Stem cell treatment for cartilage repair
In examining the latest research, doctors acknowledge that a new strategy is required in treating extensive meniscus injuries and defects. This new strategy is Mesenchymal stem cells (MSCs). The doctors found (as we have found) repetitive injections of stem cells promoted meniscus regeneration and provided protection at the medial femoral articular cartilage.1,5
stem cell injection therapy
It is becoming more and more apparent that stem cell injection therapy will be the orthopedic treatment of choice for a new generation of orthopedists. Why the confidence in saying this? Because stem cell therapy is becoming thoroughly embraced by the surgical community. In this study’s abstract, doctor’s make an amazing statement.
“Osteochondral lesions of the knee (cartilage) are a common cause of knee pain and associated diseases. A new bone-marrow-derived mesenchymal stem cells technique has been developed for the treatment of osteochondral lesions of the knee (OLK). Thirty patients with OLK underwent arthroscopic one-step procedure. The bone marrow was harvested from the patients’ posterior iliac crest and arthroscopically implanted with a scaffold into the lesion site. . .Control MRI and bioptic samples showed an osteochondral regeneration of the lesion site. The one-step technique appears to be a good and reliable option for treatment of OLK at three years of follow-up.”2
Incredible. A new technique has been developed – surgery! Albeit it is a new technique to actually reduce the number of surgeries that might be need to offer stem cell treatments.
For the Comprehensive Prolotherapy skeptic, can there be more compelling evidence of the confidence in stem cell therapy as a major tool in the regeneration of cartilage and damaged tissue than the need to develop proper surgical interventions?
“Outcomes after tendon repair are often unsatisfactory, despite improvements in surgical techniques and rehabilitation methods. Recent studies aimed at enhancing repair have targeted the paucicellular nature of tendon for enhancing repair; however, most approaches for delivering growth factors and cells have not been designed for dense connective tissues such as tendon. Therefore, we developed a scaffold capable of delivering growth factors and cells in a surgically manageable form for tendon repair.”3
Stem cell injections
Surgeons can give injections too. Writing in the medical journal titled Arthroscopy, researcher surgeons found that the results of their study showed: “intra-articular injection of infrapatellar fat pad-derived mesenchymal stem cells is effective for reducing pain and improving knee function in patients being treated for knee osteoarthritis.”4 But a surgery was still involved, the stem cells from the kneecap area was harvested at the arthroscopic lateral portal site after the patient underwent arthroscopic debridement.
Stem Cell Therapy is, in our opinion, an alternative to surgery because most times the injections work better than the surgical introduction of stem cells. There are also less risks, faster healing, etc. Recently we spoke about the surgical options and alternatives in our article Stem Cell Prolotherapy Alternative Option to Knee Replacement, ACL Surgery. In our opinion, the best use of stem cells is via Stem Cell Prolotherapy.
In research published by the Journal of Bone and Joint Surgery, doctors have found that a single stem cell injection following meniscus knee surgery may provide Knee Pain relief and aid in meniscus regrowth. In this study, patients received a single injection of adult stem cells following the surgical removal of all or part of a torn meniscus. These patients reported a significant reduction in pain. Further, some meniscal tissue regrew! Up to 15 percent increase in meniscal volume at one year. There was no additional increase in meniscal volume at year two. (Comment: Maybe they should have given more than one injection.)
Wait, that was answered in the American Academy of Orthopaedic Surgeons’ press release. “The results of this study suggest that mesenchymal stem cells have the potential to improve the overall condition of the knee joint,” said Dr. Vangsness (a study author). “I am very excited and encouraged” by the results. With the success of a single injection, “It begs the question: What if we give a series of injections?”5
Stem cell treatment for meniscus repair
Again, we have to ask, if it works so well in rebuilding meniscal tissue, why have the surgery in the first place? It does say multiple injections may benefit the patient more. It seems we have written very often that single injections are not Prolotherapy; single PRP injections are not PRP treatments; and now single Stem Cell injections are probably more effective if given more often? Sounds like Comprehensive Prolotherapy performed at Caring Medical, ie multiple injections of various and supportive elements to fit the individual case of the the patient.
Surgery or stem cell treatment for meniscal repair
On December 24, 2013, the New England Journal of Medicine published an article entitled :”Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear.”
This was the work of Finnish researchers who recognized that arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking.
So what they did was to conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis.
Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. Then a scoring system was designed to measure pain, symptom severity and knee pain after exercise at 12 months after the procedure.
the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure
What they found was “In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure.”6
This is not the first study this year to question the value of meniscal surgery. Earlier in 2013 research published in the American Journal of Sports Medicine showed what little value meniscectomy has. Researchers compared meniscectomy to nonoperative treatment for meniscus tears.2 They specifically studied degenerative horizontal tears of the medial meniscus and hypothesized that surgical treatment would produce better outcomes that nonoperative strengthening exercises.
In other research, doctors hypothesized that surgical treatment would produce better outcomes than nonoperative strengthening exercises. It didn’t.
This study was a randomized controlled trial with the highest level of evidence (level 1). The study had 102 patients with medial meniscus tears – 81 women and 21 men with the average age of 53.8.
Fifty patients underwent arthroscopic menisicectomy while 52 participated in nonoperative strengthening exercises. The results did not match up the to researchers hypothesis. At the two year follow-up there was no difference in pain relief, improved knee function or patient satisfaction. Results also showed that meniscectomy did not provide better functional improvement than the nonoperative group.3
But what was the difference between these two groups? One group of patients underwent invasive surgery, had tissue remove, and will likely experience long-term meniscus degeneration.
In fact, most surgical meniscus treatments have, “all have a high long-term failure rate with the recurrence of symptoms including pain, instability, locking, and re-injury. The most serious of the long-term consequences is an acceleration of joint degeneration.”7
Significant decline in the patients’ knee pain and stiffness
In 2010 we published our findings on Prolotherapy for meniscal tears. We perfromed a retrospective study involving 24 patients, representing 28 knees, whose primary knee complaints were due to meniscal pathology documented by MRI. The average number of Prolotherapy visits was six and the patients were followed on average 18 months after their last Prolotherapy visit. Prolotherapy caused a statistically significant decline in the patients’ knee pain and stiffness. Starting and ending knee pain declined from 7.2 to 1.6, while stiffness went from 6.0 to 1.8.
Prolotherapy caused large improvements in other clinically relevant areas such as range of motion, crepitation, exercise, and walking ability.
Patients stated that the response to Prolotherapy met their expectations in 27 out of the 28 knees (96%). Only one out of the 28 patients ended up getting surgery after Prolotherapy.
Based on the results of this study, Prolotherapy appears to be an effective treatment for meniscal pathology. 8
1. Hatsushika D, Muneta T, Nakamura T, et al. Repetitive allogeneic intraarticular injections of synovial mesenchymal stem cells promote meniscus regeneration in a porcine massive meniscus defect model. Osteoarthritis Cartilage. 2014 May 2. pii: S1063-4584(14)01066-8. doi: 10.1016/j.joca.2014.04.028. [Epub ahead of print]
2. Buda R, Vannini F, Cavallo M, Baldassarri M, Luciani D, Mazzotti A, Pungetti C, Olivieri A, Giannini S. One-step arthroscopic technique for the treatment of osteochondral lesions of the knee with bone-marrow-derived cells: three years results. Musculoskelet Surg. 2013 Feb 19. [Epub ahead of print]
3. Manning CN, Schwartz AG, Liu W, Xie J, Havlioglu N, Sakiyama-Elbert SE, Silva MJ, Xia Y, Gelberman RH, Thomopoulos S. Acta Biomater. 2013 Feb 13. pii: S1742-7061(13)00065-2. doi: 10.1016/j.actbio.2013.02.008. [Epub ahead of print]
4. Koh YG, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ.Mesenchymal Stem Cell Injections Improve Symptoms of Knee Osteoarthritis. Arthroscopy. 2013 Jan 29. pii: S0749-8063(12)01884-1. doi: 10.1016/j.arthro.2012.11.017. [Epub ahead of print].
5. Stem Cell therapy following Meniscal Surgery http://newsroom.aaos.org/media-resources/Press-releases/stem-cell-therapy-following-meniscus-knee-surgery-may-reduce-pain-restore-meniscus.htm
6. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. N Engl J Med 2013; 369:2515-2524December 26, 2013DOI: 10.1056/NEJMoa1305189
7. A Comparative Study of Meniscectomy and Nonoperative Treatment for Degenerative Horizontal Tears of the Medial Meniscus Am J Sports Med May 23, 2013 ; published online before print May 23, 2013.
8. Hauser R, Phillips H, Maddela HS. Hilary J. The Case for Utilizing Prolotherapy as First-Line Treatment for Meniscal Pathology: A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears and Degeneration. Journal of Prolotherapy. 2010;(2)3:416-437.