The Sports Physician Group, Department of Sports Medicine, OLVG West, Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
Br J Sports Med. 2017 Jul;51(13):996-1002. doi: 10.1136/bjsports-2016-096794. Epub 2017 Jan 11.
Stem cells have emerged as a new treatment option for tendon disorders. We systematically reviewed the current evidence for stem cell therapy in tendon disorders.
Randomised and non-randomised controlled trials, cohort studies and case series with a minimum of 5 cases were searched in MEDLINE, CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus. In addition, we searched grey literature databases and trial registers. Only human studies were included and no time or language restrictions were applied to our search. All references of included trials were checked for possibly eligible trials. Risk of bias assessment was performed using the Cochrane risk of bias tool for controlled trials and the Newcastle-Ottawa scale for case series. Levels of evidence were assigned according to the Oxford levels of evidence.
4 published and three unpublished/pending trials were found with a total of 79 patients. No unpublished data were available. Two trials evaluated bone marrow-derived stem cells in rotator cuff repair surgery and found lower retear rates compared with historical controls or the literature. One trial used allogenic adipose-derived stem cells to treat lateral epicondylar tendinopathy. Improved Mayo Elbow Performance Index, Visual Analogue Pain scale and ultrasound findings after 1-year follow-up compared with baseline were found. Bone marrow-derived stem cell-treated patellar tendinopathy showed improved International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score subscales and Tegner scores after 5-year follow-up. One trial reported adverse events and found them to be mild (eg, swelling, effusion). All trials were at high risk of bias and only level 4 evidence was available.
No evidence (level 4) was found for the therapeutic use of stem cells for tendon disorders. The use of stem cell therapy for tendon disorders in clinical practice is currently not advised.
干细胞已成为治疗肌腱疾病的新选择。我们系统地回顾了目前肌腱疾病干细胞治疗的证据。
在 MEDLINE、CENTRAL、EMBASE、CINAHL、PEDro 和 SPORTDiscus 中搜索随机和非随机对照试验、队列研究和至少 5 例的病例系列研究。此外，我们还搜索了灰色文献数据库和试验登记处。仅纳入人类研究，对我们的搜索没有时间或语言限制。纳入试验的所有参考文献均进行了可能符合条件的试验检查。使用 Cochrane 对照试验偏倚风险工具和纽卡斯尔-渥太华量表对病例系列进行偏倚风险评估。根据牛津证据水平分配证据水平。
共发现 4 项已发表和 3 项未发表/待发表的试验，共 79 名患者。没有未发表的数据。两项试验评估了骨髓源性干细胞在肩袖修复手术中的应用，与历史对照或文献相比，发现再撕裂率较低。一项试验使用同种异体脂肪源性干细胞治疗外侧肱骨髁突肌腱病。与基线相比，1 年随访时发现 Mayo 肘功能评分、视觉模拟疼痛量表和超声检查结果改善。骨髓源性干细胞治疗髌腱病 5 年随访时发现国际膝关节文献委员会、膝关节损伤和骨关节炎结局评分亚量表和 Tegner 评分改善。一项试验报告了不良事件，发现它们是轻微的（例如，肿胀、积液）。所有试验的偏倚风险均较高，仅提供 4 级证据。
目前没有证据（4 级）表明干细胞对治疗肌腱疾病有疗效。因此，不建议在临床实践中使用干细胞疗法治疗肌腱疾病。
