Stem cell therapy is an alternative to traditional ankle surgery as highlighted in the case discussed below.
KW is 21 y/o Oklahoma State University field and track athlete who was unable to compete due to ankle pain.
Pain was constant, 5/10 in severity and localized deep in the joint. Aggravating factors included running, weight-bearing and bending of the ankle.
Patient had a longstanding history of ankle sprains and had undergone high dose aspirin therapy as child due to a diagnosis of juvenile arthritis.
Treatment to date included NSAIDs, oral steroids, steroid and Synvisc injections into the ankle without x-ray and ultrasound guidance.
Ankle MRI was significant for degenerative changes in the joint, inflammation of the synovium and sprain of the 2 principle lateral ankle ligaments.
Patient initially underwent prolotherapy and Regenexx SCP in an effort to stabilize and strengthen the loose ankle joint followed by Regenexx SD to treat cartilage loss. Stabilization is critical as discussed in Ortho 2.0.
6 months after starting regenerative therapy I received this e-mail which she has allowed me to share.
“Besides that minor flare, I have had really promising results. I understand that my body has set limitations, and I may never be permitted to run 60 miles or more a week like before, but I am just grateful that I am back on the track completing workouts with my team. I run every other day (which are “work-out” days consisting of heavy pounding on a hard track surface) and cross train on days in between. I have also began doing olympic (short reps, but heavy and explosive) weight training without any irritation. I started doing ladder speed drills and hurdles drills this week, and have noticed no pain.”
Stem cell therapy is a alternative to traditional orthopedic knee surgery. Mesenchymal stem cells (MSC) can differentiate into cartilage, bone, tendon, ligament and disc. Studies have demonstrated that the use of cultured expanded mesenchymal stem cells are both safe and effective in the treatment of knee osteoarthritis.
Does it matter how the stem cells are delivered to a targeted area?
In the case of soft tissue this is not a concern since the surrounding tissue will confine the spread of the stem cells to the targeted area.
In the case of a joint such as the knee the delivery of cells is of critical significance. The key is that stem cell function through local attachment to the damaged site. Animal studies have demonstrated that cells injected into a large joint often times have difficulty finding their way to the damaged area.
The key is delivering stem cells directly into the damaged site. Koga demonstrated this by comparing the results of blindly injecting stem cells into a joint vs dripping the cells directly into the damaged area. The illustration below tells the story. A defect in the cartilage was created and different methods of delivery were examined. On the left there was minimal cartilage growth after the injection of saline. In the middle there was minimal cartilage growth after blindly injecting stem cells into the joint. On the right where cells were injected directly into the area of damaged there was robust cartilage growth. The new cartilage is purple in color.
Bottom Line: The exact placement of stem cells within a joint is of critical importance.
At the Centeno-Schultz Clinic we utitlize x-ray and MSK ultrasound to guide bone marrow and platetlet derived stem cells into the area of damaged tissue to maximize clinical outcomes.
The Centeno-Schultz Clinic offers PRP, prolotherapy and bone marrow and platelet derived stem cell therapies. An understanding to function and stability is essential and is covered in Ortho 2.0. Direct visualization using MSK ultrasound or x-ray is our standard to ensure accurate placement and to avoid the complications associated with blind knee injections.
Muscle and tendon function is critical to the knee joint health. A brief review of the anterior compartment is helpful.
The quadriceps is a group of large muscles in the front of the thigh. It consists of four major muscles:
Rectus femoris: A large muscle that covers most of the other, deeper quadriceps muscles.
A tendon is a fibrous band of connective tissue that connects the muscle to the bone. The quadriceps tendon attaches the quadriceps muscles to the patella.
Quadriceps control knee extension and stabilize the kneecap (patella).
Pain can arise from the quadriceps tendon due to inflammation, chronic degeneration or tear. A tear can be either partial or complete and is usually the result of trauma. Tendon weakness predisposes to tears. Conditions that can lead to tendon weakness include quadriceps tendonitis, chronic diseases, steroid use, immobilization and the use of a class of antibiotics called fluoroquinolones.
Stem cells have been successful in the treatment of common orthopedic injuries which include knee osteoarthritis, meniscus tears, quadriceps and patella tendonosis and ACL laxity. Ortho 2.0 discusses our comprehensive approach at the Centeno-Schultz Clinic.
Stem cells have also been successful in treatment of some neurologic and cardiac disorders. The world witnessed the successful creation of a trachea utilizing stem cell technology.
Stem cells are available for many sources which include blood, fat (adipose), muscle, synovial fluid and bone marrow.
For orthopedic applications does it matter where the cells come from?
Stem cells derived from the bone marrow are best for orthopedic applications as discussed in recent chapter authored by Dr. Centeno.
Regenexx is a bone marrow derived stem cell treatment for common orthopedic conditions. The procedure involves harvesting bone marrow from the iliac crest(waist bone) and processing it in a state of the art lab. Clinical differences are accomplished when processing of cells is performed by a stem cell biologist vs a bedside centrifuge. This is part of the Regenexx difference. The laboratory is accredited through the International Cellular Medicine Society and tracks patients in a non-profit registry.