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In case
of stem cell therapy, the patients should be made aware of the lack of evidence, possible risks and safety
considerations when using stem cells.
Stem cells have emerged as a novel treatment method for
tendon ill-conditions. The current evidence for stem cell therapy in tendon
disorders have been systematically reviewed in this study.
A minimum of 5 cases in the randomised and non-randomised
controlled trials, cohort studies and case series were searched in MEDLINE,
CENTRAL, EMBASE, CINAHL, PEDro and SPORTDiscus. The grey literature databases
and trial registries were also searched. Only the human studies were considered
with no time and language restrictions limited to the search. For the possible
eligible trials, all the references of included trials were thoroughly checked.
The Cochrane risk of bias tool determined the risk of bias assessment for
controlled trials and the Newcastle-Ottawa scale for the case series. The
Oxford levels of evidence was used to assign the levels of evidence.
Four published and three unpublished/pending trials were
found for with a total of 79 patients. There was no unpublished data. The bone
marrow-derived stem cells in rotator cuff repair surgery resulted from two
trials. Lower retear rates were found when compared with historical controls or
the literature. The allogenic adipose-derived stem cells to treat lateral
epicondylar tendinopathy were also used in one trial. Enhanced Mayo Elbow
Performance Index, Visual Analogue Pain scale and ultrasound findings after
1-year follow-up distinguished with baseline were revealed. After 5-year
follow-up, ameliorated International Knee Documentation Committee, Knee injury
and Osteoarthritis Outcome Score subscales and Tegner scores was found as
result of bone marrow-derived stem cell-treated patellar tendinopathy. Mild
adverse events (e.g., swelling, effusion) were noted in one trial. High risk of
bias was observed for all trials. Only level 4 evidence was present.
For
tendon disorders, no evidence (level 4) was found for the therapeutic use of
stem cells. Currently, the use of stem cell therapy for tendon disorders in
clinical practice is not suggested.
British Journal of Sports Medicine
No evidence for the use of stem cell therapy for tendon disorders: a systematic review
Haiko I M F L Pas et al.
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