Epanomeritakis Ilias Ektor, Eleftheriou Andreas, Economou Anna, Lu Victor, Khan Wasim
Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge CB2 0QQ, UK.
School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
Bioengineering (Basel). 2024 Jun 27;11(7):656. doi: 10.3390/bioengineering11070656.
Flexor tendon lacerations are primarily treated by surgical repair. Limited intrinsic healing ability means the repair site can remain weak. Furthermore, adhesion formation may reduce range of motion post-operatively. Mesenchymal stromal cells (MSCs) have been trialled for repair and regeneration of multiple musculoskeletal structures. Our goal was to determine the efficacy of MSCs in enhancing the biomechanical properties of surgically repaired flexor tendons. A PRISMA systematic review was conducted using four databases (PubMed, Ovid, Web of Science, and CINAHL) to identify studies using MSCs to augment surgical repair of flexor tendon injuries in animals compared to surgical repair alone. Nine studies were included, which investigated either bone marrow- or adipose-derived MSCs. Results of biomechanical testing were extracted and meta-analyses were performed regarding the maximum load, friction and properties relating to viscoelastic behaviour. There was no significant difference in maximum load at final follow-up. However, friction, a surrogate measure of adhesions, was significantly reduced following the application of MSCs ( = 0.04). Other properties showed variable results and dissipation of the therapeutic benefits of MSCs over time. In conclusion, MSCs reduce adhesion formation following tendon injury. This may result from their immunomodulatory function, dampening the inflammatory response. However, this may come at the cost of favourable healing which will restore the tendon's viscoelastic properties. The short duration of some improvements may reflect MSCs' limited survival or poor retention. Further investigation is needed to clarify the effect of MSC therapy and optimise its duration of action.
屈肌腱撕裂伤主要通过手术修复进行治疗。有限的内在愈合能力意味着修复部位可能会一直比较脆弱。此外，粘连形成可能会降低术后的活动范围。间充质基质细胞（MSCs）已被用于多种肌肉骨骼结构的修复和再生试验。我们的目标是确定间充质基质细胞在增强手术修复的屈肌腱生物力学性能方面的疗效。使用四个数据库（PubMed、Ovid、科学网和护理学与健康领域数据库）进行了一项PRISMA系统评价，以识别与单纯手术修复相比，使用间充质基质细胞增强动物屈肌腱损伤手术修复效果的研究。纳入了九项研究，这些研究调查了骨髓来源或脂肪来源的间充质基质细胞。提取了生物力学测试结果，并对最大负荷、摩擦力以及与粘弹性行为相关的特性进行了荟萃分析。最终随访时的最大负荷没有显著差异。然而，作为粘连替代指标的摩擦力在应用间充质基质细胞后显著降低（P = 0.04）。其他特性显示出不同的结果，且间充质基质细胞的治疗益处会随时间逐渐消失。总之，间充质基质细胞可减少肌腱损伤后的粘连形成。这可能是由于它们的免疫调节功能，减轻了炎症反应。然而，这可能是以良好愈合为代价的，而良好愈合会恢复肌腱的粘弹性特性。一些改善的持续时间较短可能反映了间充质基质细胞存活有限或留存不佳。需要进一步研究以阐明间充质基质细胞疗法的效果并优化其作用持续时间。
