I frequently see patients with an MRI of a tendon tear or chronic tendinopathy. Tendinopathy is a more recent term to describe pathology of a tendon that causes pain. Tendinopathy has classical symptoms of tenderness on palpation, and pain when exercising or with movement. It is divided into two broad categories:
- Tendinitis is typically from a new injury during the early phase when the injury is causing inflammation, a sign that the body is trying to heal the tendon.
- Tendinosis occurs at a later stage when the tendon shows wear, but no inflammation. And this is often due to anti-inflammatory medications, which block the regeneration of collagen, the major constituent of the tendon. Yes, inflammation is needed for healing.
Tendons are small, strong, thick bands of connective tissue that connect the muscle to the bone. It is the tendon that converts the muscle’s strength into musculoskeletal movement by bending and straightening joints.
Most tendon injuries we see are from athletes, and those who do fitness and weight training. But even an inactive person can twist their ankle or move any joint improperly to stretch a tendon and strain it. The place that a tendon, ligament, or muscle attaches to bone is called the enthesis, and if the strain (tendon or muscle injury) or sprain (ligament injury) occurs at that junction to bone, it is called an enthesopathy. And regenerative medicine is the best way I know to heal that.
Anti-inflammatory drugs and cortisone injections are effective at reducing pain and inflammation, but do not have a healing effect. In fact they can lead to a non-healing tendon or ligament. Further, they may lead to complete rupture which may need surgical repair.
Treatment of Tendinopathy
Are bone marrow stem cells the new player in non-surgical tendon repair?
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.
This is why the great excitement in stem cell therapy:
In their research doctors at the National University of Singapore suggest that bone-marrow derived stem cells accelerate tendon healing.1
Center of Translational Regenerative Medicine researchers, in Torino, Italy say: “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.”2
Doctors at the Feinstein Institute for Medical Research 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.3
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
Ask Dr. Darrow about tendon injuries
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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. PUBMED
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. PUBMED
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.