2017 ISAKOS Biennial Congress ePoster #415


Clinical Outcomes And Tendon Healing After Autologous Tendon Cell Implantation For Chronic Resistant Lateral Epicondylitis: A Mean 4.5 Year Outcome Study

Allan Wang, FRACS, PhD, FAOrthA, Perth, WA AUSTRALIA
Bill Breidahl, Perth, Western Australia AUSTRALIA
Katherine Mackie, PhD, Perth, WA AUSTRALIA
Ming-Hao Zheng, PhD, DM, FRCPath, FRCPA, Crawley, WA AUSTRALIA

Department of Orthopaedic Surgery, University of Western Australia, Perth, Western Australia, AUSTRALIA

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Orthocell, Autologous tenocyte preparation


In severe chronic lateral epicondylitis, injection of autologous tenocytes to the common extensor tendon origin under ultrasound guidance results in durable tendon healing ,with significant improvement in MRI tendon scores and clinical function scores at mid-term followup.



In chronic lateral epicondylitis (LE), apoptosis and autophagy lead to the loss of functional tendon cells in the common extensor tendon origin. Our previous study has shown that ultrasound guided injection of autologous tenocytes to the injured tendon in patients with severe and chronic LE improved pain, function and structural tendon healing at one year after intervention. In this study we hypothesize that significant improvements in clinical function and tendon healing after autologous tenocyte injection (ATI) will be maintained at mid term followup.


A prospective study of subjects with severe chronic LE unresponsive to conservative treatment was performed. Autologous tenocytes were harvested by patella tendon biopsy, expanded in vitro, then injected into the LE lesion under ultrasound guidance on a single occasion. Clinical evaluation was performed and structural tendon healing evaluated using a validated MRI tendon scoring protocol pre ATI, and at one year and at mid term followup following intervention.


This study included 16 subjects aged between 37 and 63 years (mean 47 years). The mean duration of symptoms at study recruitment was 29 months. Following ATI, one subject elected to proceed to epicondylitis surgery, due to a re-injury. The mean followup for the remaining 15 subjects was 4.5 years (range 3.1 to 5.2 years). No adverse events were observed in any subject at the tendon biopsy site or injection site. Clinical evaluation revealed significant improvements (p<0.01) from pre ATI to final followup in mean VAS pain score (5.73 to 1.21), mean quick DASH scores (45.88 to 6.61), and Jamar grip strength (19.85kg to 46.6kg). MRI evaluation indicated the mean tendonosis and tendon tear scores at the common extensor origin improved significantly (p<0.01) from pre ATI to one year and to final followup.


ATI significantly improved MRI and clinical function scores for up to 5 years in subjects with severe chronic LE who had previously undergone unsuccessful non surgical treatment. This study provides evidence for the mid term durability of ATI in the treatment of severe lateral epicondylitis.