Skin-derived tenocyte-like cells for patellar tendinopathy improves pain and function .
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2014;2(3):25 Am J Sports Med. 2011 Mar;39(3):614-23. doi: 10.1177/0363546510387095. Epub 2010 Dec 746 patients (60 patellar tendons) were randomized to assess the efficacy of ultrasound-guided injection of autologous skin-derived, tenocyte-like cells in treating refractory patellar tendinosis. Patients received either injection with collagen-producing cells suspended in autologous plasma or injection with autologous plasma alone (control). The assessment at 6 months indicated that ultrasound-guided injection of autologous skin-derived tendon-like cells led to a significantly greater improvement in pain and function in comparison to control injections.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
The optimal treatment method, whether surgical or nonoperative, for patellar tendinopathy remains unclear. Recently, there has been an increasing focus on ultrasound-guided interventional procedures for the treatment of patellar tendinopathy. For example, the use of tissue engineering (using stem cells) has led to tendon regeneration in animal studies. However, there is uncertainty regarding the type of cell and tissue source that should be used to produce optimal results. Therefore, this study aimed to assess the efficacy of ultrasound-guided injection of autologous skin-derived, tenocyte-like cells in treating refractory patellar tendinosis.
Qual era a principal questão de investigação?
Was the ultrasound-guided injection of autologous skin-derived, tenocyte-like cells more effective in treating patellar tendinopathy in comparison to injection with plasma alone, assessed at 6 months?
- After 6 months, there was a greater improvement in VISA scores for the cell group (44 +/- 15 to 75 +/- 17) when compared to the plasma group (50 +/- 18 to 70 +/- 14); the mean difference was 8.1 (95% CI, 2.4 to 13.7; P = 0.006).
- The cell group demonstrated significantly faster improvement and a highly significant effect of treatment in comparison to the plasma group, with the between-group difference estimated as 2.5 per unit increase in 1/square-root of time (95% CI, 0.9 to 4.1; P = 0.002).
- In respect to changes in ultrasound appearances, both groups revealed a significant decrease in hypoechogenicity and tear size (both P < 0.05); however, no significant difference was observed for neovascularity (cell group: P = 0.7248; plasma group: P = 0.6508), while a significant decrease in tendon thickness was observed only for the cell group (P = 0.0072).
De que é que me devo lembrar mais?
Ultrasound-guided injection of autologous skin-derived, tenocyte-like cells was more effective in improving pain and function in comparison to control injections with plasma alone.
Como é que isto afectará o tratamento dos meus doentes?
This study suggests that ultrasound-guided injections of skin-derived collagen-producing cells are safe and effective in the short-term for the treatment of patellar tendinopathy. Future research is required to further evaluate the application of this technique, including the number of injections and use in other tendon overuse conditions.
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