The Clinical Application of Mesenchymal Stem Cells for the Mature Athlete

Mesenchymal Stem Cells (MSCs) hold great promise for regenerative therapies in the musculoskeletal system.  Controlled MSCs delivery is generally perceived as safe and the number of clinical trials is rapidly increasing.  Their application is thought to be the most promising approach to cell based orthopedic tissue regeneration for the clinical setting.  In this Blog, I will summarize the current state of Mesenchymal Stem Cell application.

A successful regenerative approach in my practice is based on the harvest of cells from bone marrow; aspiration from the iliac crest. The Bone Marrow Aspirate is then concentrated and the number of cells counted to assure the quantity injected into the diseased tissue meets minimum requirements.  The injected cells eventually populate the targeted site and stimulate repair.  Examples of such direct approaches are MSC injection therapies for the treatment of arthritis, Avascular Necrosis, non-union of fractures, tendinitis or tendon ruptures.  Just as important as the quantity of stem cells aspirated at the time of the procedure is the quality of those cells. The patient’s age, a history of smoking, the use of statins and anti-inflammatories all play a role in the quality of the stem cell.  The use of cells within less than four hours from the harvest has the advantage that cells have not been grossly manipulated and subjected to stress factors that may impair their regenerative functions.

Bone Regeneration

In the last 10-20 years, a number of clinical studies have shown that bone marrow concentrate can be efficiently used to stimulate bone healing

Large Bone Defects and Nonunion

In the clinical setting, bone marrow concentrate has been responsible for the healing of tibial and femoral non-unions as well as high tibial osteotomies.

Arthritis

For the treatment of arthritis, the intraarticular injection of MSC suspension represents the simplest approach.  Using such an approach, cells are distributed throughout the joint space to provide their therapeutic effects. Animal studies have shown that autologous stromal stem cell suspensions were able to mediate regeneration of menisci, along with the reduction of arthritic changes to the cartilage including osteophyte remodeling, and reversal of subchondral sclerosis.

Tendon

Cell-based treatment has long been recognized as beneficial. There is yet another option to BMAC for those who don’t qualify, Platelet Rich Plasma concentrate.

While the clinical application of PRP has been added to the sports medicine and orthopedic community repertoire to enhance healing for almost all musculoskeletal tissues, the better understanding of the balance between Interlukin1 receptors and antagonists has led to the development of concentrated PRP and what concentration to offer a patient at different ages. It is increasingly believed that cellular entities derived from bone marrow aspirate concentrate are necessary to maximize the healing potential of PRP at any concentration

As an orthopedic surgeon attempting to postpone or avoid the need for joint replacement, each patient I treat is enrolled in an outcomes database.  In my first end of the year outcomes observations of patients treated in 2012, it becomes apparent that while the vast majority are realizing their goals pertaining to Regenerative Medicine therapy, there is room for increasing successes. To that ends, I will be introducing a repeat Bone Marrow Aspiration Concentrate therapy for those with low cell count numbers at the time of the initial procedure or where the quality of those mesenchymal stem cells was less than optimal.

Without a cell count, the treatment most likely won’t count.

As a father and grandfather, I wish to add my thoughts to these days of sorrow. Keep the lights burning this holiday season. To quote Peter Yarrow of Peter, Paul and Mary “Don’t let the light go out! It’s lasted for so many years. Don’t let the light go out! Let it shine through our love and our tears”