期刊
JOURNAL OF CACHEXIA SARCOPENIA AND MUSCLE
卷 13, 期 1, 页码 434-442出版社
WILEY
DOI: 10.1002/jcsm.12894
关键词
Advanced therapies; Knee joint; Trauma; PLX-PAD; Regeneration; Inflammation
In this case report, we demonstrate a successful treatment of a chronic quadriceps tendon rupture (QTR) using a synergistic surgical and biological reconstructive approach. The addition of PLX-PAD cells as a local treatment option may be considered in specific cases of chronic QTRs that are not suitable for traditional surgical procedures and have a high risk of treatment failure.
Background Quadriceps tendon ruptures (QTRs) are rare but debilitating injuries, often associated with chronic metabolic conditions or long-term steroid treatment. While the surgical treatment for acute QTRs is described thoroughly, no common strategy exists for the often frustrating treatment of chronic, reoccurring QTRs. The pro-angiogenic and immunomodulatory properties of placenta-derived adherent mesenchymal stromal-like (PLX-PAD) cells have been described to protect musculoskeletal tissues from inflammation and catabolic cytokine migration, yet little is known about the regenerative potential of PLX-PAD cells in repetitively damaged tendon tissue. Case We report the case of an 80-year-old male patient with a chronic three-time QTR of his right knee. The quadriceps tendon was reconstructed applying a conventional suture anchor repair procedure combined with a synthetic mesh augmentation and additional intramuscular and intratendineous PLX-PAD cell injections as an individualized treatment approach. No adverse events were reported, and excellent radiological and functional outcomes with a passive range of motion of 0/0/120 degrees knee extension-flexion were observed at the 12 month follow-up. Gait analysis confirmed restoration of joint motion, including gait speed, deficit in step length, and knee extensor muscle strength (pre-surgery: 0.98 m/s, 40 cm, 42.4 +/- 12.4 N; 9 months post-surgery: 1.07 m/s, 0 cm, 10.4 +/- 18.9 N) as well as hyperextension throughout stance and late swing phases (pre-surgery: -11.2 +/- 0.9 degrees; 9 months post-surgery: -2.7 +/- 1.6 degrees). Postoperative lymphocyte and cytokine analyses from the patient's peripheral blood serum suggested a systemic short-term immunoregulatory reaction with postoperatively increased interleukin (IL)-6 (pre-surgery: 0.79 pg/mL; day 1: 139.97 pg/mL; day 5: 5.58 pg/mL; 9 months: 1.76 pg/mL) and IL-10 (pre-surgery: 0.9 pg/mL; day 1: 1.21 pg/ mL; day 5: 0.3 pg/mL; 9 months: 0.34 pg/mL) levels that decreased again over time. Conclusions Herein, we demonstrate a successfully treated chronic QTR with a synergistic surgical and biological reconstructive treatment approach. This local add-on treatment with PLX-PAD cells may be considered in specific cases of chronic QTRs, not susceptible to traditional suture anchor procedures and which exhibit a high risk of treatment failure. Further scientific engagement is warranted to explore underlying immunomodulatory mechanisms of action behind PLX-PAD cell treatment for tendon injuries.
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