Effect of Umbilical Cord-Mesenchymal Stem Cells (UC-MSCs) Derived Secretome Combined with UC-MSCs in Anterior Cruciate Ligament Tear: A Case Report
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Published:
Dec 24, 2025
Keywords:
ACL tear; UC-MSCs; secretome; pain; ligament
Main Article Content
Abstract
Introduction: Anterior cruciate ligament (ACL) tears are common in athletes and active individuals, often requiring surgical reconstruction in grade 3 (complete) cases. Emerging regenerative approaches using mesenchymal stem cells (MSCs) and their secretome offer potential alternatives to surgery.
Case: A male amateur futsal player in his 30s sustained a complete ACL tear with associated meniscal injury. He reported knee instability and severe pain (Numeric Pain Rating Scale [NPRS] score of 7). MRI confirmed a grade 3 ACL tear. The patient declined surgical intervention.
Intervention: Treatment included periarticular trigger-point injection of 1.5?mL UC-MSC-derived secretome, followed later by intra-articular injection of 1×10? UC-MSCs suspended in 3?mL saline and 1.5?mL secretome. A structured home-based rehabilitation program and biomechanical correction using insoles were provided.
Results: Pain improved from an NPRS score of 7 to 0 within six months. The patient returned to sport, reporting minimal residual instability. Follow-up MRI showed restored ACL continuity. No adverse events occurred.
Conclusion: This case highlights the potential of UC-MSCs and secretome combination therapy as a non-invasive alternative for ACL repair. Further research is needed to validate its clinical efficacy and long-term safety.
Case: A male amateur futsal player in his 30s sustained a complete ACL tear with associated meniscal injury. He reported knee instability and severe pain (Numeric Pain Rating Scale [NPRS] score of 7). MRI confirmed a grade 3 ACL tear. The patient declined surgical intervention.
Intervention: Treatment included periarticular trigger-point injection of 1.5?mL UC-MSC-derived secretome, followed later by intra-articular injection of 1×10? UC-MSCs suspended in 3?mL saline and 1.5?mL secretome. A structured home-based rehabilitation program and biomechanical correction using insoles were provided.
Results: Pain improved from an NPRS score of 7 to 0 within six months. The patient returned to sport, reporting minimal residual instability. Follow-up MRI showed restored ACL continuity. No adverse events occurred.
Conclusion: This case highlights the potential of UC-MSCs and secretome combination therapy as a non-invasive alternative for ACL repair. Further research is needed to validate its clinical efficacy and long-term safety.
Article Details
How to Cite
Mulyo, A., Qlintang, S., Harry Murti, Lubis, V. K., Sihombing, I. N. N., Fatimah, A., & Nabila, M. (2025). Effect of Umbilical Cord-Mesenchymal Stem Cells (UC-MSCs) Derived Secretome Combined with UC-MSCs in Anterior Cruciate Ligament Tear: A Case Report. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 245 - 251. https://doi.org/10.36803/indojpmr.v14i2.493
Section
Case Report
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References
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13. Kanaya A, Deie M, Adachi N, et al. Intra-articular injection of mesenchymal stromal cells in partially torn anterior cruciate ligaments in a rat model. Arthroscopy 2007; 23: 610–617.
14. Sun Y, Chen W, Hao Y, et al. Stem Cell-Conditioned Medium Promotes Graft Remodeling of Midsubstance and Intratunnel Incorporation After Anterior Cruciate Ligament Reconstruction in a Rat Model. Am J Sports Med 2019; 47: 2327–2337.
15. Gao F, Chiu SM, Motan D a. L, et al. Mesenchymal stem cells and immunomodulation: current status and future prospects. Cell Death Dis 2016; 7: e2062.
16. Jenkins SM, Guzman A, Gardner BB, et al. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15: 170–179.
17. Crenshaw K, Fritz S, Fryer G, et al. Muscle Energy Technique. 3rd ed. Elsevier Limited, 2006.
18. Srinivasan M, Lam C, Alm J, et al. Trigger Point Injections. Physical Medicine and Rehabilitation Clinics 2022; 33: 307–333.
19. Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, et al. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther 2021; 27: 597–604.
2. Anand S. Best Practice for Management of Anterior Cruciate Ligament (ACL) Injurie, https://www.boa.ac.uk/static/88a4c3e3-df3e-4e51-a92e7d2f86d7d82a/Best-Practice-Book-for-management-of-Anterior-Cruciate-Ligament-injuries.pdf (2003).
3. Shom P, Varma AR, Prasad R. The Anterior Cruciate Ligament: Principles of Treatment. Cureus 2023; 15: e40269.
4. Ahmad Z, Wardale J, Brooks R, et al. Exploring the Application of Stem Cells in Tendon Repair and Regeneration. Arthroscopy 2012; 28: 1018–1029.
5. Vizoso FJ, Eiro N, Cid S, et al. Mesenchymal Stem Cell Secretome: Toward Cell-Free Therapeutic Strategies in Regenerative Medicine. Int J Mol Sci 2017; 18: 1852.
6. Rhatomy S, Prasetyo TE, Setyawan R, et al. Prospect of stem cells conditioned medium (secretome) in ligament and tendon healing: A systematic review. Stem Cells Transl Med 2020; 9: 895–902.
7. Yea J-H, Kim Y, Jo CH. Comparison of mesenchymal stem cells from bone marrow, umbilical cord blood, and umbilical cord tissue in regeneration of a full-thickness tendon defect in vitro and in vivo. Biochem Biophys Rep 2023; 34: 101486.
8. Marotta N, de Sire A, Calafiore D, et al. Impact of COVID-19 Era on the Anterior Cruciate Ligament Injury Rehabilitation: A Scoping Review. J Clin Med 2023; 12: 5655.
9. Amini M, Venkatesan JK, Nguyen TN, et al. rAAV TGF-? and FGF-2 Overexpression via pNaSS-Grafted PCL Films Stimulates the Reparative Activities of Human ACL Fibroblasts. Int J Mol Sci 2023; 24: 11140.
10. Uchida R, Horibe S, Nakamura N. Stem cell-based therapy in anterior cruciate ligament repair. Annals of Joint; 2. Epub ahead of print 30 November 2017. DOI: 10.21037/aoj.2017.11.03.
11. Zou J, Yang W, Cui W, et al. Therapeutic potential and mechanisms of mesenchymal stem cell-derived exosomes as bioactive materials in tendon-bone healing. J Nanobiotechnology 2023; 21: 14.
12. Wu J, Wu J, Liu Z, et al. Mesenchymal stem cell-derived extracellular vesicles in joint diseases: Therapeutic effects and underlying mechanisms. J Orthop Translat 2024; 48: 53–69.
13. Kanaya A, Deie M, Adachi N, et al. Intra-articular injection of mesenchymal stromal cells in partially torn anterior cruciate ligaments in a rat model. Arthroscopy 2007; 23: 610–617.
14. Sun Y, Chen W, Hao Y, et al. Stem Cell-Conditioned Medium Promotes Graft Remodeling of Midsubstance and Intratunnel Incorporation After Anterior Cruciate Ligament Reconstruction in a Rat Model. Am J Sports Med 2019; 47: 2327–2337.
15. Gao F, Chiu SM, Motan D a. L, et al. Mesenchymal stem cells and immunomodulation: current status and future prospects. Cell Death Dis 2016; 7: e2062.
16. Jenkins SM, Guzman A, Gardner BB, et al. Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations. Curr Rev Musculoskelet Med 2022; 15: 170–179.
17. Crenshaw K, Fritz S, Fryer G, et al. Muscle Energy Technique. 3rd ed. Elsevier Limited, 2006.
18. Srinivasan M, Lam C, Alm J, et al. Trigger Point Injections. Physical Medicine and Rehabilitation Clinics 2022; 33: 307–333.
19. Farazdaghi M, Kordi Yoosefinejad A, Abdollahian N, et al. Dry needling trigger points around knee and hip joints improves function in patients with mild to moderate knee osteoarthritis. J Bodyw Mov Ther 2021; 27: 597–604.