Patellar Tendon Structural Changes after BM-MSC and Lp-PRP Treatments: A Double-Blind Clinical Trial
Patellar tendinopathy, commonly affecting athletes, is marked by pain and degeneration in the patellar tendon. While various treatments exist, finding effective therapies that offer long-term structural improvement remains challenging. A recent clinical study by Silvia Ortega-Cebrián, Robert Soler-Rich, Lluis Orozco and Gil Rodas highlights the role of Ultrasound Tissue Characterization (UTC) in evaluating two promising therapies for patellar tendinopathy: bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP). The study demonstrates how UTC can objectively measure structural changes, providing a precise assessment of treatment effectiveness.
Study Overview: A Rigorous Approach to Comparing Treatments
This double-blinded, randomized controlled trial involved 20 male patients diagnosed with patellar tendinopathy. The participants received either BM-MSC or Lp-PRP treatments, and were assessed at intervals of 3, 6, and 12 months post-treatment. By using UTC Imaging, researchers captured detailed 3D views of the patellar tendon to track tissue changes across three critical areas:
- Insertion
- Proximal
- Mid-tendon
Unlike traditional ultrasound, UTC imaging provides a more comprehensive, quantified view of the tendon’s internal structure, allowing researchers to evaluate collagen organization, tissue regeneration, and degeneration with high precision.
What Makes UTC imaging Unique?
UTC imaging goes beyond standard ultrasound by using advanced algorithms to categorize tendon tissue into four distinct echo-types, which represent different states of tissue health:
- Type I (Green): Healthy, aligned collagen fibers
- Type II (Blue): Less organized fibers found in healing or scar tissue
- Type III (Red): Disorganized fibers, often indicating lesions or overstrain
- Type IV (Black): Fluid-filled spaces, showing a lack of structural integrity
This color-coded, quantitative assessment provides clinicians with a clear view of tendon composition, enabling an objective measure of healing progress or degeneration.
Key Findings: BM-MSC Outperforms Lp-PRP
- Better Tendon Organization with BM-MSC
- Patients treated with BM-MSC showed significant improvements in tendon structure compared to those receiving Lp-PRP. UTC scans revealed a reduction in disorganized Type II and Type III fibers in the BM-MSC group, indicating healthier collagen organization.
- In the Lp-PRP group, higher levels of disorganized fibers (Type II and III) were observed, especially in the mid-tendon area, as early as 3 months after treatment. These findings suggest that BM-MSC promotes more effective tissue regeneration than Lp-PRP.
- Pain Reduction and Enhanced Strength
- Both pain levels and strength showed notable improvement in the BM-MSC group. Patients reported less discomfort and greater functionality, suggesting a more comprehensive recovery process.
- UTC’s objective data on structural changes complemented these clinical results, reinforcing BM-MSC as a superior option for restoring both function and tendon health.
- Long-Term Healing Tracking with UTC Imaging
- By capturing 3D images at multiple intervals (3, 6, and 12 months), UTC imaging provided a unique, longitudinal view of healing progress. This allowed clinicians to observe gradual, consistent improvements in tendon health over time in the BM-MSC group, which were sustained across all follow-up points.
Copyright by the authors
Ultrasound tissue characterization of the proximal tendon. Resection of the crossed sectional area at 20% tendon length. Color green, blue, red and black correspond to echo-type I, II, III, and IV respectively.
Clinical Implications of UTC imaging
This study highlights the invaluable role of UTC imaging in both research and clinical settings for tendon health assessment. By offering precise, data-driven insights, UTC supports better decision-making in tendon treatment. Some key clinical benefits of UTC Imaging include:
- Objective, Quantitative Data: UTC imaging produces clear metrics on tissue health, allowing clinicians to make informed, data-driven treatment decisions.
- Early Detection of Structural Changes: The sensitivity of UTC imaging enables early detection of improvements or degeneration, allowing for timely adjustments in treatment or rehabilitation protocols.
- Personalized Treatment Guidance: UTC imaging helps tailor treatment by providing detailed insights into different tendon regions, enabling clinicians to customize strategies for optimal patient outcomes.
Conclusion: UTC imaging as a Game-Changer in Tendon Therapy
The use of UTC imaging in this study demonstrates its potential to redefine tendon diagnosis and treatment. By providing clear, quantifiable data on tendon structure, UTC enables a more personalized and effective approach to treating conditions like patellar tendinopathy. In this trial, BM-MSC showed superior benefits in enhancing tendon organization, reducing pain, and restoring strength, as validated by UTC’s detailed imaging.
As UTC imaging becomes more integrated into clinical practice, it promises to advance diagnostic accuracy and improve treatment outcomes for tendon injuries. For clinicians and researchers alike, UTC offers a powerful tool for delivering better patient care and supporting innovative therapies in tendon rehabilitation.
Publication:
Evaluation of Patellar Tendon Structural Changes following Biological Treatments: Secondary Analysis of Double-Blinded Clinical Trial of Bone Marrow Mesenchymal Stromal Cells and Leukocyte-Poor Platelet-Rich Plasma
by Authors: Silvia Ortega-Cebrián, Robert Soler-Rich, Lluis Orozco, Gil Rodas
Publisher: Biomedicines. 2024 Jul 18;12(7):1599. doi: 10.3390/biomedicines12071599.
PMID: 39062172
LINK: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11275081/
Abstract
Objective quantification of tendon structural changes through imaging is only achieved by evaluating tendon structure using ultrasound tissue characterization (UTC) technology.
This study compares the effects of bone marrow mesenchymal stromal cells (BM-MSC) and leukocyte-poor platelet-rich plasma (Lp-PRP) on tendon structure and clinical outcomes in male patients with patellar tendinopathy measured with UTC at 3, 6, and 12 months after treatment.
This is a double-blinded clinical trial with a randomized active control study with 20 male patients diagnosed with patellar tendinopathy who underwent BM-MSC and Lp-PRP. Bilateral ultrasound tissue characterization scans of the patellar tendon were carried out after 3, 6, and 12 months, as well as tests for strength and pain.
UTC patellar tendon was analyzed at the insertion, proximal, and mid-tendon. BM-MSC showed a greater capacity to promote further positive changes than Lp-PRP. Lp-PRP presented higher disorganized echo-type II in the mid-tendon (p = 0.04; ES = 1.06) and III (p = 0.02; ES = -1.47) after 3 months in the Lp-PRP group.
Similar results were seen after 6 and 12 months. Pain and strength data show improvement in the treated tendon. BM-MSC treatment demonstrates a superior capacity to promote tendon regeneration and organization, restore strength, and reduce pain compared to Lp-PRP, after 3, 6, and 12 months in male patients with patellar tendinopathy.
Keywords: imaging; patellar tendon; tendinopathy.