Musculoskeletal Care of the Mature Patient
FROM THE INTERNATIONAL CELLULAR MEDICINE WORKSHOP
Warning: stem cells are not FDA approved for use in orthopedic surgery unless the application is in conjunction with a surgical procedure. Strictly forbidden are staged expansion and any form of “pushing”. Be aware that experimentation is not necessarily research.
When might stem cells be indicated in orthopedics?
Stem cells from Platelet Rich Plasma
Stem Cells from Adipose Tissue
Stem cells from Bone marrow
Stem cells from Aphaeresis (hematopoietic stem cells)
At this time, there is a paucity of published, statistically based evidence to support the use of stem cells in lieu of established safe and successful treatment modalities. The claims for clinical success are anecdotal or published in foreign medical literature. At the same time patients are going offshore and abroad for stem cell management of ligaments, tendons, bone and cartilage. The process involves autologous, adult cell harvesting, separation, activation, and return. If the aforementioned can be accomplished within 45 minutes and as an adjunct to a surgical procedure, I believe the use of autologous stem cells is approved in the United States. While in the described setting, adipose tissue would produce the largest number of stem cells and present machinery would make the application come closer to meeting FDA requirements, the manner of “pushing” is still a concern. Bone marrow by producing less stem cells and thus necessitating a subsequent procedure has little application in the US under FDA standards as now written. Platelet rich plasma may provide some growth factors but a paucity of cells.
Several clinical researchers have been able to use stem cells to heal non-unions. Autologous Mesenchymal Stem Cells have been used to heal segmental defects (> 4 cm) in limited numbers of patients.
When autologous MSCs were transplanted into an animal research model of degenerative disk disease, the treated achieved 91 percent of the height of their disks 24 weeks after transplantation; the control group achieved only 67 percent of disk height
Injuries related to disruption of ligaments or tendons are common and healing of these disrupted tissues results in an inferior-quality tissue. Cell-based therapy is actively being investigated as a new method of treating these injuries.
MSCs have been studied in the repair of meniscal injuries. Tears in the inner third of the avascular region of the meniscus have a limited capability to heal. New studies are beginning to examine whether these same techniques can be used to improve the results of human meniscal repair.
The hope is that stem cells placed near a damaged joint surface will stimulate hyaline cartilage growth.
Tissue engineering procedures are still at an experimental stage. Most tissue engineering is performed at research centers in the United States as part of clinical trials.
Offshore operations: a dangerous scam or are we behind the curve?