Di Matteo Berardo, Ranieri Riccardo, Manca Angelo, Cappato Simone, Marcacci Maurilio, Kon Elizaveta, Castagna Alessandro
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.
First Moscow State Medical University, Sechenov University, Moscow, Russia.
Stem Cells Int. 2021 Apr 24;2021:5558040. doi: 10.1155/2021/5558040. eCollection 2021.
Tendinopathies are a common cause of disability among the general population, and their management is challenging due to the degenerative nature of these disorders. The aim of this paper is to perform a scoping review of the available clinical evidence on the application of cell-based therapies for the management of elbow and rotator cuff tendinopathies, in order to summarize the current application methods and to shed light on the therapeutic potential and current limitations of these biologic approaches.
A scoping review of the literature was performed on the PubMed and Scopus databases using the following inclusion criteria: clinical reports of any level of evidence, written in English, with no time limitation, on the use of cell-based approaches to treat rotator cuff or elbow tendinopathies, including studies on biological augmentation during the surgical procedure. Exclusion criteria were as follows: case reports or mini case series (<5 patients), articles not written in English, and reviews. Relevant data were then extracted and collected in a single database with the consensus of the two observers to be analyzed for the purposes of the present manuscript.
Seven papers dealing with rotator cuff tears were included. Four of them investigated the effect of injections, either MSCs alone or in combination with PRP, whereas three studies investigated the use of MSCs in combination with surgery. In all cases, an improvement was found in terms of clinical scores, with even evidence of tendon healing documented at second-look arthroscopy. Six papers dealt with elbow tendinopathies: three studies described the use of MSCs either with or without surgery, reporting significant clinical improvement and three studies analyzed the use of different types of cells (collagen-producing cells and autologous tenocytes) and, even in this case, clinical improvement was reported.
All the papers included suggested a beneficial role of cell-based approaches to treat common upper limb tendinopathies, with an overall satisfactory safety profile. However, the lack of high-level evidence and the presence of controversial issues, such as interproduct variability, harvest source, and application strategies, do not allow standardization of these novel biologic approaches, whose efficacy needs to be confirmed with properly designed randomized trials.
肌腱病是普通人群致残的常见原因，由于这些疾病的退行性本质，其治疗具有挑战性。本文的目的是对基于细胞的疗法应用于肘部和肩袖肌腱病治疗的现有临床证据进行范围综述，以总结当前的应用方法，并阐明这些生物方法的治疗潜力和当前局限性。
在PubMed和Scopus数据库上进行文献范围综述，使用以下纳入标准：任何证据水平的临床报告，英文撰写，无时间限制，关于使用基于细胞的方法治疗肩袖或肘部肌腱病，包括手术过程中生物增强的研究。排除标准如下：病例报告或小型病例系列（<5例患者）、非英文撰写的文章以及综述。然后，在两位观察者达成共识的情况下，将相关数据提取并收集到一个单一数据库中，以便为本手稿的目的进行分析。
纳入了7篇关于肩袖撕裂的论文。其中4篇研究了单独注射间充质干细胞（MSCs）或与富血小板血浆（PRP）联合注射的效果，而3项研究探讨了MSCs与手术联合使用的情况。在所有病例中，临床评分均有改善，甚至在二次关节镜检查时有肌腱愈合的证据。6篇论文涉及肘部肌腱病：3项研究描述了使用MSCs（有或无手术），报告了显著的临床改善，3项研究分析了使用不同类型的细胞（胶原生成细胞和自体肌腱细胞），即使在这种情况下，也报告了临床改善。
所有纳入的论文都表明基于细胞的方法在治疗常见上肢肌腱病方面具有有益作用，总体安全性良好。然而，缺乏高级别证据以及存在诸如产品间变异性、采集来源和应用策略等有争议的问题，使得这些新型生物方法无法标准化，其疗效需要通过设计合理的随机试验来证实。
