By the same token, what about the frequently associated meniscal tear, will it respond to stem cell management? Assume for the sake of discussion, that a patient sustains a major sports related trauma affecting the knee. The examination either prior to the onset of swelling or 48 to 72 hours or for that matter, 5 years later is compatible with anterior cruciate insufficiency. The MRI is interpreted as indicating a tear of the medial meniscus, an osteochondral lesion of the articular cartilage, and an ACL injury. Is surgery the only option? There is an increasing body of evidence suggesting that certain types of injuries as described above successfully lend themselves to stem cell intervention.
In the case of the ACL injury, if the MRI indicates injury, but not complete anatomic disruption, even if there is functional instability, there is a roll for stem cell management. To determine if the type of ACL injury would lend itself to stem cell therapy, contrast dye is injected into the ACL sheath with the aid of a fluoroscope. Should the dye remain contained within the ACL sheath, that ACL tear can be successfully treated with stem cells and surgery avoided.
The Regenexx web site has several illustrations of meniscal tears successfully treated with stem cell intervention as evidenced by pre and post treatment MRI documentation. As far as the osteochondral injury, that’s the real pain generator and the basis for the later development of osteoarthritis. Please realize that ACL injuries are frequently painless; it is the associated damage to the articular cartilage that causes the delayed onset of pain. Even a torn meniscus may be silent and only manifest with mechanical signs of “clunking” or “snapping”. Pain is the result of cartilage injury and chronic low-grade inflammation.
Returning to the question posed in the title of this Blog, “Might an ACL tear be successfully treated with stem cells?” and surgery avoided, as a Regenexx network affiliate, what follows is a description of the proposed Broomfield clinical trial. Following an acute injury, patients will be randomized to either a stem cell intervention or a non-operative rehabilitation protocol. The interested patient would have to follow up in Broomfield on five separate occasions in year one; hence out of state patients would be discouraged from participation. The clinical trial does not apply to chronic ACL insufficiency or instability. In the setting of a chronic ACL and meniscal tear, the question is surgery versus stem cell management; an active person has already engaged in rehab and has been fitted with a brace. A patient so presenting has already opted to postpone or avoid surgery. I am available to offer stem cell intervention for a chronic ACL injury in lieu of reconstructive surgery just as I am ready to offer stem cells to postpone or avoid a joint replacement for arthritis.