The use of stem cells during arthroscopic surgery

Dr. David Woznica ProlotherapistDavid N. Woznica, MD

In this article we will explore patient questions about their surgeon suggesting stem cells can or cannot be used during arthroscopic surgery.

Stem cells are so exciting that your surgeon may be anxiously waiting the ability and training to offer stem cell during surgery- here is the proof: Editorial  – The Journal of Arthroscopic and Related Surgery a publication of the Arthroscopy Association of North America.

“we are believers in stem cell therapy” and “stem cells have substantial potential to allow 21st century physicians and surgeons… to achieve unprecedented tissue healing and repair.”(1)

Stem cells are often misunderstood and their ability to heal is often the subject to overinflated claims or whether or not we are talking about a medical treatment for today or a medical treatment being developed in the laboratory for tomorrow.

Please see our articles Why didn’t stem cell therapy work for my knee pain?, and Are you a candidate for stem cells?

A team of University researchers in Italy, Germany and the United States published research in 2016 to their arthroscopic surgeon readership that suggested:

This is why stem cell therapy has generated so much excitement in the medical community. It is the “unprecedented tissue healing and repair” as recent study proclaimed, and continued:

As documented by researchers in Spain writing in the journal Transplantation. (3)

Which agrees with other studies and those cited above on the safety of stem cell injections, including this research on the ability of stem cells to promote meniscus regeneration following partial meniscectomy, and the positive effects of stem cells on osteoarthritic changes in the knee supporting the study of  stem cells for  knee-tissue regeneration. This research is documented in a study from the University of Southern California and published in the Journal of bone and joint surgery.(4)

The educated patient will also find that not all research is favorable to stem cell therapy at this time due to “great deal of heterogeneity that is discrepancy in treatment methods,”(5) the great variety of ways stem cell therapy is performed, some variations are not as potent as others, and the inability to come up with a gold standard platform to conduct clinical trials.

Seemingly the same issues that critics of our similar injection treatments of Prolotherapy and Platelet Rich Plasma Therapy point to. Variations in treatments and inability to conduct true controlled studies because of the nature of the treatment.(6) Our article on Prolotherapy for Knee Osteoarthritis Injections explores the many different types of injections and the research.

One such variation is being led by researchers in China who have explored replacing apoptotic chondrocytes (dead or dying cartilage cells) in the cartilage by injecting mesenchymal stem cells. This effect was termed as bio-resurfacing.(7)

Stem cell injection therapy – use during surgery

Based on editorials and accompanying studies like those above, 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. “A new bone-marrow-derived mesenchymal stem cells technique has been developed for the treatment of osteochondral lesions of the knee. (Surgery!)

Thirty patients with osteochondral lesions underwent an 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.”(8)

Incredible. A new technique has been developed and it is surgery!

For the 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?

More research
“…most (surgical) approaches for delivering growth factors and stem 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.”(9)

In other words, in surgery they could not pinpoint the delivery of the growth factors. This may have lead to why surgeons developing injection techniques.

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.”(10) 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.

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.)

That question was seemingly 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?”11

If you have questions about Arthroscopic surgery and stem cells, Get help and information from Caring Medical

1. Wetzler, Merrick J. Editorial Commentary: Doc, Can You Inject Stem Cells in My Knee? Arthroscopy, Volume 32 , Issue 1 , 110 [Google Scholar]

2. De Girolamo L, Kon E, Filardo G, Marmotti AG, Soler F, Peretti GM, Vannini F, Madry H, Chubinskaya S. Regenerative approaches for the treatment of early OA. Knee Surgery, Sports Traumatology, Arthroscopy. 2016 Jun 1;24(6):1826-35.  [Google Scholar]

3. Orozco L, Munar A, Soler R, Alberca M, Soler F, Huguet M, Sentís J, Sánchez A, García-Sancho J. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation. 2013 Jun 27;95(12):1535-41. doi: 10.1097/TP.0b013e318291a2da.  [Google Scholar]

4. Vangsness CT Jr, Farr J 2nd, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M, et al. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am. 2014 Jan 15;96(2):90-8. doi: 10.2106/JBJS.M.00058.  [Google Scholar]

5. Wolfstadt JI, Cole BJ, Ogilvie-Harris DJ, Viswanathan S, Chahal J. Current concepts: the role of mesenchymal stem cells in the management of knee osteoarthritis. Sports Health. 2015 Jan;7(1):38-44. doi: 10.1177/1941738114529727.  [Google Scholar]

6. Uth K, Trifonov D. Stem cell application for osteoarthritis in the knee joint: A minireview. World J Stem Cells. 2014 Nov 26;6(5):629-36. doi: 10.4252/wjsc.v6.i5.629.  [Google Scholar]

7. Yang X, Zhu TY, Wen LC, Cao YP1, Liu C, Cui YP, Meng ZC, Liu H. Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis. Chin Med J (Engl). 2015 20th Sep;128(18):2516-2523. doi: 10.4103/0366-6999.164981.  [Google Scholar]

8. 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.  [Google Scholar]

9. Manning CN, Schwartz AG, Liu W, Xie J, Havlioglu N, Sakiyama-Elbert SE, Silva MJ, Xia Y, Gelberman RH, Thomopoulos S. Controlled delivery of mesenchymal stem cells and growth factors using a nanofiber scaffold for tendon repair. Acta biomaterialia. 2013 Jun 30;9(6):6905-14.  [Google Scholar]

10. 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.  [Google Scholar]

11. 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

 

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