I frequently see patients with an MRI of a tendon tear or an MRI of a problem of chronic tendinopathy. Tendinopathy is a more recent term to describe a chronic pathology of a tendon that causes pain. The problem of Tendinopathy can be It is divided into two broad categories:
- Tendinitis means inflammation of the tendon. This is the characteristic swelling that comes with a worsening wear and tear or acute injury.
- Tendinosis is the “old, nagging injury.” The tendon is injured but the body has given up trying to heal it. It is an injury without inflammation. Why did the body give up? In some of the people we see, it comes as the result of a long and extensive anti-inflammatory or cortisone treatment history.
Anti-inflammatory drugs and cortisone injections are effective at reducing pain and inflammation, but do not have a healing effect. Worse, their detrimental effects may lead to complete tendon rupture which usually requires surgical repair. For more on this and supportive research, I invite you to review my articles:
- Systemic effects of corticosteroid injections
- How anti-inflammatories accelerate degenerative knee disease.
For many people with tendon problems, tendonitis, there may be an eventual suggestion for an arthroscopy surgery or a type of “release,” surgery to improve range of motion in a joint. Many people that contact us have already had the surgery and their tendinopathy returned. Now they would like to explore a non-surgical treatment to treat tendinopathy.
Medicine is not always an inflammation problem
Doctors know that chronic tendon pain treatment present unique management challenges because of the long assumed belief that these injuries result from ongoing inflammation. This thinking has caused physicians to rely on treatments demonstrated to be ineffective in the long term–anti-inflammatory medications and cortisone shots for injury. Research is showing us now that pro-inflammatory treatments, such as stem cell therapy, may present a superior options for sports and work injury.
There has been a lot of animal and human studies looking at the benefit of stem cell therapy in tendon treatment. Here are some that point to a more favorable assessment of stem cell therapy for tendon damage. There are others that find less favorable assessments.
Bone-marrow derived stem cells
An August 2023 study wrote (1) : “Mesenchymal stem cells (MSCs) are attracting attention (for tendon injuries) because of their high proliferative and self‑renewal capacity.” These functions of MSCs show “especially satisfactory effects in the treatment of tendon injury. . . .In tendon injury, MSCs promote tendon repair through four mechanisms: Decreasing inflammation and promoting neovascularization (the formation of new blood vessels) and cell proliferation and differentiation. They are also involved in extracellular matrix reorganization by promoting collagen production and transforming type III collagen fibers to type I collagen fibers. ”
In their research, (2) doctors at the National University of Singapore suggest that bone-marrow derived stem cells accelerate tendon healing from injury. This animal study looked at rabbit tendons and results good enough to suggest that, “Further work is needed determine the value of stem cell therapy in flexor tendon healing in humans.”
Center of Translational Regenerative Medicine researchers,(3) in Torino, Italy looked at powerful horse tendons and found that damage to these tendons responded well enough to suggest: “Tendon injuries represent even today a challenge as repair may be exceedingly slow and incomplete. Regenerative medicine and stem cell technology have shown to be of great promise. . . . The horse has been advocated as an animal model of tendon and ligament injuries, since many of the spontaneous injuries seen in horses are similar to those seen in human athletes.”
Doctors Moving forward to humans
- Doctors at the Feinstein Institute for Medical Research (4) in New York say: Most recently studies have indicated the potential effectiveness of bone marrow (stem cells) and its positive effects on Achilles tendon healing.
References
1 Jiang L, Lu J, Chen Y, Lyu K, Long L, Wang X, Liu T, Li S. Mesenchymal stem cells: An efficient cell therapy for tendon repair. International Journal of Molecular Medicine. 2023 Aug 1;52(2):1-21.
2. He M, Gan AW, Lim AY, Goh JC, Hui JH, Chong AK, Bone Marrow Derived Mesenchymal Stem Cell Augmentation of Rabbit Flexor Tendon Healing. Hand Surg. 2015 Oct;20(3):421-9. doi: 10.1142/S0218810415500343.
3. Tetta C, Consiglio AL, Bruno S, Tetta E, Gatti E, Dobreva M, Cremonesi F, Camussi G. Muscles The role of microvesicles derived from mesenchymal stem cells in tissue regeneration; a dream for tendon repair? Ligaments Tendons J. 2012 Oct 16;2(3):212-21. Print 2012 Jul.
4. Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6.