Over the last few years there has been a virtual explosion in interest in stem cells and the concept of using stem cells from a person’s own body to rebulld and regenerate damaged or degenerated structures. As far as orthopedic applications go, stem cells are being used for a wide variety of conditions ranging from persistent tendonitis, chronic back pain or rotator cuff issues to full blown “bone-on-bone” osteoarthritis of the knee or hip. These regenerative orthopedic treatments are attractive in that (if done properly) there is virtually no down time, very little risk of complications and, with an experienced and skilled specialist, a pretty good chance of success for a long-term resolution of a problem.
The downside of stem cell treatments? The treatments involve a same-day mini liposuction usually from the abdominal region (most of us are willing to part with a little belly fat!). Also, depending on the joint involved and the skill of the injector, there is usually some mild discomfort with the injections. Finally, unfortunately, most insurance companies do not cover such treatments. Depending on what joints or regions are involved, we are usually talking in the range of 7-11K..
The good news is most people respond to a single treatment and discomfort associated with the injections usually passes in a day or two. It is however important for people to realize that there is wide variation in the quality and hence effectiveness of a stem cell treatment. For optimal results it is most important that the final stem cell preparation has a high total number of free stem cells (usually in the order of a 100 million+). Also it is crucial that people select a Regenerative Orthopedic specialist who is experienced and knowledgable in the evaluation and proper injection of connective tissue structures..
As far as stem cells go, there is debate in the regenerative orthopedic community whether we should use stem cells from bone marrow as well as those from abdominal fat. In our opinion, fat is much superior in that it represents a far richer store of adult mesenchymal stem cells. Also, we feel that a mini-addominal liposuction is less invasive and generally better tolerated by patients. Although many protocoals use only 30 CC’s of fat at our center we like to take at least 60 cc’s of fat to work with (which will yield double the total number of stem cells). In addition, we then use a proprietary enzymatic process to dissolve the fat and release the stem cells. Since stem cells are like little workers that have homing characteristics to damaged tissue it is most important that they be free so they can do their thing. Also, PRP (Platelet Rich Plasma) should be mixed with the stem cells prior to injection to activate and energize them. The PRP is the fertilizer and the stem cells are the seed.
In short, the way the stem cells are harvested and prepared makes a huge difference to the effectiveness of the treatment. At our center we have fine tuned our harvesting and processing procedures to make sure the stem cell preparation is optimal in number and quality prior to injection.
Regarding the criteria of choosing the right Regenerative Orthopedic specialist. Once you have the stem cells, the second crucial parameter is to put them as close as possible to the damaged or degenerated structure(s). This begs the question of exactly how do we know which structures are involved and precisely where the problem is?
It is important to understand that injecting joints, ligament and tendon attachments is a sub-specialty onto itself. It is most important that the specialist has superior palpation skills since palpation and looking for the “jump sign” is by far the most important diagnostic test to find exactly which structures are damaged and properly diagnose the “primary pain generators”. Unfortunately, MRI of limited value in Regenerative Orthopedics since it is not sensitive enough to pick up the subtle sprains and strains that are so often a major part of the problem. Ultrasound can be helpful for certain situations but in the absence of palpation skills may be quite misleading. In short, Regenerative Orthopedics is a hands-on specialty. After hearing some history, an experienced specialist should be most interested in palpating suspected regions and structures in order to make a correct diagnosis and treatment plan.
When a joint or region is addressed it is vital that not only the joint be injected but also the supporting joint capsule, ligaments and tendon attachments since they are very often a very important part of picture. These accessory connective tissue structures are highly innervated tissues that are the major pain generators in the musculoskeletal system. Unfortunately they are commonly overlooked. In my opinion these structures must be addressed as well the joint itself for an optimal outcome. In my experience the best injectors have a background in Prolotherapy, which is the science and art of assessing and injecting connective tissue structures.
So, can stem cells regenerate your joints? The answer in most cases is a resounding yes. If they will or not no one can tell for sure but if you find a good Regenerative Orthopedic specialist who uses a good protocol (i.e. high count of free cells) your chances of success increase significantly. Stem cells are the power of nature that, if properly placed, can heal a whole host of musculoskeletal and orthopedic conditions in a most efficient and elegant manner. We often stand in awe as we observe what they can achieve.
