By Phillip Steele, MD RMSK CAQ Sports Medicine
Performance Injury Care & Sports Medicine
I recently reviewed an article that discusses the merits for stem cell therapy after meniscus surgery. Although this article showed the value of stem cell therapy after surgery, one should only wonder if the stem cell therapy should have been conducted before considering meniscus surgery. Some highlights of the study and article are included below.
Based on research published in the Journal of Bone and Joint Surgery (JBJS), knee arthroscopy procedures are performed more than one million times annually in the US. The majority of these surgeries are for the surgical repair or partial excision of meniscal tears. JBJS further stated in this article: “Unfortunately, the failure rate of approximately 20 to 24 % has not substantially changed even with the advent of all-inside (arthroscopic) surgical techniques.“
This paper titled in JBJS “Adult Human Mesenchymal Stem Cells Delivered Via Intra-Articular Injection to the Knee Following Partial Medial Meniscectomy” (removal of meniscus) – concluded that, “The results of this study suggest that mesenchymal stem cells (MSC) have the potential to improve the overall condition of the knee joint.”
The research conducted was a randomized, double blind, controlled study of MSC delivered by a single intra-articular injection after partial meniscectomy. The study included sixty patients between the ages of sixteen and sixty who were randomly assigned to one of three treatment groups – one group receiving 50 million human mesenchymal stem cells, another receiving 150 million stem cells, and a control group.
For those of you reading this without a foundation in cell biology, ”Mesenchymal stem cells are connective tissue cells that can differentiate into a variety of cell types, including articular cartilage and meniscal tissue.
These cells have also demonstrated significant anti-inflammatory effects that appear to alter the course of osteoarthritis.
According to the conclusion of this article, “Mesenchymal stem cells can not only improve the outcome of patients who have had a meniscectomy, but also who have a meniscectomy in the presence of osteoarthritis (OA).”
Further this article discusses “that patients can potentially avoid a surgical procedure with injections of mesenchymal stem cells. Research on patients with osteoarthritis show 93% of patients report some improvement with pain and function and at 1 year follow-up, patients average 72% improvement in pain and 50% improvement in function.”
The stem cell protocol used in this article has the, “Patients receive 3 injections on the day of the procedure, which include platelet-rich plasma (PRP), adipose derived stem cells, and bone marrow stem cells. These patients follow-up at 6 weeks, 18 weeks, and 1 year. The bone marrow and adipose stem cells are not repeated, however the patient may receive a PRP injection at the 6 week and 18 week follow-up, depending on level of improvement.”
Finally, the article ponders why are patients with osteoarthritis improving? “The reason patients are improving is due to the fact that stem cells decrease the inflammation associated with osteoarthritis and are nourishing existing cartilage cells, allowing the cells the potential to repair. The stem cells can also differentiate into new cartilage cells.”
This is another research paper showing that stem cell or regenerative therapy with PRP, Adipose derived stem cells (ADSC) and bone marrow concentrate (BMC) helps slow the progression of osteoarthritis and may help decrease the need for meniscus surgery in some patients.