Stemcelldoc's Weblog

June 9, 2010

Anterior Cruciate Ligament Injuries and Stem Cell Therapy

Ligaments are  dense  fibrous connective tissue which connect bone to bone.  They provide stability to a given joint. The knee has four principal ligaments.  The anterior cruciate ligament stabilizes the knee and prevents forward motion of the tibia (shin bone) in relation to the femur (thigh bone).  The ACL originates from the femur (thigh bone) and is attached to the tibia .

  The ACL is the most commonly injured knee ligament and is very common  in athletes.  Injury occurs during sudden dislocation, torsion or hypter-extension of the knee.  Diagnosis can be made clinically with either the anterior drawer test or Lachman test.  The diagnosis is typically confirmed by MRI.

Surgical options include repair of the damaged ligament vs complete reconstruction with a patient’s own tendon.  Complications from surgery include infection, blood clots, technical failure, damage to muscles, tendons and associated ligaments and the risk of anesthesia.

Mesenchymal stem cells have the ability to regenerate damaged ligaments.  At Centeno-Schultz Clinic using the Regenexx procedure we are utilizing regenerative therapies to treat ACL injuries.  These treatments include the injection of prolotherapy as well as autologous culture expanded mesenchymal stem cells directly into the ACL.  Below is a recent injection of stem cells into the ACL.  30 days post injection patient reports improved stability and decreased pain.

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17 Comments »

  1. [...] The Anterior Cruciate Ligament (ACL) is critical to the support and function of the knee. [...]

    Pingback by Anterior Cruciate Ligament Repair Without Surgery « Stemcelldoc’s Weblog — July 8, 2010 @ 10:44 am

  2. As a skier I have suffered from a knee injury approximately 6 years ago. When I had an MRI it showed a complete rupture of my MCL, LCL and PCL as well as a partial tear in my ACL. This also showed limited damage to the meniscus and cartilage in my knee. Since I have been using a rigid knee brace (DonJoy) for all my active sports. I am curious if your treatments will allow my fully ruptured ligaments to “re-grow” and if so how long would this take. Please help in returning my knee to its former glory.
    If it helps I have the MRI from days after the injury and am scheduled to have a second in a few months time.

    Comment by Gareth Kingsford — June 14, 2012 @ 6:16 am

  3. Hello
    My 17 year old son has been told he has torn his ACL, as a result of falling whilst ice skating ( first time on the ice) he is active and I am worried that it will result in a permanent weakness and affect him for life ?
    I had a similar injury some years ago and have found it to be the case.
    I would rather he did not undergo surgery and was wondering if this sort of therapy could help him ?
    We live in the UK in Surrey, not far from London. Do you know of any hospital that is offering this kind of treatment here ? I am a lone parent on a limited income so I could not afford to come to the USA.
    Thanks
    Angela

    Comment by Angela Dart — June 19, 2012 @ 4:50 am

    • Angela,
      I am not aware of any UK clinic currently providing this non surgical therapy.
      I am hopeful that as our success continues more clinics will adopt stem cell therapy for patients with orthopedic injuries.

      Comment by stemcelldoc — June 19, 2012 @ 9:02 am

  4. I suffered a catastrophic knee injury 20 years ago playing high school lacrosse.I was pushed from behind while pivoting to pick up a free ball. The grass was wet and as my feet began to slide out beneath me the heel of my left foot got stuck in a hole on the field. My foot remained in a fixed position as my body continued its forward momentum. My bottom hit the ground, but I did not come to a full stop until it was flush against my calf muscle. The extensive damage was the result of the fixed position of my ankle and the lateral motion of my leg. The tearing and popping of the tissues was audible as the inside of my left knee hit the ground. (I sprained my ankle and dislocated my patella as well.) My MRI revealed a complete ACL tear, a torn MCL, stress fractures in my femur and tibia, and torn menisci. The severity and type/shape of the meniscal tears locked my knee joint at approximately 120 degrees – I could neither bend nor straighten my leg. The lateral meniscus was removed due to a massive bucket-handle tear. The area of the medial meniscus that sustained a tear was removed, but enough healthy tissue remained intact that complete removal was not necessary. I was young and active at the time so a patellar tendon graft was used. It was the most excruciatingly painful experience imaginable and the complications were seemingly endless. The strength training exercises were causing so much fluid production that the swelling was inhibiting the progress of the range-of-motion exercises. Despite an aggressive PT program I developed scar tissue that locked my knee at 90 degrees. (When the PT tried to push my heel toward my buttocks while I lay face down on the floor mat I nearly passed out. My surgeon had to perform another procedure (req. anesthesia) to break up the adhesions. (Suffice it to say that no one was thrilled when he told us that, “in a small percentage of patients the tibia breaks during the procedure.” This standard warning/disclaimer was of greater concern to us because I was thin, small-boned and had sustained tibial stress fractures from the original injury.) The procedure was a success – the adhesions were dislodged, my leg was not broken, and an incision was not required to regain full extension of the joint. I have always known that the major challenge in restoring stability to the knee following ligament damage stems from the fact that the ACL, PCL, and interior portion of menisci do not have blood supplies and therefore cannot regenerate. The patellar tendon graft is considered by many orthopedic surgeons to be the strongest replacement for the ACL, but it has lasting, painful side effects. The bone that is removed from the knee cap and tibia at either end of the graft (the middle third of the patellar tendon) causes lifelong pain in many patients. (I can attest to this. I still cannot kneel on my left knee. It’s a very odd sensation to be able to feel the hollow area where the bone and tendon used to be. It’s also unattractive. The missing bone and tendon cause a noticeable disfigurement which exacerbates the 3.5″ incision scar. This may not bother every patient, but it’s traumatic for a teenage girl. I still don’t like looking at it as an adult.) I am aware that various techniques are being used to try to regenerate articular cartilage in the knee (which is anatomically different from menisci) including the use of PRP to improve healing. I would like to know whether or not stem cell research is being conducted to attempt to repair/regenerate menisci. The loss of this cushion that separates the femur and tibia in the knee joint leads to articular cartilage damage, osteoarthritis and knee replacement. Further, is any stem cell research being conducted to attempt to recreate cruciate ligaments from a patient’s own tissues thereby avoiding the inherent drawbacks to cadaver, hamstring and patellar tendon grafts? Since the interior portions of the menisci and ligaments do not have a blood supply those areas, if I’ve understood the science correctly, would not regenerate even if stem cells (in conjunction with PRP) were introduced. I am suggesting research into the growth of a new ligament, in a laboratory setting, using a patient’s own cells and/or cells culled from umbilical cord blood. (This would side-step the never-ending embryonic stem cell debate.) If this line of inquiry is NOT being explored, WHY not? The financial incentive alone should be sufficient to fund this research.

    Comment by JLynn — September 4, 2012 @ 11:54 am

    • JLynn,
      I am sorry to hear about your knee injury and subsequent surgeries.
      your inquiry:
      1) I would like to know whether or not stem cell research is being conducted to attempt to repair/regenerate menisci. yes we continue to explore stem cell options.
      2) is any stem cell research being conducted to attempt to recreate cruciate ligaments from a patient’s own tissues. Yes. We have now injected 3 additional patients with complete ACL tears with bone marrow derived stem cells and are awaiting their results.

      Comment by stemcelldoc — September 4, 2012 @ 3:32 pm

  5. I am also in the process of being tested for Ehlers-Danlos Syndrome. I have some of the characteristics of the vascular type, but my echocardiogram was unremarkable so the geneticist is leaning more toward the classical or hypermobile types of the syndrome. I went to an orthopedic spine surgeon when I began experiencing pain after using a leg press machine at the gym. Films revealed a bilateral pars defect, disc degeneration at L5-S1, slight scoliosis and spondylolisthesis of one vertebra. None of the standard treatments were effective so my doctor referred me to a respected osteopath specializing in the use of Prolotherapy and PRP to treat joint and soft tissue injuries. I received Prolo injections in my lower lumbar spine and sacroiliac joint as well as in my cervical spine (MVA injury). i have not had this treatment for my rotator cuff, but that may be in my future. This is the only treatment I’ve received that has been effective and remains the only treatment available for ligament laxity. Joint hypermobility caused by ligament laxity can result in pain during the normal course of daily activities as joints move beyond their normal range of motion (hyperextend). Pediatricians and youth sports coaches/trainers rarely look for hypermobile joints/ligament laxity in their patients or athletes and lead this condition can lead to severe joint damage in children and teens who participate in sports. Prolotherapy and PRP have been used to treat joint and soft tissue injury for more than 20 years, yet insurance companies continue to classify it as an “experimental procedure.” Subsequently, patients must pay for these treatments out-of-pocket. Prolotherapy requires multiple treatments (usu. 3 minimum, spaced several weeks apart) with an average cost of $600 or more per body part, plus maintenance injections. PRP (Platelet rich plasma) injections cost substantially more, putting the average cost for one course of treatment for one body part around $1200. What action can be taken by patients to advocate for the approval of these modalities as standard treatment for joint instability and soft tissue damage thereby forcing insurance companies to cover a portion of their cost? Are any studies being conducted, NIH sponsored or otherwise, to improve current treatments as well as investigate new and better treatments for people with various connective tissue disorders?

    Comment by JLynn — September 4, 2012 @ 12:49 pm

    • JLynn,
      Contact your HR department and discuss with them.
      alternatively call your insurance carrier and ask for an explanation.
      Drug companies sponsor clinical trials and are not interested in examining the effectiveness of prolotherapy which is dextrose based injection.

      Comment by stemcelldoc — September 4, 2012 @ 3:36 pm

  6. Please accept my apology for asking so many questions. I will list them so they are more easily visible.

    1) Where can I find a clinic/physician who has experience (or specializes) in using/testing these emerging stem cell therapies for knee injuries (ex: ACL reconstruction, torn menisci)?
    2) Would anyone/has anyone attempted to regenerate the patella tendon? The middle third that was removed and used to replace my ACL still causes discomfort after all these years.
    3) Insurance companies should be interested in any treatment alternatives to surgery because they would be the most cost-effective. Joint replacements do not last 20-30 years so they inevitably need to be repeated – they aren’t “one & done” procedures – and the cost of surgery continues to increase as hospital overhead increases. Insurance companies pursuing preventative treatments and nonsurgical interventions as a result of logic and forethought is, admittedly, an oxymoron, but that shouldn’t deter the NIH from conducting research in this area. I thought physicians applied for NIH grants to conduct this type of research. Is that not the case?

    Comment by JLynn — October 6, 2012 @ 10:22 am

  7. hello i have a dwarfism type genetic desease. with bad cartilage and very soft, weak ligament.I have regularly ankle sprain who brother me a lot due to this genetic conditions.I would like undergo stem cell to repair ligament or cartilage but my stem cell are probably not so efficient. how can i get repaired by regnerative methods if my stem cell are not so good.
    i am very interested by this because at 16 i had an ankle sprain who repair in quick time. Now i am 46 years old and it take me so long to repair that i am asking myself if my stem cell are lazy or do not work anymore.
    wil be possible for me to go trough this type of treatment ??? stem cell or tissue ingenieuring
    thanks a lot for your reply

    Comment by christine Etienne — April 3, 2013 @ 7:29 pm

  8. Everyone loves what you guys tend to be up too.
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    Comment by creaciones75.drupalgardens.com — September 24, 2013 @ 6:54 am

    • Thank you for taking the time to read the blog and provide support. Much appreciated.

      Comment by stemcelldoc — September 24, 2013 @ 3:48 pm

  9. Siva,
    Thank you for your inquiry. We have extensive experience and success in treating loose ligaments including the ACL. It is important to have a recent MRI of the knee to evaluate the other important structures in the knee as well as to exclude a complete tear in the ACL. Success varies from patient to patient. Many of our patients have a loose ACL in combination with cartilage damage. Treatment options include prolotherapy, Regenexx SD and Regenexx SCP. If interested you can submit your information on our website: http://www.regenexx.com

    Comment by stemcelldoc — March 13, 2011 @ 6:09 pm

  10. Adam,

    For those patients with ACL issues two things are ciritical:
    1) mirco motion can be identified and corrected thereby stopping the degenerative process.
    2) X-ray or ultrasound guided cellular therapy is a successful and non operative therapy.

    Comment by stemcelldoc — March 22, 2011 @ 9:07 pm

  11. Can this treatment be used for damaged ligaments in elbows and the lower back and if so, is it available on the British NHS? I had a lot of prolotherapy for the above over a period of 2 years and it worked but only lasted about 6-8 months and I think it put too much strain on my immune system as I started, after the first 9 months, to get one long-term virus after another and began also to get sudden awful lower back pain. I wonder, therefore, whether a combination of prolo and stem cell woul be better and work for me – my back is very bad – I cannot walk for more than 10 minutes in a day, and can do little with my right arm before the pain sets in; this is laboriously written with left arm.

    Comment by Vivien Giles — March 21, 2012 @ 2:08 pm

  12. Vivien,
    I am not aware of any clinic that is providing stem cell treatments for orthopedic conditions in Britian. We use the combination of prolotherapy and cell stems frequently in patients with lax ligaments.
    clinical results vary with patient and severity of damage. Please see Regenexx.com for additional information and testimonials.

    Comment by stemcelldoc — March 22, 2012 @ 8:59 am


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