Ortho Stem Cell Treatments: The Importance of Delivery

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.

Orthopedic Stem Cells: Cell Sources

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?

Yes!

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.

Recovery from Stem Cell Therapy

Knee surgery often requires significant post procedure rehabilitation.

Microfracture, a common surgical procedure designed to create new joint cartilage, requires 6-8 weeks of non weight bearing after surgery.  This can lead to muscle weakness, joint stiffness and significant post procedure physical therapy.

CB, a professional athlete, despite undergoing two knee surgeries continued to have significant knee pain and limited range of motion.  CB was unable to climb stairs or run without significant pain.  Instead of undergoing an additional surgery, CB elected to use his own expanded stem cells using the Regenexx procedure.

 CB underwent additional therapies at the Centeno-Schultz Clinic which  included  prolotherapy to tighten loose ligaments and lumbar epidural injections with platelet derived growth factors. Compared to many orthopedic surgeries which require limited activity and extensive physical therapy, CB’s postprocedure restrictions were minor:  no high impact activity such as running and the use of an un-loader brace for 2 weeks. 

Several weeks following stem cell therapy, CB reports 85% improvement in his range of motion and knee pain.  He wanted to challenge himself so he tackled Vail Mountain.  Looking sharp…….

Ultrasound And Stem Cell Differentiation

Mesenchymal stem cells have the potential to change into bone, cartilage, ligament or fat.  In a previous blog, I discussed the importance of exercise in providing clues to the mesenchymal stem cells to change into cartilage.

Are there other factors which provide clues to mesenchymal stem cells?

Schumann et. al., demonstrated that low intensity pulsed ultrasound (LIPUS)  made a significant difference in prompting mesenchymal stem cells to morph into cartilage.  At Regenexx, where patients are afforded the opportunity to utilize their own mesenchymal stem cells,  now utilizes LIPUS   in all patients with cartilage damage.  It is critical that the correct stem cells are placed in the correct location and provided every opportunity to prosper as well as to change into the desired tissue.  That is our commitment at Regenexx.

Exercise Directs Path of Mesenchymal Stem Cells

Mesenchymal stem cells(MSC) can morph into ligament, cartilage, bone or fat.   How and why they differentiate is critical.    Sen et. al., recently demonstrated that mechanical stress (the laboratory equivalent of exercise) lead mesenchymal stem cells to differentiate into bone instead of fat, even if they are given chemical signals to become fat.  What does this mean?  MSC can become fat cells simply by lack of exercise.  There are other factors which give MSC’s clues to turn into fat vs cartilage, bone or ligament.

If you are a patient with worn knee cartilage and are restricted as a result of pain, one surgical option would be micro-fracture. 

This is a surgical procedure where multiple small punctures are made into the femur(thigh) bone in an effort to stimulate cartilage regeneration.  A fragile thin clot is formed at the site which mandates a period on 6-8 weeks of non-weight bearing.  No running, golfing, cycling.  No fun! 

Multiple Puncture Sites From Micro-Fracture

Regenexx offers patients the opportunity to use their own MSC’s to generate cartilage via a needle-in, needle-out procedure.  No surgery is required.  Most importantly, the physical restriction are minimal.  In contrast to micro-fracture technique, the Regenexx patient is encouraged to exercise.  The mechanical loading associated with exercise gives the stem cells signals to change into cartilage.

Please review knee MRI of a patient who underwent stem cell therapy at Regenexx with radiographic evidence of increased cartilage as well as complete resolution of her severe  knee pain.

Recovery from knee replacement surgery

Recovery from knee replacement surgery is extensive.  The knee is a complex joint which involves muscles, ligaments and cartilage.

 

 

 

Knee replacement surgery is a major undertaking and involves cutting the ends of both the femur and the tibial plateau not to mention the supporting muscles and ligaments.  A prosthesis is then inserted with the expectation that it will fit correctly and function similar to one’s God given joint. 

 

Risks of knee replacement surgeryinclude but are not limited to blood clot formation, infection, stiffness, implant loosening and failure.  Revision of total knee implants are ………………  The patient is also exposed to the inherent risks of anesthesia.

Postoperatively the patient is placed in a continuous passive motion machine (CPM) that constantly moves the knee.   Next the patient transitioned to a walker or crutches with extensive and often painful physical therapy.  Physical therapy while time consuming and painful not only  is essential but  is a critical part of the rehabilitation.

Now patients have an alternative to knee surgery, knee replacement and the extensive post knee surgery recovery process.  Regenexallows a patient to use their own stem cells to regenerate damaged cartilage.  Centeno published a study which clearly demonstrated an increase in knee  cartilage after stem cell therapy.  Avoid the lengthy painful recovery from knee replacement surgeryby using our own stem cells. To hear a testimonial of a patient who underwent stem therapy rather than surgery please click on video .

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