2015 ISAKOS Biennial Congress ePoster #503

Evidence of Long Term Durability on Autologous Tenocyte Injection for Treatment of Chronic Lateral Epicondylitis

Allan Wang, FRACS, PhD, FAOrthA, Dalkeith, western australia AUSTRALIA
Bill Breidahl, Perth, Western Australia AUSTRALIA
Katherine Mackie, PhD, Perth, WA AUSTRALIA
Timothy Ackland, PhD, FASMF, Perth, WA AUSTRALIA
Ming-Hao Zheng, PhD, DM, FRCPath, FRCPA, Crawley, WA AUSTRALIA
University of Western Australia, Perth, WA, AUSTRALIA

FDA Status Not Applicable

Summary: Autologous tenocyte injection (ATI) by single injection significantly improved both clinical function and MRI tendinopathy scores at the 3 year follow up in patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of conservative treatment.

Abstract:

Introduction

& aims- Chronic lateral epicondylitis is associated with degenerative tendon changes, extracellular matrix breakdown and tendon cell loss. Previously we reported a pilot study on 12 month followup of ATI for severe tendinopathy associated with chronic lateral epicondylitis (Wang et al AJSM 2013). Here we provide an update on long term followup over 36 months on the efficacy of ATI.

Method

-Patients with severe refractory lateral epicondylitis underwent clinical evaluation and MRI prior to intervention. A patellar tendon needle biopsy was performed under local anaesthetic and tendon cells expanded by in vitro culture in a GMP-certified TGA-licensed facility. Autologous tenocytes were injected into the tendinopathy identified at the common extensor tendon origin under ultrasound guidance on a single occasion. Patients underwent serial clinical evaluations for up to 5 years after intervention. Repeat MRI scanning was performed at 1 year and latest time of at least 3 year after treatment.
Results- Twenty patients, eleven males and nine females (mean age 49.4 years) were included in the study. Three patients withdrew consent prior to ATI. The average symptoms duration prior to study recruitment was 31 months (range 6-240 months). The mean follow-up time at final assessment was 4.51 years (range 3.1-5.2 years). No complications were observed at the patellar tendon biopsy site for any patient. No adverse events, infection or excessive fibroblastic reactions were observed in any patient at the injection site. One patient elected to proceed to surgery three months after ATI following re-injury at work and one patient died of natural causes during the follow-up period. In the remaining 15 patients, clinical evaluation revealed improvement in mean visual analogue scale for maximum pain score from 5.73 at initial assessment to 1.21 at final follow-up (p<0.001). Mean QuickDASH score and grip strength scores also significantly improved over the follow-up period (mean percentage improvements were 84% and 207% respectively; p<0.001). Using a validated MRI scoring system, the grade of tendinopathy at the common extensor origin improved significantly by 12 months (p=<0.001), and these results were maintained to final follow-up.
Conclusions- ATI by single injection significantly improved both clinical function and MRI tendinopathy scores at the 3 year follow up in patients with chronic lateral epicondylitis who had previously undergone an unsuccessful full course of conservative treatment. This study provides evidence of long term durability of ATI for treatment of tendinopathy.