Arthroscopic surgery and stem cells – the best of both worlds?

The healing potential of stem cells are so exciting that surgeons believe that it can make arthroscopic surgery much more successful. Here is an 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

Based on editorials and accompanying studies like those above, it is becoming more and more apparent that stem cells 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 suggest:

“A new bone-marrow-derived mesenchymal stem cells technique has been developed for the treatment of osteochondral lesions of the knee. (The excitement is over a new surgical technique).

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 osteochondral lesions of the knee at three years of follow-up.”2

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 and alternative to knee replacement 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.”3

In other words, in surgery they could not pinpoint the delivery of the growth factors. The need to develop a scaffold or a “soil” for the stem cells to grow in and take root is necessary.

Writing in the medical journal titled Arthroscopy, research 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.” 4 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 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?”5

 

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

2 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.  [Pubmed] [Google Scholar]

3. 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.  [Pubmed] [Google Scholar]

4. 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.[Pubmed] [Google Scholar]

5. 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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