RESUMO
La ortobiología está emergiendo como una nueva subespecialidad de la Ortopedia, con una aceptación gradual. Si bien el primer impulso del uso masivo de las terapias biológicas en Ortopedia vino de la mano del plasma rico en plaquetas y el concentrado de médula ósea por su elaboración y aplicación fáciles; en la última década, se han producido avances importantes y ha surgido numerosa evidencia clínica sobre los resultados de otras terapias biológicas prometedoras, como el lisado plaquetario, las células mesenquimales derivadas del tejido adiposo y los cultivos celulares. Este artículo tiene como objetivo describir las terapias biológicas más utilizadas actualmente en Ortopedia, con especial énfasis en su proceso de elaboración, su composición y mecanismo de acción. Nivel de Evidencia: V
Orthobiologics is emerging as a new subspecialty of orthopedics, with gradual acceptance. While platelet-rich plasma (PRP) and bone marrow concentrate (BMC) provided the initial catalyst for the widespread use of biological therapies in orthopedics due to their ease of preparation and application, there have been significant advances in the last decade, with numerous clinical evidence emerging on the outcomes of other promising biological therapies such as platelet lysate, adipose-derived stromal vascular fraction cells (SVF), and cell cultures. The following article aims to describe the most widely used biological therapies currently used in orthopedics, with special emphasis on their manufacturing process, composition, and mechanism of action. Level of Evidence: V
Assuntos
Ortopedia , Células da Medula Óssea , Medicina Regenerativa , Plasma Rico em Plaquetas , Células-Tronco MesenquimaisRESUMO
PURPOSE: Study the effect of Adipose derived stromal cells (ASCs) injection as therapeutic procedure on the common extensor tendinopathy. METHODS: Eighteen Tennis players with chronic, recalcitrant LET (who have previously been unsuccessfully treated with nonoperative treatments) underwent clinical evaluation and magnetic resonance imaging (MRI) before intervention. Stromal vascular fraction cells (SVF) were expanded by in vitro culture and ASCs were obtained and characterized by flow cytometry. ASCs were injected into the site of tendinopathy (identified by ultrasound imaging at the origin of the common extensor tendon) on a single occasion followed by physiotherapy. Players underwent serial clinical evaluations during a 12-month period and repeated MRI at 6-month post-injection. RESULTS: At 6-month clinical evaluation revealed significant improvements compared to baseline in mean Visual Analog Scale (VAS) scores for: (1) maximum pain score (from 6.28 ± 1.65, to 1.0 ± 0.43; p < .001); (2) Mean quick Disabilities of the Arm, Shoulder and Hand (QuickDASH-Compulsory score: 51.38 ± 12.02 to 12.33 ± 4.66; p < .001); (3) QuickDASH-Sport score: 56.94 ± 15.44 to 8.68 ± 8.86; p < .001). Validated MRI scoring system grade of tendinopathy also improved significantly: 4.22 ± 0.26 to 2.22 ± 0.10 (p < .001). At 12-month from injection, VAS maximun pain score further decreased to 0.74 ± 0.44 (p < .001) and QuickDASH-Compulsory score to 5.56 ± 3.58 (p < .001). Average time to return to play tennis was 3,31 ± 0,61 month post-intervention. CONCLUSION: Tennis players with recalcitrant LET showed significant clinical improvement and structural repair at the origin of the common tendon origin after injection of autologous ASCs. Results of this study are promising and open a new biological therapeutic modality to treat LET. Even if the results of this pilot study are positive, future well-designed studies, i.e. prospective randomized trials are needed to define the role of cell therapy in treating LET.