Why stem cell therapy did not work for your knee pain
When a patient sends us an email or comes into our office seeking answers to why stem cell therapy did not work for their knee pain, we suggest that perhaps the answer was NOT:
- Because fat stems cells were used when bone marrow stem cells should have been used or vice versa.
- Because placenta or amniotic stem cells are not as superior to fat stem cells or vice versa,
- or even Because the number of stem cells were inadequate.
Sometimes stem cell therapy did not work because it was never given the full chance to work. This may be a more difficult idea for patients to understand. How could the stem cells not be given a chance to work?
- Do you want to ask about your stem cell treatment for your knees? Get help and information from our Caring Medical staff
Before I get into the answers, patients need to know that despite the best intention of a surgeon, many joint replacements do not work. Despite the best intention of conservative care, hyaluronic acid, cortisone injections, anti-inflammatory medications, and physician therapy do not always work.
- Despite the best intention of a doctor knowledgeable in stem cell injection therapy, stem cell treatment does not always work. Nothing in medicine is 100%.
This article will discuss why stem cell therapy may not work and what I believe we can do to give it its best chance of working.
A joint does not try to repair one part of itself, it tries to repair its whole self
In Japan, doctors writing in the Journal of orthopaedic research examined why reduced meniscal function in mice significantly accelerated articular-cartilage degeneration and problems of knee osteoarthritis.
What the Japanese researchers looked at was the impact of meniscectomy, the surgical removal of meniscal tissue from the knee and why this meniscus tissue removal caused the whole knee to begin an accelerated degenerative process.
What they found in this study was the body’s rapid response to repair the meniscus, not only tries to regenerate meniscal tissue damaged by the surgery, but also tried to prevent damage to the articular cartilage of the knee by sending repair cells there. Why? Because without the meniscus the cartilage covering the thigh and shin bones is subject to accelerated load forces.
The Japanese researchers concluded that the remaining meniscus and the articular cartilage of the meniscectomized knee tried, in vain, to work together to regenerate the meniscus and protect the cartilage.(1)
In other words, the knee tried to reinforce the articular cartilage because it knew the meniscus was gone.
Research is filled with knee osteoarthritis challenges after arthroscopic procedures because medicine does understand the knee needs its padding, remove the padding the knee spontaneously falls under duress of amplified load force.
But what about the other structures of the knee? Do they know they are part of the whole knee environment?
Doctors in Iran are among the leading researchers when it comes to the problems of the knee and their regenerative medicine solutions. Listen to this research from doctors at Tabriz University of Medical Sciences, publishing in the prestigious international journal Therapeutic advances in musculoskeletal disease, published in London.
In this research doctors explored the use of simple dextrose Prolotherapy for problems of knee osteoarthritis. Here 24 female patients were followed after treatment. The results:
Prolotherapy with three intra-articular injections of hypertonic dextrose given four weeks apart for selected patients with knee osteoarthritis, resulted in significant improvement of validated pain, range-of-motion, and WOMAC-(post-treatment questionnaire based function scores), when baseline levels were compared at 24 weeks.
But while the documented success of dextrose Prolotherapy in treating knee osteoarthritis is a great validation for the treatment, the best part of the research was the acknowledgement that these doctors would have had greater success had they treated the whole knee. Listen to this, remember, the results of the study showed benefits of Prolotherapy for knee osteoarthritis:
Studies have reported that the (Prolotherapy) improvements reduce over time and sometimes the symptoms are worse after several months, which indicate the short-term effects of the treatment, similar to the injections of hyaluronic acid agents. Though post-treatment pain is not as severe as their experienced original pretreatment pain, this could suggest that these patients need several injections at intervals to keep the desired results.
Here is the extraordinary part:
“Ignoring the patient’s other pain sources including joint-surrounding tendons and ligaments could be another potential cause in this regard; we did not treat enthesopathies or the ligament fibro-osseous junctions with extra-articular dextrose injections around these elements in our study. So, it appears that ligaments or other structures need to be treated to get the full benefit from Prolotherapy.”(2)
You need to treat the whole knee. Here is more and a primary reason not only for why Prolotherapy and stem cell therapy for knee osteoarthritis will not achieve the desired results:
“(In this study) extra-articular injection (those to the outer and surrounding ligaments and tendons) in addition to intra-articular injection (directly into the knee meniscus and cartilage area) was not included in the research protocol.
“In other words, the first priority in our study was a focus on the damaged cartilage and not on external ligaments or tendons. However, this would be a promising method for showing the better efficacy of prolotherapy, especially for young or middle-aged patients with ligament injury, and even for elderly patients with knee osteoarthritis in whom lateral collateral ligament (LCL) damage is not uncommon.”(2)
How remarkable. This is what we find in patients who come to us with failed stem cell and Prolotherapy knee treatments. The doctor they went to focused on the damaged cartilage NOT on the supporting ligaments.
The stem cell treatment these patients received were likely to fail because the reason the cartilage was compromised in the first place was knee instability caused by ligament laxity and tendon weakness.
More validation for treating the whole knee
In this study, doctors from the University of Tehran compared results in patients who received Prolotherapy with dextrose periarticular injections around the knee joint with patients who received Prolotherapy intra-articular injections. In other words, one group received injections around the knee joint, another group received injections directly into the knee joint.
- Both peri- and intra-articular prolotherapy patients showed reduced pain and disability of their knee osteoarthritis after 5 months of follow-up.
- Interestingly, periarticular prolotherapy group had better effects on pain scores and disability scores in some respects.
- Periarticular Prolotherapy injections showed superior effects on healing of knee disability and pain score compared with intra-articular injections.
- Pain score was significantly lower at 1-, 2-, 3-, 4-, and 5-month visits in the periarticular group compared with the intra-articular group.
- Periarticular injections have been suggested in some recent reports for analgesic effect after total knee replacement
- Periarticular injections can significantly reduce the requirements for patient-controlled analgesia and can improve patient satisfaction following total knee replacement.
- Periarticular injection showed adjuvant effects to intra-articular prolotherapy.(3)
Simply, Prolotherapy for knee osteoarthritis is not a single or few injections, it is many injections. For stem cell therapy to achieve its best chance of success you need to treat the whole joint.
Do you want to ask about your stem cell treatment for your knees? Get help and information from our Caring Medical staff
1 Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. J Orthop Res. 2016 Nov 2. doi: 10.1002/jor.23470. [Google Scholar]
2 Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Therapeutic Advances in Musculoskeletal Disease. 2015;7(2):35-44. [Google Scholar]
3 Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. Journal of Pain Research. 2017;10:1179-1187. [Google Scholar]