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.
Treatment of tendinopathy with stem cell therapy
For many people with tendon problems, 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.
It 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. Research is showing us now that pro-inflammatory treatments, such as stem cell therapy, may present a superior options.
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.
In their research, (1) doctors at the National University of Singapore suggest that bone-marrow derived stem cells accelerate tendon healing. 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,(2) 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.”
Moving forward to humans
- Doctors at the Feinstein Institute for Medical Research (3) 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.
Knee cap and tendons
Chondromalacia patella is a condition that has been show to respond very favorably to our regenerative techniques. Platelet Rich Plasma Therapy. Researchers in the Netherlands evaluated the outcome of patients with patellar tendinopathy treated with platelet-rich plasma injections (PRP) and whether certain characteristics, such as activity level or previous treatment affected the results. What they found was:
- “After PRP treatment, patients with patellar tendinopathy showed a statistically significant improvement. In addition, these improvements can also be considered clinically meaningful.”(4)
Most recently doctors in Switzerland compared PRP injections to cortisone in the shoulder. The doctors found good results for the PRP and were able to conclude that PRP injections are a good alternative to cortisone injections, especially in patients with contraindication to cortisone.(5) Equally, new research suggested that bone marrow stem cell therapy showed encouraging results in pain and motion relief for patients with rotator cuff and shoulder osteoarthritis.(6)
Doctors looked at the increasing popularity of platelet-rich plasma therapies for soft tissue injuries such as ligament, muscle and tendon tears and tendinopathies.
In Achilles tendinopathy and plantar fasciitis, PRP is an effective and safe alternative for the management of patients with a poor response to conventional non-surgical treatment. 7,8 PRP was effective in patients affected by mid-portion Chronic Recalcitrant Achilles Tendinopathies treated with a single platelet-rich plasma (PRP) treatment.9
Do you have questions? Ask Dr. Darrow
A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
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1. 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.
2. 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.
3. Shapiro E, Grande D, Drakos M. Biologics in Achilles tendon healing and repair: a review. Curr Rev Musculoskelet Med. 2015 Feb 6.
4. Gosens T, Den Oudsten BL, Fievez E, van ‘t Spijker P, Fievez A. Pain and activity levels before and after platelet-rich plasma injection treatment of patellar tendinopathy: a prospective cohort study and the influence of previous treatments.Int Orthop. 2012 Apr 27. [Epub ahead of print]
5. von Wehren L1, Blanke F, Todorov A, Heisterbach P, Sailer J, Majewski M. The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2015 May 28. [Epub ahead of print]
6. Valencia Mora M, Ruiz Ibán MA, Díaz Heredia J, Barco Laakso R, Cuéllar R1, García Arranz M. Stem cell therapy in the management of shoulder rotator cuff disorders. World J Stem Cells. 2015 May 26;7(4):691-9. doi: 10.4252/wjsc.v7.i4.691.
7. Guelfi M, Pantalone A, Vanni D, Abate M, et al. Long-term beneficial effects of platelet-rich plasma for non-insertional Achilles tendinopathy. Foot Ankle Surg. 2015 Sep;21(3):178-81. doi: 10.1016/j.fas.2014.11.005. Epub 2014 Dec 11.
8. López-Gavito E, Gómez-Carlín LA, Parra-Téllez P, Vázquez-Escamilla J. Platelet-rich plasma for managing calcaneus tendon tendinopathy and plantar fasciitis. Acta Ortop Mex. 2011 Nov-Dec;25(6):380-5.
9. Gaweda K, Tarczynska M, Krzyzanowski W. Treatment of Achilles tendinopathy with platelet-rich plasma. Int J Sports Med. 2010 Aug;31(8):577-83. Epub 2010 Jun 9. — 1210