Efficacy of Stem Cell Therapy for Tendon Disorders: A Systematic Review

Noortje Anna Clasina van den Boom; Marinus Winters; Hidde Jacobs Haisma; Maarten Hendrik Moen

doi:10.1177/2325967120915857

Efficacy of Stem Cell Therapy for Tendon Disorders: A Systematic Review

Orthop J Sports Med. 2020 Apr 30;8(4):2325967120915857. doi: 10.1177/2325967120915857. eCollection 2020 Apr.

Authors

Noortje Anna Clasina van den Boom¹, Marinus Winters², Hidde Jacobs Haisma³, Maarten Hendrik Moen^{4

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Affiliations

¹ Maastricht University, Faculty of Health and Medicine, Maastricht, the Netherlands.
² Center for General Practice at Aalborg University, Aalborg, Denmark.
³ Department of Chemical and Pharmaceutical Biology, Groningen Research Institute of Pharmacy, Groningen University, Groningen, the Netherlands.
⁴ The Sports Physician Group, Department of Sports Medicine, OLVG West, Amsterdam, the Netherlands.
⁵ Bergman Clinics, Naarden, the Netherlands.
⁶ Department of Elite Sports, NOCNSF, Medical Staff, Arnhem, the Netherlands.

Abstract

Background: Stem cell therapy is an emerging treatment for tendon disorders.

Purpose: To systematically review the efficacy of stem cell therapy for patients with tendon disorders.

Study design: Systematic review; Level of evidence, 4.

Methods: MEDLINE/PubMed, EMBASE, CINAHL, CENTRAL, PEDro, and SPORTDiscus; trial registers; and gray literature were searched to identify randomized controlled trials (RCTs) and non-RCTs, cohort studies, and case series with 5 or more cases. Studies investigating any type of stem cell therapy for patients with tendon disorders were eligible if they included patient-reported outcome measures or assessed tendon healing. Risk of bias was assessed through use of the Cochrane risk of bias tools.

Results: This review included 8 trials (289 patients). All trials had moderate to high risk of bias (level 3 or 4 evidence). In Achilles tendon disorders, 1 trial found that allogenic-derived stem cells led to a faster recovery compared with platelet-rich plasma. Another study found no retears after bone marrow-derived stem cell therapy was used in addition to surgical treatment. There were 4 trials that studied the efficacy of bone marrow-derived stem cell therapy for rotator cuff tears. The controlled trials reported superior patient-reported outcomes and better tendon healing. A further 2 case series found that stem cell therapy improved patient-reported outcomes in patients with patellar tendinopathy and elbow tendinopathy.

Conclusion: Level 3 evidence is available to support the efficacy of stem cell therapy for tendon disorders. The findings of available studies are at considerable risk of bias, and evidence-based recommendations for the use of stem cell therapy for tendon disorders in clinical practice cannot be made at this time. Stem cell injections should not be used in clinical practice given the lack of knowledge about potentially serious adverse effects.

Keywords: Achilles; injection; shoulder; tear; tendinopathy.

Publication types

Review