Vol. 5 (2021): International Journal of Case Reports
Case Reports

Autologous Tenocyte Implantation (ATI) and the Use of Collagen Scaffolds: a Case Report of a Novel Surgical Treatment for Gluteal Tendon Repair

John M O’Donnell1,2, Rowan Flanagan3, Jane Fitzpatrick4,5
1Hip Arthroscopy Australia, Richmond, Australia; 2Swinburne University, Melbourne, Australia; 3The Northern Hospital, Melbourne, Australia; 4Centre for Health and Exercise Sports Medicine, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; 5Joint Health Institute Ltd, Melbourne, Australia


  • Lateral hip pain, gluteal tendinopathy, greater trochanteric pain syndrome, autologous tenocyte implantation, collagen scaffold.

How to Cite

John M O’Donnell1,2, Rowan Flanagan3, Jane Fitzpatrick4,5. (2021). Autologous Tenocyte Implantation (ATI) and the Use of Collagen Scaffolds: a Case Report of a Novel Surgical Treatment for Gluteal Tendon Repair. International Journal of Case Reports, 5, 194. https://doi.org/10.28933/ijcr-2020-12-2605


Background: Ortho-biological therapies such as platelet-rich plasma and autologous tenocyte implantation injections are hypothesized to introduce cellular mediators such as growth factors into tendons, promoting natural healing.

Methods: This case introduces a 63-year-old female with an extensive history of lateral hip pain and treatment refractory tendinopathy with tearing. She underwent open surgery to repair the gluteus medius tendon, using supplementary autologous tenocyte implantation (ATI) in conjunction with a Celgro (Orthocell, Perth, Australia) collagen scaffold.

Level of evidence: 4

Results: She had normal function in the hip at 12 months. MRI scans post-operatively at 12 months showed a marked reduction in inflammation, an intact tendon and a reduction in atrophic changes in the muscle belly.

Conclusion: Surgical repair of a large degenerate tear of the gluteus medius tendon, augmented with autologous tenocyte implantation in a collagen scaffold led to an excellent patient outcome and MRI findings demonstrated tendon healing with improved tendon structure and reduced inflammation.


  1. Reid D. The management of greater trochanteric pain syndrome: A systematic literature review. Journal of orthopaedics. 2016;13[1]:15-28.
  2. Grimaldi A, Mellor R, Hodges P, Bennell K, Wajswelner H, Vicenzino B. Gluteal Tendinopathy: A Review of Mechanisms, Assessment and Management. Sports medicine. 2015;45[8]:1107-19.
  3. Fearon AM, Cook JL, Scarvell JM, Neeman T, Cormick W, Smith PN. Greater trochanteric pain syndrome negatively affects work, physical activity and quality of life: a case control study. The Journal of arthroplasty. 2014;29[2]:383-6.
  4. Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N. Management of the greater trochanteric pain syndrome: a systematic review. British medical bulletin. 2012;102:115-31.
  5. Long SS, Surrey DE, Nazarian LN. Sonography of greater trochanteric pain syndrome and the rarity of primary bursitis. AJR American journal of roentgenology. 2013;201[5]:1083-6.
  6. Gordon EJ. Trochanteric bursitis and tendinitis. Clinical orthopaedics. 1961;20:193-202.
  7. Fearon AM, Scarvell JM, Neeman T, Cook JL, Cormick W, Smith PN. Greater trochanteric pain syndrome: defining the clinical syndrome. British journal of sports medicine. 2013;47[10]:649-53.
  8. Cook JL, Purdam CR. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine. 2009;43[6]:409-16.
  9. Fearon A, Stephens S, Cook J, Smith P, Neeman T, Cormick W, et al. The relationship of femoral neck shaft angle and adiposity to greater trochanteric pain syndrome in women. A case control morphology and anthropometric study. British journal of sports medicine. 2012;46[12]:888-92.
  10. Bhabra G, Wang A, Ebert JR, Edwards P, Zheng M, Zheng MH. Lateral Elbow Tendinopathy: Development of a Pathophysiology-Based Treatment Algorithm. Orthopaedic journal of sports medicine. 2016;4[11]:2325967116670635.
  11. Fearon AM, Scarvell JM, Cook JL, Smith PN. Does ultrasound correlate with surgical or histologic findings in greater trochanteric pain syndrome? A pilot study. Clinical orthopaedics and related research. 2010;468[7]:1838-44.
  12. Fitzpatrick J, Bulsara MK, O’Donnell J, Zheng MH. Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up. The American journal of sports medicine. 2019;47[5]:1130-7.
  13. Fitzpatrick J, Bulsara MK, O’Donnell J, McCrory PR, Zheng MH. The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. The American journal of sports medicine. 2018;46[4]:933-9.
  14. Bucher TA, Ebert JR, Smith A, Breidahl W, Fallon M, Wang T, et al. Autologous Tenocyte Injection for the Treatment of Chronic Recalcitrant Gluteal Tendinopathy: A Prospective Pilot Study. Orthopaedic journal of sports medicine. 2017;5[2]:2325967116688866.
  15. Padulo J, Oliva F, Frizziero A, Maffulli N. Muscles, Ligaments and Tendons Journal – Basic principles and recommendations in clinical and field Science Research: 2016 Update. Muscles Ligaments Tendons J. 2016;6[1]:1-5.
  16. Davies JF, Stiehl JB, Davies JA, Geiger PB. Surgical treatment of hip abductor tendon tears. The Journal of bone and joint surgery American volume. 2013;95[15]:1420-5.
  17. Whiteside LA. Surgical technique: Transfer of the anterior portion of the gluteus maximus muscle for abductor deficiency of the hip. Clinical orthopaedics and related research. 2012;470[2]:503-10.
  18. Chen J, Yu Q, Wu B, Lin Z, Pavlos NJ, Xu J, et al. Autologous tenocyte therapy for experimental Achilles tendinopathy in a rabbit model. Tissue engineering Part A. 2011;17[15-16]:2037-48.