With the increasing data supporting biological repair of certain forms of ACL injury and with the increasing evidence supporting cartilage repair in an injured joint, is there a case for expanding the scope of Bone Marrow Aspirated Concentrate to these increasingly common injuries in the adolescent? For one, the healthiest resource for active and large numbers of mesenchymal derived stem cells is the marrow of an adolescent. There are all kinds of operative approaches for the adolescent presenting with Osteochondritis Dissecans from debridement to whole segment cartilage grafting through open procedures. The net result though of OD in a weight bearing zone is early onset osteoarthritis. There is ever increasing scientific evidence that the adverse long term outcome of joint trauma may be reversed by early application of mesenchymal stem cells. If you add to the treatment algorithm, the cartilage restoration potential of stem cells in the joints of patient’s under age 40, the fact about stem cell repair in adolescents speaks for itself
Turning our discussion to the adolescent Anterior Cruciate Ligament injury, there is no question that said surgical repair has limited survivorship and is only the beginning of a series of revisions over a lifetime. With the recent evidence reported by Regenexx at its annual network meeting, there is a roll for stem cell management of ACL injury in selected cases. Presented were several successfully repaired ACL ruptures in adolescent girls who had sustained recent injury on the athletic field. While we are early in the development of Regenerative Medicine and stem cell treatment for orthopedic injury is still investigational, there are no bridges burned; and just maybe, a lifetime of repeat surgical procedures avoided.
I had occasion on Monday to discuss the stem cell debate with a writer for an orthopedic weekly newsletter. I pointed out that we have been using stem cells in orthopedics for over 70 years whenever we harvest tissue from elsewhere for repairing a defect be it traumatic or degenerative. Bone graft is a means of delivering stem cells to foster bone healing from any cause. Tendon graft is a means of facilitating healing of a traumatic instability, another application of stem cells to effect healing. It just maybe that the legal and payer bottlenecks are the result of lack of clinical understanding of what orthopedics is all about. Would a repackaging of terminology change the stem cell debate in the USA? Stay tuned!
Mitchell B. Sheinkop, M.D.
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