Stem Cells

Stem cells are precursor cells that can differentiate into other, more specialized cells. They are often used in the sports medicine field as well as in cardiology, gastroenterology and orthopedics.

Mesenchymal stem cells (MSCs) are utilized to help treat sports-related injuries because of their capacity to differentiate into chondrocytes (cells that produce new cartilage) and osteoblasts (cells that produce new bones). MSCs are found in blood, fat, and bone marrow. Dr. Robert uses all three, as well as platelets (PRP), to help the stem cells grow For indications such as:

    1. Osteoarthritis (OA): The goal of this procedure in OA treatment is to restore and regrow the new cartilage. This can decrease pain and inflammation, improve the quality of the patient’s life (permits the return to activity), and postpone or even eliminate the need for surgery. However, this procedure is only one part of the recovery. If required, the patient may need to lose weight, obtain orthotics, and/or correct any patella mistracking pattern or abnormal gait. The patient will be asked to do physical therapy twice a week for the first month following the procedure, as well as take supplements (provided for the first month). Dr. Robert will measure the patient’s body composition to make sure it is in an anabolic state (growing tissue) and not in a catabolic state (destroying tissue). The patient will be asked to refrain from activity while providing the body with all the nutrients needed to repair tissue. Therefore, it is not recommended to go on a diet for the first month following the procedure.
    2. Other procedures: Stem cell injections can also be used for osteochondral defects (OCDs), AVN, stress fractures, and meniscus tears.

BIBILIOGRAPHY

  1. Murphy JM, Fink DJ, Hunziker EB, Barry FP, et al. Stem cell therapy in a caprine model of osteoarthritis. Arthritis & Rheumatism, 48 (12): 3464-3474, December 2003.
  2. Rose NB and Dellon AL: Epicondylitis and Denervation Surgery. Current Orthopaedic Practice, 25 (5): 446-452, September/October 2014.
  3. Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind study, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42: 463-471, 2014.
  4. Mascarenhas R, Salzman BM, Fortier LA, et al. Role of platelet-rich plasma in articular cartilage injury and disease. J Knee Surg, 28(1): 3-10. February 2015.
  5. Gosens T, Peerbooms JC, van Laar W, et al. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind ramdomized controlled trial with 2- year follow up. Am J Sports Med, 39:1200-1208, 2014.
  6. Anz AW, Hackel JG, Nilssen EC, Andrews JR: Application of biologics in the treatment of rotator cuff, meniscus, cartilage, and osteoarthtis, J AM Acad Orthop Surg. 22(2): 68.-79, February 2014.
  7. Pham PV, Bui KH, Ngo DQ, et al. Activated platelet-rich plasma improves adipose-derived stem cell transplantation efficiency in injured articular cartilage. Stem Cell Res Ther, 4(4):91, August 2013.
  8. Orth P, Rey-Rico A, Venkatsesan JK, et al. Current perspectives in stem cell research for knee cartilage repair. Stem Cells Clon, 7:1-17, January 2014.
  9. Michalck J, Moster R, Lukac L, et al. Autologous adipose tissue-derived stromal vascular fraction cells application in patients with osteoarthritis. Cell Transplant, January 2015.
  10. Xia P, Wang X, Lin Q, et al. Efficacy of mesenchymal stem cells injections for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop, May 2015.
  11. Centeno CJ, Schultz JR, Cheever M, et al. Safety and complications reporting update on the re- implantation of cultre-expanded mesenchymal stem cells using autologous platelet lysate technique. Curr Stem Cell Res Ther, 2011; 6:368-378.
  12. Davatchi F, Abdollahi BS, Mohyeddin M, et al. Mesenchymal stem cell therapy for knee osteoarthritis. Preliminary report of four patients. Int J Rheum Dis, 20411; 14:211-215.
  13. Emadedin M, Aghdami N, Taghiyar L, et al. Intra-articular injection of autologous mesenchymal stem cells in six patients with knee osteoarthritis. Arch Iran Med, 2012; 15:422-428.
  14. Lee KB, Wang VT, Chan YH, et al. A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic micro-fracture and injections of mesenchymal stem cells and hyaluronic acid-a prospective comparative study on safety and short-term efficacy. Ann Acad Med Singapore, 2012; 41:511-517.
  15. Wakitani S, Okabe T, Horibe S, et al. Safety of autologous bone marrow-derived mesenchymal stem cell transplantation for cartilage repair in 41 patients with 45 joints followed up for 11 years and 5 months. J Tissue Eng Regen Med, 2011; 5: 146-150.
  16. Teo BJ, Buhary K, Tai BC, et al. Cell-based therapy improves function in adolescents and young adults with patellar osteochondritis dissecans. Clin Orthop Relat Res, 2013; 471: 1152-1158.
  17. Kasemkijwattana C, Hongeng S, Kesprayura S, et al. Autologous bone marrow mesen-chymal stem cells implantation for cartilage defects: two cases report. J Med Assoc Thai, 2011; 94:395-400.
  18. Vangsness CT Jr, Farr J II, Boyd J, et al. Adult human mesenchymal stem cells delivered via –intra- articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am, 2014; 96:90-98.
  19. Pak J, Lee JH, Lee SH. A novel biological approach to treat chondromalacia patellae. PLoS One, 2013; 8e64569.
  20. Orozco L, Munar A, Soler R, et al. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: a pilot study. Transplantation, 213; 95:1535-1541.
  21. Jo CH, Lee YG, Shin WH, et al. Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial. Stem Cells, 2014;32:1254-1266.
  22. Saw KY, Anz A, Merican S, et al. Articular cartilage regeneration with autologous peripheral blood progenitor cells and hyaluronic acid after arthroscopic subchondral drilling: a report of 5 cases with histology. Arthroscopy, 2011;27:493-506.
  23. Orozco L, Munar A, Soler R, et al. Treatment of knee osteoarthritis with autologous mesenchymal stem cells: two-year follow-up results. Transplantation, 2014; 97:e66-68.
  24. Centeno CJ, Schultz JR, Cheever M, et al. Safety and complications reporting on the re-implantation of culture-expanded mesenchymal stem cells using autologous platelet lysate technique. Curr Stem Cell Res Ther, 2010;5:81-93.
  25. Centeno CJ, Freeman MD. Percutaneous injection of autologous, culture-expanded mesenchymal stem cells into carpometacarpal hand joints: a case series with an untreated comparison group. Wien Med Wochenschr, 2014;164:83-87.
  26. Koh YG, Jo SB, Kwon OR, et al. Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy, 2013; 29:748-755.
  27. Koh YG, Choi YJ, Kwon SK, et al. Clinical results and second-look arthroscopic findings after treatment with adipose-derived stem cells for knee osteoarthritis. Knee Surg sports Traumatol Arthrosc, 2015; 23:1308-1316.
  28. Randelli et al (2014) Regenerative medicine in rotator cuff injuries. Biomed Res Int. 2014:129515 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145545/pdf/BMRI2014-129515.pdf
  29. Centeno et al. (2015) A prospective multi-site registry study of a specific protocol of autologous bone marrow concentrate for the treatment of shoulder rotator cuff tears and osteoarthritis. J Pain Res. 2015 Jun 5:8:269-76. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463777/pdf/jpr-8- 269.pdf
  30. Hernigou et al (2014) Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014 Sep:38(9):1811-8 http://www.ncbi.nlm.nih.gov/pubmed/24913770 http://link.springer.com/article/10.1007%2Fs00264-014-2391-1#page-1
  31. Ajibade et al.(2014) Emerging Applications of Stem Cell and Regenerative Medicine to Sports Injuries. Orthop J Sports Med.2014 Feb 6;2(2):2325967113519935 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555618/pdf/10.1177_2325967113519935.pdf
  32. Hak et al. (2015) A Double Blinded Placebo Randomized Controlled Trial Evaluation Short-term efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair: A Pilot Study. Sports Health. 2015 Jan;7(1)58-66 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4272693/pdf/10.1177_1941738114548413.pdf
  33. Scapone et al. (2013) Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study. Glob Ady Health Med. 2013 Mar:2(2):26-31 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833522/pdf/gahmj.2012.054.pdf
  34. Saltzman, Bryan M., MD, Benjamin D. Kuhns, MD, Alexander E. Weber, MD, Adam Yanke, MD, and Shayne J. Nho, MD, MS. “Stem Cells in Orthopedics: A Comprehensive Guide for the General Orthopedist.” The American Journal of Orthopedics. N.p., 27 June 2016. Web. http://www.amjorthopedics.com/specialty-focus/biologics/article/stem-cells-in-orthopedics-a-comprehensive-guide-for-the-general-orthopedist/0f69edd5e4752103279b01489f829dce.html https://au.news.yahoo.com/video/watch/30973494/relief-for-hip-and-joint-pain-sufferers-as-world- first-stem-cell-trial-regrows-damaged-cartilage/ – page1