Orthopedic Conditions

Stem cell therapy is used to treat joint pain related to local cartilage injury and arthritis. These injections will not cure these conditions, but they can offer much effectiveness and pain relief. Because no two patients are alike, each person will respond to stem cell therapy uniquely. This is a low-risk procedure, which is often used as an alternative to orthopedic surgery. A candidate for stem cell therapy is anyone who wishes to heal soft tissue injuries of the cartilage, ligament, or tendon. In addition, you may be a candidate if you have not responded to other orthopedic treatments for arthritis. Finally, candidates for stem cell therapy are persons wishing to delay surgery.

People of all ages can benefit from regenerative medicine therapy. However, you may not be a good candidate if you:

• Have a chronic illness.
• Have a current infection.
• Have certain cancers or blood diseases.
• Use Coumadin or blood thinners.
• Have blood cancer that has not been in remission for five years.

Orthopedic conditions treated with stem cells include partial tears of the:

• Knee cruciate ligaments (anterior and posterior)
• Knee collateral ligaments (medial and lateral)
• Elbow medial and lateral ligaments
• Ankle and wrist ligament
• Patellar (knee) tendon
• Quadriceps (thigh) tendon
• Achilles (ankle) tendon
• Rotator cuff (shoulder) tendon
• Hip and wrist tendons
• Cartilage

Before you have stem cell injections, you will meet with the orthopedic specialist for a consultation. The doctor will discuss your treatment options. The doctor will give you a physical examination, ask you questions about your condition, and conduct some diagnostic tests. After deciding on stem cell injections, the doctor will discuss the risks and benefits and have you sign a consent form. Before the procedure, you should wash in an antibacterial soap, and wear loose-fitting clothes.

The procedure is performed in the physician office. When you arrive, you will change into a gown. Once being positioned on the procedure table, the physician will obtain mesenchymal stem cells from either your hip bone (iliac crest) or fat tissue. The skin is first numbed with a local anesthetic, and the procedure needle is inserted into the hip bone. After removing the bone marrow, a bandage is applied to the site.

Recently, the utility of adipose derived stem cells has been shown for treatment of orthopedic injuries. To obtain fat cells, a doctor makes a small incision over the stomach and inserts a tiny catheter to dislodge the cells (liposuction).

Adipose derived stem cells are useful because more cells (10 million to 40 million) can be harvested in this manner, relative to bone marrow techniques. For many diseases and injuries, the number of cells used for treatment affects the success rate.

It may be possible that placenta-derived cells are used, which are obtained from a donor.

Articular cartilage damage of the knee can be treated with stem cell therapy. Chondrocytes (cartilage cells) differentiate into many cell types. These stem cells can be injected into knee joints. Stem cells have been proven effective in many clinical studies. The injections were highly promising, but more research is needed at this time. In a recent study, pain scores improved in all study subjects with knee joint problems following the stem cell injections.

In another knee arthritis study, patients were separated into two groups. In one group, the patients received one injection of autologous bone marrow-derived MSCs, which were stimulated with collagen hyaluronic acid and protein matrix. In the study, the paste was transplanted to the defect during arthroscopic surgery. In the other group, patients received two injections. All subjects were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and other pain/outcome score tools. Researchers found that combinations of scaffolds and growth factors offered structural and biomechanical benefits with the injections.

Adipose stem cells have been investigated as an improved strategy for treating orthopedic injuries, due to their ability to differentiate into different cell lineages. The potential of adipose stem cells to differentiate to restore chondral, bone, and tendon tissue has been shown in studies performed both inside and outside of the body. This technique has shown promise for restoring cells and the extracellular matrix of intervetebral disc, which could provide relief for millions of back pain sufferers.

When treating osteonecrosis in one study, researchers evaluated 128 patients and 190 hips. The treatment involved two groups: 1) multiple drillings in the bone with stem cell implantation to the drilled openings, and 2) core decompression, curettage, and bone grafting. The patients were evaluated at a five-year follow-up. In the stem cell transplant group, 65% of those with stage IIa disease, 57% of those with stage IIb disease, and 43% of those with stage III disease had not had surgery. Of the conventional group, results were similar. There were no statistical significant differences between the stem cell group and the bone graft group.

Researchers evaluating multiple studies found that multiple drilling and stem cell implantation produced outcomes much like the core decompression techniques. Significant differences in outcomes were observed in patients who had more stem cells implanted as opposed to those with fewer transplanted cells. Overall, study investigators have found that stem cell therapy is quite beneficial for treating orthopedic conditions.

Anderson JA, Little D, Toth AP, et al. (2016). Stem Cell Therapies for Knee Cartilage Repair: The Current Status of Preclinical and Clinical Studies. Am J of Sports Medicine.

DOI: 10.1177/0363546513508744

Lim YW, Kim YS, Lee JW, & Kwon SY (2013). Stem cell implantation of osteonecrosis of the femoral head. Experimental & Molecular Medicine, 45, e61.