Tenocyte Treatment Research

Treatment Procedure

• Small biopsy taken from a healthy tendon (patellar tendon)
• Patient’s own tendon cells were cultured in a laboratory
• Cells were later injected back into the damaged shoulder tendons
• Injections performed under ultrasound guidance
• Cells injected into:

• Supraspinatus tendon
• Long head of the biceps tendon

Followed by structured physiotherapy

Cell Type Used

• Autologous tenocytes (mature tendon cells)
• Cells came from the patient’s own tendon tissue

How Cells Were Prepared

• Tendon biopsy taken from a healthy patellar tendon
• Cells expanded in culture for approximately 4–5 weeks
• Cells assessed for morphology and quality before implantation
• Standard blood screening performed (infection and viral safety)

Full Results and Clinical Outcomes

• Significant reduction in shoulder pain
• Return to normal daily activities (gardening, sleeping without pain)
• Return to sport (golf) and strength activities (push-ups)
• Sustained improvement at 12-month follow-up

MRI findings showed:

• Reduced bursitis
• Resolution of muscle edema
• No progression to tendon rupture

How the Cells Were Thought to Work

The authors suggest the tenocytes worked by repopulating the damaged tendon with healthy tendon cells, supporting better collagen organization and tendon repair

Safety

• No serious adverse events reported
• Procedure was well tolerated
• Minimal post-procedure discomfort

What We Don’t Know

• This was a single-patient case, so results cannot be generalized
• No control group to compare against placebo or standard care
• Cannot separate how much improvement came from cells versus rehabilitation
• Long-term durability beyond one year remains uncertain

Key Limitations

• Single case report (lowest level of clinical evidence)
• Not randomized or blinded
• Designed to show feasibility and safety, not proof of effectiveness

Treatment Procedure

• Small biopsy taken from the patient’s patellar tendon under ultrasound guidance
• Patient’s own tendon cells were cultured in a laboratory
• Approximately four weeks later, a single injection was performed
• Cells were injected directly into the gluteal tendon under ultrasound guidance

Cell Type Used

• Autologous tenocytes (mature tendon cells)
• Cells derived from the patient’s own tendon tissue

How Cells Were Prepared

• Tendon tissue was treated with enzymes to separate and collect the tendon cells
• The tenocytes were grown and multiplied in the laboratory at a TGA-licensed GMP facility that follows strict safety and quality rules
• Standard blood tests were carried out to check for infections and viruses before the cells were used
• The cells were tested using real-time PCR to confirm they produced tendon-related growth factors, including:

• platelet-derived growth factor alpha (PDGF-α)
• fibroblast growth factor beta (FGF-β)
• transforming growth factor beta (TGF-β)

Full Results and Clinical Outcomes

• Significant reduction in hip pain scores
• Meaningful improvement in hip function and daily activities
• Improvements evident by 6–12 months and maintained at 24 months
• Most patients reported satisfaction with the outcome

MRI Findings

• No statistically significant group-level structural tendon improvement on MRI
• Some individual cases showed imaging improvement, but this was not consistent across patients

How the Cells Were Thought to Work

The authors suggest that the injected tenocytes may help repair the tendon by replacing missing or damaged tendon cells and releasing tendon-specific growth factors that help maintain collagen and support normal tendon healing.

Safety

• No infections or serious adverse events reported
• Mild, short-term discomfort at the biopsy site in some patients
• No long-term complications related to the procedure

What We Don’t Know

• No control group to compare against placebo or standard care
• Small patient number limits certainty of effectiveness
• MRI may not reliably reflect tendon recovery after cell-based treatments

Key Limitations

• Prospective case series (Level 4 evidence)
• Not randomized or blinded
• Designed to assess safety and early clinical signal, not to prove efficacy

Treatment Procedure

• Small tendon biopsy taken from the palmaris longus tendon during arthroscopy
• Patient’s own tendon cells were cultured in a laboratory
• Approximately 5–7 weeks later:

• 5 million autologous tenocytes were injected
• Injection performed under ultrasound guidance
• Cells were placed directly into the damaged subscapularis tendon

Cell Type Used

• Autologous tenocytes
• Mature tendon cells taken from the patient’s own tendon tissue

How Cells Were Prepared

• Tendon tissue was harvested surgically
• Cells were expanded in laboratory culture
• Manufacturing performed under Australian Therapeutic Goods Administration (TGA) clinical manufacturing standards
• Mandatory blood screening performed before treatment to rule out infection

Full Results and Clinical Outcomes

• Shoulder internal rotation strength returned close to pre-injury baseline
• Pain reduced significantly during swimming and daily activity
• Athlete returned to:

• Full training without pain
• International-level competition within ~4 months

MRI Findings

• Three independent, blinded radiologists reviewed scans
• MRI showed:

• Marked reduction in tendon tear size
• Improved tendon structure and appearance
• Two of three radiologists judged the tear as completely healed

How the Cells Were Thought to Work

The authors suggest the injected tenocytes supported tendon repair by restoring healthy tendon cells within the damaged tissue and promoting improved tendon structure.

Safety

• No infections or serious adverse events reported
• Mild, short-term shoulder discomfort after injection
• No long-term complications from biopsy or injection

What We Don’t Know

• No comparison to placebo, surgery, or standard care
• Cannot separate the effect of tenocyte therapy from rehabilitation with certainty
• Findings from one athlete may not apply to non-athletes or the general population

Key Limitations

• Single-patient case report (Level 4 evidence)
• Not randomized or controlled
• Designed to explore feasibility and biological signal, not to prove effectiveness

Study Type

• Human case series
• Level 4 evidence
• Long-term follow-up (up to 5 years)

Treatment Procedure

• Small needle biopsy taken from the patellar tendon under local anesthetic
• Tendon cells grown in laboratory culture
• Single ultrasound-guided injection performed
• Cells injected directly into the diseased portion of the elbow tendon

Cell Type Used

• Autologous tenocytes
• Mature tendon cells taken from the patient’s own tendon tissue

How Cells Were Prepared

• Tendon tissue obtained by needle biopsy
• Tendon cells expanded in laboratory culture
• Cells were re-implanted after laboratory expansion
• Single injection per patient

Full Results and Clinical Outcomes

• Pain scores improved by 78% on average
• Arm and hand function scores improved by 84%
• Grip strength increased by over 200%
• Improvements at 1 year were maintained at final follow-up

MRI Findings

• MRI scans performed at baseline, 1 year, and final follow-up
• Tendinopathy severity scores improved significantly by 1 year
• Structural tendon improvement was maintained at 4–5 years
• No evidence of tendon deterioration over time

Patient Satisfaction

• 93% of patients reported being satisfied or highly satisfied with treatment

How the Cells Were Thought to Work

The authors suggest that injecting a patient’s own cultured tendon cells into the damaged tendon helped replace missing or damaged tendon cells and supported the tendon’s ability to heal and stay healthier over time.

Safety

• No infections reported
• No serious adverse events
• No excessive fibroblastic or abnormal tissue reactions
• No complications at the tendon biopsy site

What We Don’t Know

• No comparison to placebo, surgery, PRP, or standard care
• Cannot definitively rule out contribution from natural healing or rehabilitation

Key Limitations

• Small sample size
• Case series design (no control group)
• Designed to assess durability and biological signal, not to prove superiority

What they’re trying to find out

• Whether injecting a patient’s own cultured tendon cells improves:

• Pain
• Physical function
• Tendon structure seen on MRI

• Whether this approach is safe
• Whether it could be a useful option when standard treatments fail

How the cells were prepared

• A small piece of healthy tendon was taken from the patient
• The tendon cells (tenocytes) were:

• Isolated
• Grown in a laboratory for 3–7 weeks

• The cultured tenocytes were then:

• Injected back into the damaged tendon
• Usually under ultrasound guidance

• The review does not report specific cell surface markers
• The number of injected cells, culture duration, and injection volume varied between studies

What they found

1. Pain

• All studies reported pain reduction
• Most improvement occurred within:

• First 3–6 months

• Pain relief generally:

• Continued up to 12 months

• One long-term study showed:

• Mild symptom worsening after several years
• Pain did not return to pre-treatment levels

2. Function

• Patients showed improvements in:

• Arm and shoulder use
• Grip strength
• Hip function (for gluteal tendinopathy)

• Functional improvements closely followed pain reduction and were:

• Noticeable within months
• Largely maintained over time in most patients

3. MRI (tendon structure)

• Mixed results
• Some studies showed:

• Reduced tendon thickening
• Reduced abnormal signal on MRI
• Partial tear healing

• One study found:

• Clear symptom improvement
• No obvious structural change on MRI

4. Safety

• No serious adverse events
• Mild pain at biopsy site in a few patients
• No reported:

• Infections
• Immune reactions
• Tendon ruptures

• Overall safety profile was favorable

Limitations across studies

• Very small patient numbers
• No control or placebo groups
• All studies from one country
• Different:

• Injection protocols
• Cell culture times
• Outcome measures

• Imaging improvement did not always match symptom improvement
• High cost and long preparation time compared to other injections

What they concluded

• Autologous tenocyte injection may help reduce pain and improve function in chronic tendon conditions
• It appears safe based on current evidence
• It should be considered a second-line option when standard treatments fail
• Current evidence is weak and preliminary
• Stronger evidence is needed, including:

• Controlled trials
• Larger patient groups
• Studies from multiple countries
• Standardized protocols and outcome measures