Knee articular cartilage surgery and stem cells
In this article we will present the non-surgical stem cell – comprehensive Prolotherapy alternative to various surgical techniques that are designed to repair or regrow the articular cartilage of the knee.
In our non-surgical options we look at success as whether or not there has been an improvement in the patient’s condition and whether or not we met the pre-treatment goals of the patient. We also ask, did we help the patient avoid a surgery?
In researching such surgical options as:
- Microfracture knee surgery
- Arthroscopic microfracture drilling
- Arthroscopic abrasion arthroplasty
- Autologous Chondrocyte Implantation (ACI)
- Osteochondral Autograft Transplantation (Donor cartilage from you)
- Osteochondral Allograft Transplantation (Donor cartilage from cadaver)
We often find one of the successes of the surgery outcome is that the patient did not need multiple surgeries. Let’s look at new research on these procedures.
Microfracture surgery for articular cartilage repair
Surgical researchers are happy to announce that cartilage repair or regeneration procedures (e.g., microfracture, Autologous Chondrocyte Implantation – ACI) typically result in a satisfactory outcome in selected patients.
This was detailed by doctors at the University of New Mexico who published research in which they suggest success in selective patients undergoing chondroplasty, debridement, drilling, microfracture autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft, and that while these techniques may improve patient outcomes, NONE can reproduce normal hyaline cartilage.2
This is the problem, the cartilage repair is not as durable as the native cartilage. It is not a long-term solution.
A team of international researchers agreed in their research stating that the vast majority of patients with chronic symptoms and, in general, a more diseased joint, do not benefit from these surgical techniques.2
In March 2017, a paper will be published from Rush University Medical Center which will state:
“For the vast majority of patients, marrow stimulation results in reduced pain and improved function, providing overall satisfactory outcomes. In some cases, however, marrow stimulation fails, resulting in symptom recurrence and often, the need for repeat surgery.3
And in January 2017 research from Rush and Duke Universities about youth athletes:
“Autologous Chondrocyte Implantation is an effective treatment for adolescent patients with symptomatic, large chondral lesions, resulting in significant improvements in knee-specific functional outcome scores and health-related quality of life scores.
Although patients must be cautioned on the relatively high reoperation rate (37.8%) and limitations in knee function even after ACI”4
Cartilage repair surgery an example
Here in our opinion is another example of over complicating a simple procedure, the introduction of reparative stem cells into the knee.
Here is the more complicated surgical process: Researchers wanted to know if they could regenerate articular cartilage in patients with severe cartilage deterioration by drilling the bone underneath the cartilage (to jump start healing) and then after the surgery if intra-articular injections of hyaluronic acid with and without peripheral blood stem cells (PBSC) repaired the tissue.
The doctors took 50 patients (young patients age 18 to 50) with cartilage loss and began to drill the bones. One week after the drilling, 25 of the patients received a weekly injection of hyaluronic acid (HA) with peripheral blood stem cells, 25 without. Then 6 months later the injections were repeated.
The researchers found that arthroscopic subchondral drilling (drilling underneath the cartilage) into grade 3 and 4 chondral lesions, postoperative intra-articular injections of (stem cells) in combination with hyaluronic acid resulted in an improvement of the quality of articular cartilage repair over the same treatment without (stem cells). In other words when the stem cells were added, everything worked better.5
So here is the understanding of it all:
1. Arthroscopic drilling
2. hyaluronic acid injections
3, stem cells therapy
and more injections six months later.
The study focused on the surgery and what made the surgery work better, and it wasn’t hyaluronic acid. It was the stem cells.
Why not try the repair with stem cells without the surgery?
In another study doctors writing in the medical journal Arthroscopy found that in 55 knees that underwent High Tibial Osteotomy (bone resurfacing or reshaping) and microfracture, those who received stem cells with hyaluronic acid had significantly better results than those who just received hyaluronic acid.6
- Back to the original question, why not try the repair without the surgery FIRST when research suggests stem cells have the ability to repair and reshape bone.7
- Other research, including our own, shows complete relief of symptoms in arthritic joints with bone marrow stem cell treatments.8 Below we will discuss three case studies from this research.
Here is a new study that can suggest that trying the stem cell injections first may be a more realistic option for patients especially those concerned with microfracture knee surgery recovery time and rehab.
Abrasion Arthroplasty is a procedure that sounds exactly what is is – abrasions are created on the cartilage to create an injury with the hope that the body will repair not only the new injury but the deterioration of the joint as well. This is a surgical procedure. Studies have pointed out that this procedure may help alleviate symptoms but it is not curative.9
Not only non-curative – may not work at all.
Doctors at RWTH Aachen University in Germany had a problem with Arthroscopic abrasion arthroplasty. They are not sure it worked at all. To test the theory that the surgery was helpful – they examined the effusion, the swelling fluids in the knee following the surgery.
What they found was the surgery indeed starting a healing process by stimulating STEM CELLS to repair the cartilage.
Now here is the amazing part. The doctors found that during the surgery, the doctors used constant suction to drain the surgical area. The researchers now “recommend not to use suction drainage as by this procedure a considerable amount of the regeneratory potential of postoperative joint effusions might be extracted.”10
- In other words the stem cells were stimulated to repair spontaneously and mobiles to the wound site.
- The benefit to the surgery was to get stem cells to the wound
- The surgery’s benefit was being removed as soon as it started.
Treatment for articular cartilage is challenging because knee cartilage shows limited reparative and regeneration abilities following injury. Traditional non-operative (RICE therapy), various injection therapies and traditional arthroscopic techniques cannot restore the normal anatomy and function of cartilage in osteoarthritis.
Stem cell therapy for cartilage repair need not be a complicated procedure. In many instances bone marrow stem cells are drawn from a patient and injected into the patient’s knee with the hope of repairing cartilage and bone damage typical of a knee with severe osteoarthritis or damage from injury. The procedure is simple in concept: inject stem cells, heal knee. Please watch the video below.
Please see our discussions in the medical journal Clinical medicine insights. Arthritis and musculoskeletal disorders where our team presented three difficult knee pain case histories treated with Bone Marrow Stem Cell Aspirate:
References for this article
1. Richter DL, Schenck RC Jr, Wascher DC, Treme G. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. 2015 Oct 12. pii: 1941738115611350 Pubmed citation
2. Scotti C, Gobbi A, Karnatzikos G Martin I, Shimomura K, Lane JG, Peretti GM, Nakamura N. Cartilage repair in the inflamed joint: considerations for biological augmentation towards tissue regeneration. Tissue Eng Part B Rev. 2015 Oct 15. Pubmed citation
3. Frank, Rachel M., et al. Failure of Bone Marrow Stimulation Techniques. Sports Medicine and Arthroscopy Review 25.1 (2017): 2-9. Citation
4. Cvetanovich, Gregory L., et al. “utologous Chondrocyte Implantation Improves Knee-Specific Functional Outcomes and Health-Related Quality of Life in Adolescent Patients. The American Journal of Sports Medicine (2016): 0363546516663711. Pubmed Citation
5. Saw KY, Anz A, Siew-Yoke Jee C, Merican S, Ching-Soong Ng R, Ahmad RS, Ragavanaidu K. Articular Cartilage Regeneration With Autologous Peripheral Blood Stem Cells Versus Hyaluronic Acid: A Randomized Controlled Trial. Arthroscopy. 2013 Feb 4. Pubmed citation
6. Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable Cultured Bone Marrow-Derived Mesenchymal Stem Cells in Varus Knees With Cartilage Defects Undergoing High Tibial Osteotomy: A Prospective, Randomized Controlled Clinical Trial With 2 Years’ Follow-up. Arthroscopy. 2013 Dec;29(12):2020-8. Pubmed citation
7. Gobbi A, et al. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up.Cartilage. Published online Feb.14, 2011. Sage Pub citation
8. Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. Pubmed citation
9. Johnson LL. Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res. 2001 Oct;(391 Suppl):S306-17. Citation
10. Beckmann R, Lippross S, Hartz C, et al. Abrasion arthroplasty increases mesenchymal stem cell content of postoperative joint effusions. BMC Musculoskelet Disord. 2015 Sep 12;16:250. doi: 10.1186/s12891-015-0705-0. Pubmed citation