Tennis elbow, also commonly known as lateral epicondylitis or common extensor tendinosis, is a common musculoskeletal injury in the adult population. Currently, the standard treatment regimen prescribed for this injury involves a combination of rest, physical therapy, bracing and anti-inflammatory medications. If refractory to these conservative measures, platelet-rich plasma has been shown effective. However, in the case of full thickness tears, surgery has remained the only treatment option until now. We present a case report of a 56-year-old man with a diagnosis of a left large full thickness tear and rupture with retraction of his common extensor tendon (CET) following a corticosteroid injection. The patient was treated with microfragmented adipose transfer. He was re-evaluated around 7 weeks and again at 15 weeks post-treatment and demonstrated ultrasound evidence of complete bridging and remodeling of his prior full thickness CET tear and resolution of retraction. This case presents a promising option for patients with full thickness CET tears who would like to refrain from or are unable to have surgery. Further research and possible randomized controlled trials are needed to further assess the full efficacy of microfragmented adipose transfer in the treatment of full thickness CET tears.
Keywords: MFAT; adipose graft; adipose-derived stem cells; common extensor tendon; mesenchymal stem cells; regenerative medicine; tennis elbow; ultrasound guided.
Adipose cells from a patient’s own body fat are one of the best sources of mesenchymal stem cells (MSC) and growth factors that contribute to the generation of collagen protein fibers. MSC’s are versatile cells that can differentiate into a variety of cell types, while collagen is an important component of muscles and tendons, as it provides structure. MSC’s can be harvested from one’s own fat and then used to help supplement the body’s natural repair process of a variety of injured tissues. This case presents a patient with a history of persistent elbow pain caused by a large full-thickness tear and rupture of the common extensor tendon (CET) of the elbow. Full thickness tears are large deep tears that extend across the entirety of the tendon. Generally, partial CET tears of varying severities are some of the most common tendon injuries seen in the elbow and are injuries that historically, are treated with conservative management, such as pain medication, cortisone injection, physical therapy, platelet-rich plasma or surgery once/if conservative interventions fail. Full thickness tears, however, usually require surgery for patients to feel better. In this case, the patient underwent a novel regenerative treatment alternative to surgery, known as microfragmented adipose transfer (MFAT), to repair the torn CET. Fat was harvested from his flanks, was washed and cleaned, then injected into the CET tear of the elbow. He experienced significant improvements in function and pain and tendon healing was documented using ultrasound and MRI imaging. This case supports using MFAT for lateral elbow pain caused by full-thickness CET tears as a novel and significantly less invasive method than surgery. Our case illustrates the need for more research and possible clinical trials evaluating MFAT as a treatment option for common musculoskeletal pathologies.