Autologous Tenocyte Injections
6th September 2017
By Danielle Santarelli, PhD
Tendons are strong and flexible connective tissues that attach muscles to bones. They are largely comprised of tenocytes (mature tendon cells), tenoblasts (immature tendon cells) and collagen.
Tendon Injury & Tendinopathy
Tendon injuries, especially tears, and tendinopathy are particularly common in sports. Even under normal conditions, injured tendons take a relatively long time to heal. Tendinopathy is essentially caused by an abnormal healing process, abnormal tissue matrix remodelling, or tissue degeneration, and may occur due to overuse or an underlying medical condition. Symptoms include pain, swelling, stiffness and poor functioning. The tendons most often affected are the Achilles (ankle), patellar (knee), rotator cuff (shoulder) and the lateral epicondyle (elbow).
Management and treatment of tendon injuries and tendinopathy is limited. Numerous therapies are available, such as: exercise therapy, surgery, steroid and/or local anaesthetic injections, extracorporeal shock wave therapy, radiofrequency microtenotomy, minimally invasive stripping, dry needling and autologous therapies. Unfortunately, many traditional therapies appear only to be helpful in the short term or simply treat the symptoms and fail to address the underlying biological issues in cases of tendinopathy.
Autologous therapies have gained interest over recent years due to their potential to assist the healing process and promote tissue regeneration. They involve collecting a sample of the patient’s own cells/tissues, growing and processing them in sterile conditions, and then reintroducing them into the affected site. Autologous therapies used to treat tendon conditions include autologous blood injections, platelet-rich plasma and autologous tenocyte therapy.
Autologous Tenocyte Injections
An Australian regenerative medical company (Orthocell Ltd*) has developed an autologous therapy for use in damaged or degenerated tendons that have not responded to traditional treatments. Autologous tenocyte implantation (ATI) involves harvesting a small piece of healthy tendon (such as the patellar tendon) from the patient under local anaesthetic. The biopsy is sent to the laboratory where the tenocytes are isolated and grown (cultured) under carefully regulated, monitored conditions. Approximately 4 - 5 weeks later, the injectable cells are received by the treating doctor and injected into the patient’s affected tendon under ultrasound guidance.
The injected healthy tenocytes will further grow and produce tendon specific growth factors that enhance tissue healing and promote correct tissue regeneration and remodelling. Improvements in symptoms are typically seen within 4 weeks of therapy, with further improvements seen after 3 months. Clinical studies have reported significant, long term improvements in symptoms (i.e. pain), disability, tendon strength and function in chronic rotator cuff tear/tendinopathy, lateral epicondylitis (tennis elbow) and gluteal tendinopathy.
References & Further Reading:
- Maffulli N, Longo UG, Loppini M, Spiezia F and Denaro V. New Options in the Management of Tendinopathy. Open Access J Sports Med. (2010) 1: 29-37. Open access:
- Schulze-Tanzil G, Mobasheri A, Clegg PD, Sendzik J, John T and Shakibaei M. Cultivation of human tenocytes in high-density culture. Histochem Cell Biol (2004) 122(3): 219-228.
- Tendon Regeneration. Orthocell (Accessed online – June 2017): https://www.orthocell.com.au/new-page
- Ackermann PW and Renström P. Tendinopathy in Sport. Sports Health (2012) 4(3): 193-201. Open access:
- Wang AW, Bauer S, Goonatillake M, Breidahl W and Zheng MH. Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete. BMJ Case Rep (2013). Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603857
- Wang A, Breidahl W, Mackie KE, Lin Z, Qin A, Chen J and Zheng MH. Autologous Tenocyte Injection for the Treatment of Severe, Chronic Resistant Lateral Epicondylitis. Am J Sports Med (2013) 41(12): 2925-32. https://www.ncbi.nlm.nih.gov/pubmed/24068695
- Wang A, Mackie K, Breidahl W, Wang T and Zheng MH. Evidence for the Durability of Autologous Tenocyte Injection for Treatment of Chronic Resistant Lateral Epicondylitis. Am J Sports Med (2015) 43(7): 1775-83. https://www.ncbi.nlm.nih.gov/pubmed/25908113
- Bucher TA, Ebert JR, Smith A, Breidahl W, Fallon M, Wang T, Zheng MH and Janes GC. Autologous Tenocyte Injection for the Treatment of Chronic Recalcitrant Gluteal Tendinopathy. Orthop J Sports Med (2017) 5(2): 2325967116688866. Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347438
*Orthocell did not initiate or fund the production of this article.