A phase 1 study to evaluate the potential role of mesenchymal stem cells in the treatment of chronic refractory tendinopathy
- Conditions
- Chronic Refractory TendinopathyMusculoskeletal - Other muscular and skeletal disorders
- Registration Number
- ACTRN12610000985088
- Lead Sponsor
- MMRI
- Brief Summary
Not available
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Recruiting
- Sex
- All
- Target Recruitment
- 9
1. Male or female from 40 to 75 years of age.
2. Clinical diagnosis of mid-substance Achilles tendonopathy based on clinical assessment, including painful arc sign and The London Hospital Test.
3. Symptoms of Achilles tendonopathy for at least 18 months.
4. Power Doppler Ultrasound confirmation of diagnosis of Achilles tendonopathy by independent specialist musculoskeletal radiologist. The tendonopathy must be maximal within the mid-portion of the tendon (2-7cm from insertion), and must not involve the tenoperiosteal (insertion) or musculo-tendonous junctions.
6. Victorian Institute of Sport Assessment Score (VISA-A Questionnaire) of less than or equal to 55.
7. Previous treatment for Achilles tendonopathy from an Australian Registered Specialist Medical Practitioner relevant to the condition - Orthopaedic Surgeon, Rheumatologist, Sports Physician or Rehabilitation Physician.
8. Completion of medical specialist prescribed, Achilles exercise program for at least 4 days per week for 8 weeks. After which, VISA-A score must still be less or equal to 55.
9. Competency to understand the information given in the Human Research and Ethics Committee (HREC) approved Achilles tendonopathy Participant Information Sheet, and must sign the consent form prior to the initiation of any study procedures.
1. Insertional Achilles tendonopathy, or muscle-tendon junction tendonopathy, as defined by an ultrasound scan.
2. Persisting full thickness tendon defect (e.g. full thickness tear which would not provide tendon construct.)
3. Evidence of underlying inflammatory or rheumatological disorder.
4. Calcific tendonopathy, or other abnormal tissue within the mid-portion of the Achilles tendon. (Note ectopic calcification, at the Achilles tendon insertion on the calcaneus would not constitute an exclusion criteria).
5. Tendonopathy associated with or aggravated by the recent use of medication known to cause tendonopathy (e.g. Fluoroquinones)
6. Either Achilles surgery within previous 6 months, or persistence of non-dissolving surgical material (e.g. sutures visible on ultrasound).
7. Local injection of corticosteroid or potential growth factors (e.g. Autologous Blood or Platelet Rich Plasma) within previous 3 months of potential MSC injection.
8. Recent use of oral corticosteroids within 3 months of potential MSC injection.
9. Inability to perform, or poor compliance to undertake, an exercise rehabilitation program. This will include assessment for co-existing conditions (e.g. osteoarthritis of the knee/ankle).
10. Bilateral tendonopathy whereby the principal investigator believes disease on the contralateral side may affect ability to undertake rehabilitation exercise program.
11. Requirement to take oral anti-inflammatories (including Aspirin).
12. Use of anticoagulant medication (e.g. Warfarin).
13. History of malignancies within the past 5 years, with the exception of squamous or basal cell carcinoma of the skin or successfully treated in situ carcinoma of the cervix.
14. Female who is of child-bearing potential .
15. Known history of alcohol abuse within 1 year of enrolment.
16. Co-morbid condition or illness limiting life expectancy to < 1 year at time of screening.
17. Serious or active medical or psychiatric illness which, in the opinion of the Investigator, would interfere with treatment, assessment or compliance with the protocol.
18. Allergy to all available antiseptics or local anaesthetics.
19. Positive serology for any of the following: HIV1, HIV2, HTLV1, HTLV2, Hepatitis B, Hepatitis C, or Syphilis (VDRL).
20. Abnormal haematology and biochemistry profiles. Abnormal profiles will be defined with respect to the normal laboratory ranges. Any measurement up to and including 5% variation of the normal laboratory ranges will be repeated after 1 week. If the abnormality persists, then the subject will be referred to their treating General Practitioner. If both the GP and the PI determine that the abnormality is of no clinical significance, then the subject will be able to re-enter the trial. Any subject with a laboratory measurement above 5 % from the normal range will not be able to enter trial and will be referred to their GP
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method The primary objective of this study is to establish the feasibility and safety of precision local injections of allogeneic MSCs, from unrelated donors, in the treatment of chronic refractory degenerative Achilles tendonopathy.<br><br>This will be assessed by no evidence of acute toxicity within the first four hours following injection, adverse events, VISA score assessments and ultrasound assessment of the tendon[2 weeks, 4 weeks, 10 weeks and 26 weeks]
- Secondary Outcome Measures
Name Time Method The secondary objective is to document changes in related signs, symptoms, function, and radiological parameters, following precision intratendonous injection of MSCs, over a six month evaluation period.<br><br>This wll be assessed be VISA-A score assessments and ultrasound assessment of the tendon[2 weeks, 4 weeks, 10 weeks and 26 weeks]