). At mean follow-up of 29.7 ± 6.1 months, there were no reruptures. Walking without a boot was at 1.8 ± 0.7 months, participation in light activity was at 3.4 ± 1.8 months and 92 % (25 of 27) of patients returned to their sport at 5.9 ± 1.8 months. Mean ATRS at final follow-up was 91 (range 72–100) points. One case of superficial wound dehiscence healed with local wound care. No soft-tissue masses, bone formation or tumors were observed in the operative extremity.
Excellent results, including no re-ruptures and early mobilisation, were observed in this small cohort with open Achilles tendon repair augmented by BMAC. No adverse outcomes of biologic treatment were observed with this protocol. The efficacy of BMAC in the operative repair of acute Achilles tendon ruptures warrants further study.
Level of Evidence: IV - Therapeutic
KeywordsAchilles Tendon Rupture Repair Biologic
- 10.Kolodziej L, Bohatyrewicz A, Kromuszczynska J, Jezierski J, Biedron M (2013) Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study–preliminary report. Int Orthop 37:625–629. doi: 10.1007/s00264-012-1737-9 CrossRefPubMedCentralPubMedGoogle Scholar
- 21.Machova Urdzikova L, Sedlacek R, Suchy T, Amemori T, Ruzicka J, Lesny P, Havlas V, Sykova E, Jendelova P (2014) Human multipotent mesenchymal stem cells improve healing after collagenase tendon injury in the rat. Biomed Eng Online 13:42-925X-13-42. doi: 10.1186/1475-925X-13-42
- 22.Nilsson-Helander K, Thomee R, Silbernagel KG, Thomee P, Faxen E, Eriksson BI, Karlsson J (2007) The achilles tendon total rupture score (ATRS): Development and validation. Am J Sports Med 35:421–426. doi: 0363546506294856Google Scholar
- 23.Schon LC, Gill N, Thorpe M, Davis J, Nadaud J, Kim J, Molligan J, Zhang Z (2014) Efficacy of a mesenchymal stem cell loaded surgical mesh for tendon repair in rats. J Transl Med 12:110-5876-12-110. doi: 10.1186/1479-5876-12-110
- 24.Courneya JP, Luzina IG, Zeller CB, Rasmussen JF, Bocharov A, Schon LC, Atamas SP (2010) Interleukins 4 and 13 modulate gene expression and promote proliferation of primary human tenocytes. Fibrogenesis Tissue Repair 3:9-1536-3-9. doi: 10.1186/1755-1536-3-9
- 28.Olsson N, Silbernagel KG, Eriksson BI, Sansone M, Brorsson A, Nilsson-Helander K, Karlsson J (2013) Stable surgical repair with accelerated rehabilitation versus nonsurgical treatment for acute Achilles tendon ruptures: a randomized controlled study. Am J Sports Med 41:2867–2876. doi: 10.1177/0363546513503282 CrossRefPubMedGoogle Scholar