title: Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up.
abstract: OBJECTIVE
  Although platelet-rich plasma (PRP) injection has shown controversial results for the treatment of Achilles tendinopathy, it remains the most used biological treatment. Recent findings seem to demonstrate that the stromal vascular fraction (SVF) within adipose tissue may counteract the impaired tendon homeostasis. The aim of this study was to prospectively compare the efficacy of PRP and SVF injection for the treatment of non-insertional Achilles tendinopathy.
  
  
  METHODS
  Fourty-four patients were recruited in the study; 23 of them were assigned to the PRP group whereas 21 to the SVF group, treated unilaterally or bilaterally for a total of 28 tendons per group. All patients (age 18-55 years) were clinically assessed pre-operatively and at 15, 30, 60, 120 and 180 days from treatment, using the VAS pain scale, the VISA-A, the AOFAS Ankle-Hindfoot Score and the SF-36 form. The patients were also evaluated by ultrasound and magnetic resonance before treatment and after 4 (US only) and 6 months.
  
  
  RESULTS
  Both treatments allowed for a significant improvement with respect to baseline. Comparing the two groups, VAS, AOFAS and VISA-A scored significantly better at 15 and 30 days in the SVF in comparison to PRP group (p < 0.05). At the following time points the scores were not significantly different between the two groups. No correlation has been found between clinical and radiological findings.
  
  
  CONCLUSIONS
  Both PRP and SVF were safe, effective treatments for recalcitrant Achilles tendinopathy. The patients treated with SVF obtained faster results, thus suggesting that such a treatment should be taken into consideration for those patients who require an earlier return to daily activities or sport.
  
  
  METHODS
  Randomized Controlled Clinical Trial, Level 1.
authors.affiliation: CASCO Department, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy. fusuelli@gmail.com.
authors.forename: Federico Giuseppe
authors.initials: FG
authors.lastname: Usuelli
authors.affiliation: USPeC, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Grassi
authors.affiliation: CASCO Department, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.|Universita' degli Studi di Milano, Milano, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Maccario
authors.affiliation: Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Vigano'
authors.affiliation: Plastic Surgery Department, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Lanfranchi
authors.affiliation: USPeC, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Alfieri Montrasio
authors.affiliation: Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: de Girolamo
mesh_terms: D000125:Achilles Tendon; D000273:Adipose Tissue / Q000166:cytology*; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation / Q000379:methods*; D008875:Middle Aged; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D012038:Regeneration; D013177:Sports; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: Achilles tendinopathy; Achilles tendon; Adipose-derived mesenchymal stem cells; PRP; Stromal vascular fraction (SVF)