What is the Stem Cell Procedure?
The techniques we use for Stem Cell is The Gold Standard for stem cell regeneration. We use all four kinds of regenerative Orthopedics for this procedure. Many other clinics only use one or two of these procedures, but not all four. We use bone marrow stem cells as well as adipose (fat) stem cells. Both solutions are then centrifuged and concentrated to get a solution with the highest amount of stem cells. We inject both of these sources of stem cells and then use PRP Therapy to accelerate their healing. In addition, we use Dextrose Prolotherapy on the outside of the joint to help stabilize the ligaments and tendons that hold the joint in place. Using two sources of stem cells (bone and fat) as well as PRP Therapy and Dextrose Prolotherapy is The Gold Standard for stem cell regeneration. Again, this procedure is usually used for cases where one has been told to have their joint replaced, have bone-on-bone, advanced arthritis, severe meniscus or labral tear or other aggressive injuries. This is only recommended after a very thorough history and physical exam. It is important to have an x-ray to confirm what is known from the above exams. Not everyone is a candidate for this procedure, but many are.
Remember that once surgery is done, it cannot be un-done!
Types of Stem Cell and the Research:
BONE MARROW STEM CELLS
Stem cells are contained within bone marrow. This has been shown in studies for many years now. Harvesting them from one’s own body eliminates the possibility of cross reaction or rejection since it is your own body supplying the stem cells. This autologous (obtained from oneself) bone marrow aspirate contains not only mesenchymal stem cells (cells that are able to develop into the tissues such as bone and cartilage) and progenitor cells, which are a different type of stem-like cell. Bone marrow also contains other cells that produce growth factors and cytokines (cells that affect the behavior of other cells). These cytokines aid in fibroblastic proliferation. Fibroblasts are cells that synthesize the structural framework. Stem cells have the ability to form tissues like bone, cartilage, labrum, meniscus, ligaments and more. All this allows for repair and remodeling of cartilage, bone and other soft tissue structures such as meniscus, labrums, ligaments and tendons.
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ADIPOSE STEM CELLS
On the other hand adipose tissue is also a rich source of adult stem cells. These cells, harvested from one’s own fat, have an extensive proliferative capacity and can differentiate into multiple cell lines. Stem cells derived from adipose tissue can differentiate ligaments, bone, cartilage, muscle or ligaments. This type of stem cell is now being used in musculoskeletal medicine to regenerate not only the above tissues but to provide a scaffolding to hold the stem cells in place and allow them to grow. Adipose derived stem cells are similar but not identical to bone marrow cells.
Not all injuries require stem cells to heal. The success rate with traditional Prolotherapy (both Dextrose and PRP) is in the 90%+ range for all patients. However, for those cases of advanced arthritis, severe meniscus tears or labral tears, bone-on-bone, aggressive injuries or where one has been told to have their joint replaced, some may need to use Stem Cell Prolotherapy to regenerate the defective joint. I use this in combination with PRP Prolotherapy (to accelerate the stem cell healing) and with Dextrose Prolotherapy (to strengthen and stabilize the surrounding support structures).
As more and more research comes out, what is known by a few physicians is being proven. A recent research study was conducted and titled, “Transplanted bone marrow and fat mesenchymal stem cells with platelet-rich fibrin glue scaffold stimulates full-thickness cartilage defects to heal.”
Several human studies using bone marrow and fat stem cells for articular cartilage lesions have been done. Articular cartilage is a type of cartilage that covers joint surfaces and is most susceptible to injury compared to other types of cartilage. Researchers at Cairo University School of Medicine and the University of Pittsburgh School of Medicine reported on the use of bone marrow mesenchymal stem cells and a platelet-rich fibrin scaffold to heal full-thickness cartilage defects in five patients. The researchers studied the treatment results from the bone marrow mesenchymal stem cells with success.
Articular Cartilage has limited repair capacity and marrow-stimulation procedures such as micro fracture, osteochondral grafts and autologous cartilage implantations have had limited success in articular cartilage defects. The researchers from this study chose mesenchymal stem cells from bone marrow because these have the ability to differentiate into cartilage cells. In the case of these five patients the bone marrow was harvested from the iliac crest (hip bone).
Platelets were used as a scaffold because platelets contain various growth factors that stimulate cartilage regeneration. The researchers expected that the biological effect of multiple growth factors on tissue regeneration is greater than that of a single growth factor.
The patients showed significant functional improvement. Two of the patients underwent arthroscopy after the transplantation and showed near normal articular cartilage. Three postoperative MRIs revealed complete healing and congruent cartilage tissue, whereas two patient MRIs showed incomplete (it was partial and not 100% complete) congruity in the cartilage tissue.
The researchers concluded that the transplantation of autologous culture-expanded bone marrow-mesenchymal stem cells in platelet rich-fibrin glue shows great promise in the treatment of full-thickness articular cartilage defects, particularly large-sized defects (>4 cm). The positive 1 year clinical outcomes support further randomized controlled clinical trials of this treatment modality with larger numbers of patients and longer follow-up periods.
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