Viganò Marco, Ragni Enrico, Marmotti Antonio, de Girolamo Laura
Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
San Luigi Gonzaga Hospital, Orthopedics and Traumatology Department, University of Turin - Medical School, Turin, Italy.
J Exp Orthop. 2022 Apr 8;9(1):31. doi: 10.1186/s40634-022-00468-w.
The aim of this systematic review is to explore the current available knowledge about tendon disorders and orthobiologics derived by preclinical experiments to evaluate their role and efficacy in the different stages and conditions related to the tendon healing processes.
The systematic review was performed according to the PRISMA guidelines. Different electronic databases (MEDLINE, Web of Science, EMBASE) were searched for studies investigating orthobiologics (PRP and cell-based products from adipose tissue or bone marrow) in animal models or veterinary clinical trials for tendon pathologies (complete/partial tendon ruptures, rotator cuff tears, tendinopathy, enthesis-related injuries). Data regarding the specific product used, the treatment site/pathology, the host and the model were collected. The results were classified into the following categories: histological, biomechanical, molecular and imaging.
A large pool of preclinical studies on tendon disorders have been found on platelet-rich plasma (PRP), while data about stromal vascular fraction (SVF) and bone marrow concentrate (BMAC) are still limited and frequently focused on expanded cells, rather than orthobiologics prepared at the point of care. The effect of PRP is related to an acceleration of the healing process, without improvements in the final structure and properties of repaired tendon. Cell-based products have been reported to produce more durable results, but the level of evidence is currently insufficient to draw clear indications.
The preclinical results about orthobiologics applications to tendon pathologies would support the rationale of their clinical use and encourage the performance of clinical trials aimed to confirm these data in human subjects.
本系统评价旨在探索目前有关肌腱疾病和通过临床前实验得出的骨科生物制剂的现有知识，以评估它们在与肌腱愈合过程相关的不同阶段和情况下的作用及疗效。
本系统评价按照PRISMA指南进行。检索了不同的电子数据库（MEDLINE、科学网、EMBASE），以查找在动物模型或兽医临床试验中研究用于肌腱病变（完全/部分肌腱断裂、肩袖撕裂、肌腱病、附着点相关损伤）的骨科生物制剂（富血小板血浆和来自脂肪组织或骨髓的细胞产品）的研究。收集了有关所使用的特定产品、治疗部位/病理、宿主和模型的数据。结果分为以下几类：组织学、生物力学、分子和影像学。
已发现大量关于富血小板血浆（PRP）治疗肌腱疾病的临床前研究，而关于基质血管成分（SVF）和骨髓浓缩物（BMAC）的数据仍然有限，且经常集中在扩增细胞上，而非即时制备的骨科生物制剂。PRP的作用与加速愈合过程有关，但对修复后肌腱的最终结构和特性并无改善。据报道，基于细胞的产品能产生更持久的效果，但目前证据水平不足以得出明确结论。
关于骨科生物制剂应用于肌腱病变的临床前结果将支持其临床应用的基本原理，并鼓励开展旨在在人体中证实这些数据的临床试验。
