Articular cartilage, found on the surface of most musculoskeletal joints, distributes and transfers forces between bones and joints, provides a smooth surface for joint mobility, and plays an important role in human mobility.
However, articular cartilage is also easily susceptible to damage, but difficult to repair itself on its own (primarily due to the fact it is mostly avascular). Over time, the inability of articular cartilage to repair itself leads to progressive joint pain, disfigurement, movement disorders, and ultimately osteoarthritis.
The CDC estimates that nearly 33 million Americans are currently affected by osteoarthritis, most often in the form of pain, stiffness, decreased mobility and range of motion, and swelling in the joints.
Current treatment methods, including microfracture technology, autologous or allogeneic cartilage transplantation, and autologous chondrocyte implantation (ACI) have demonstrated the ability to repair and regenerate fibrous cartilage, but not articular cartilage required for smooth, fluid, natural mobility.
To address this issue, recent research has focused on the efficacy of stem cells, and specifically mesenchymal stem cells (MSCs) found in bone marrow, adipose tissue, synovial membrane, and umbilical cord Wharton’s jelly, as potential therapeutic treatments for regeneration of articular cartilage. MSCs are particularly of interest due to their demonstrated abilities of self-renewal, multi-differentiation, and immunoregulation.
While the use of MSCs has demonstrated tremendous potential in the field of regenerative therapy, one notable drawback continues to be unstable or suboptimal results resulting from the heterogeneity of various mesenchymal stem cells.
Specifically, the stability and efficacy of MSCs appear to differ based on a number of factors, including the donor, the tissue source, and their ability for proliferation, differentiation, and immunoregulation.
For example, some of the key heterological differences highlighted in this review include the efficacy of MSCs based on donor’s age (with younger donors providing higher quality MSCs), Wharton’s Jelly MSCs showing greater prospects for application in cartilage regeneration than other MSCs, and differences within specific MSC subpopulations.
The authors of this review acknowledge the potential of MSCs in repairing arterial cartilage, but also point out that there needs to be a deeper understanding of the heterogeneity of various MSCs in order to improve the efficiency of MSC-based therapies designed to repair arterial cartilage. In addition, the authors also call for greater standardization in MSC isolation and harvesting methods among laboratories in order to provide better consistency with respect to results obtained from studies using MSCs.
Research exploring the benefits of mesenchymal stem cells (MSCs) has demonstrated tremendous potential as a regenerative therapy option for the musculoskeletal system. Research into these cell-based regenerative therapies is promising, and they must continue to provide the data necessary to show their therapeutic potential in clinical settings.
In this review, Steinert et al. review and summarize some of the promising and unique therapeutic features of adult MSCs, detail their current state of clinical application as a regenerative musculoskeletal therapy, and describe the potential for future developments in this field.
Specifically, as a part of this review, the authors share the status of 31 clinical cell therapies for musculoskeletal regeneration occurring between 1996 through 2011 and specifically covering bone defects and nonunions, avascular necrosis of the hip, cysts and benign tumors of the bone, cartilage lesions, and tendons and ligaments; results for the majority demonstrate the safety of and/or the efficacy associated with the specific method of cell-delivery being evaluated.
The field of regenerative orthopedics points to the large body of MSC clinical research indicating the successful treatment of myocardial infarction, post-stroke or spinal cord injury nerve regeneration, graft versus host disease, and a variety of other conditions as an indication that the application has tremendous potential as a regenerative therapeutic option in a wide variety of musculoskeletal indications.
Although there appears to be evidence demonstrating the paracrine and trophic functions of MSCs, research explaining the specifically demonstrated therapeutic effects is still being determined. The authors highlight that research continues to explore the reasonable therapeutic expectations associated with MSC-based treatments, an essential step required to fully understand the range of healing associated with musculoskeletal regenerative cell-based therapy.
The authors, in concluding this review, point out that the demand for MSC-based musculoskeletal regenerative therapies continues to increase. Steinert et al. call for further study into the specific combination of cell preparation, bioactive factors, and stimuli for each specific MSC therapeutic application. Once these have been demonstrated for each application and should they demonstrate better or improved outcomes compared to standard treatments, only then can they be considered for long-term clinical application.
Recent breakthroughs in the field of regenerative medicine continue to support the tremendous healing potential of stem cell therapy. Until a few years ago, stem cell research was limited to only what could be gathered from the research gathered from embryonic stem cells; this research was limited by the well-documented ethical concerns surrounding the practice of harvesting stem cells from embryonic sources.
Fortunately, alternative – and less controversial – sources of stem cells, harvested primarily from autologous bone marrow and adipose tissue have demonstrated promise in treating many diseases ranging from autoimmune conditions to myocardial infarctions.
Considering this, the ability of adult stem cells to undergo division and multipotent differentiation has garnered the attention of spinal surgeons and specialists around the world, specifically for the potential benefits of these stem cells in the treatment of a variety of spine issues related to neural damage, muscle trauma, disk degeneration as well as it potential in supporting bone and spine fusion.
Stem Cells in Spine Surgery
Although the rate of spinal surgery, and specifically lumbar, cervical and thoracolumbar fusions, has continued to rapidly increase over the last 20 year, there has not yet been a breakthrough in surgical technology that has consistently demonstrated the ability to reduce reoperation rates associated with these procedures; additionally, these procedures have demonstrated little success in reducing the issue of pseudoarthrosis in patients.
As a result, spinal surgeons have begun experimenting with using stem cells to support the process of bone growth and fusion. As stem cell research continued to evolve, the discoveries of the ability of mesenchymal stem cells (MSCs) harvested from bone marrow, adipose tissue, and skeletal muscle differentiate when cultivated in the correct microenvironment has led to the realization that these stem cells demonstrated a significant effect of the process of spinal fusion.
Adding to the potential benefits of these stem cells are several animal model studies confirming the benefits of the much more available, and much easier harvested adipose-derived stem cell (ADSC). In fact, several of these animal studies have confirmed similar fusion results observed when comparing MSCs and ADSCs.
Stem Cells in Disc Regeneration
Changes occurring in the discs of the spine and specifically starting in the second decade of life, contribute to decreased disc height that contributes to the impingement of nerves and the development of lower back pain consistent with Degenerative Disc Disease.
Until recently, treatment of Degenerative Disc Disease was limited to conservative management techniques, including work and lifestyle modifications, physical therapy, medication, and epidural injections, or surgery in the form of disc replacement or spinal fusion.
Although realizing the actual effects of stem cells therapy for treating this condition has been limited in humans (primarily due to concerns associated with the potential for an immune reaction to allogeneic stem cells in humans), several animal studies have demonstrated decreased disc degeneration as well as significant improvement in height and hydration of previously damaged discs. In addition, small-scale studies in humans have demonstrated improvements in pain and disability within three months of stem cell treatment.
Considering this, Schroeder J et al. call for larger clinical trials designed to further explore the benefits associated with using stem cell therapy to treat Degenerative Disc Disease.
Stem Cells in Treatment of Spinal Cord Injury (SCI)
Spinal Cord Injury (SCI) resulting from damage to the spinal cord most often is the result of motor vehicle accidents, falls, or injuries occurring during sports, work, or in the home; currently, the World Health Organization (WHO) estimates that worldwide between 250,000 and 500,000 people suffer an SCI each year.
SCIs range in severity, but most often are accompanied by some degree of tissue damage and/or cell death. As a result, spine surgeons have been exploring the potential of stem cell transplantation with the hope of supporting functional recovery after an SCI is sustained.
There are several phases associated with SCI. Regardless of the specific phase associated with an SCI, scientists have realized that creating a microenvironment that enhances neuron and axon regeneration appears to be the most desirable outcome of stem cell therapy. It is hypothesized that this is best achieved by suppression of the inflammation that typically accompanies cell apoptosis and necrosis.
Although embryonic stem cells appear to provide greater differentiation than adult stem cells, the ethical concerns surrounding their use have limited further exploration of these potential benefits. However, to date, adult mesenchymal stem cells (MSCs) used in the treatment of SCI have not demonstrated immunologic reactions and have demonstrated the potential to promote axonal regeneration, suppress demyelination, induce nerve regeneration, and induce nerve regeneration.
Unfortunately, the in vivo differentiation of MSCs into neuron-like cells has been documented to be inefficient, meaning that MSCS is currently not capable of directly repopulating or physically restoring the tissue damaged in SCI.
While there have since been studies exploring the transplantation of neural stem cells (NSC) that have demonstrated sensory and motor improvements after stem cell transplantation and when combined with other cell and growth factors, these improvements were not statistically significant. Considering this, the authors of this study indicate that it’s difficult to provide a definitive statement on the clinical potential of stem cell therapy for the treatment of SCI.
In conclusion, the authors point out that there are additional areas, including iatrogenic nerve and muscle injury resulting from spinal surgery, that have not yet been clinically addressed. The authors also point out that greater standardization of in vitro experimentation and animal models may aid in the speed of translation of stem cell therapy in spinal surgery.
Many studies support platelet-rich plasma (PRP) to help benefit patients with chronic pain and injuries. This article will cover the major aspects of post management care and the best tips to optimize results.
Important tips to keep in mind:
· Avoid Taking any anti-inflammatory drugs after the procedure avoid for 14 days following the procedure
· Apply heat only for 10-14 days , you may experience some soreness and swelling in this time period.
· Avoid any strenuous activities, exercising and physical therapy for the week following treatment
· Stay hydrated
· Improvements typically begin after 2 weeks
About a week after the procedure, patients should start physical therapy, which involves myofascial release, gentle stretching, engaging the articular range of motion, and core stabilizing exercises.
Other activities (e.g., stationary bike, swimming) are also an appropriate choice during the recovery phase. Interventional imaging techniques such as stimulation therapy and Transcutaneous electrical nerve stimulation (TENS) should not be used at this stage.
Once 4-8 weeks have passed, patients can gradually engage in more intense activities, including yoga, Pilates, and light weight lifting. However, forceful rotation and manipulation are not recommended.
Following the correct guidelines during the first few weeks of recovery is crucial for the success of the procedure. The injected cells are quite delicate, hence the need to avoid strenuous physical activities that may cause irreversible damage to the cells.
Patients should also keep in mind that the side effect profile is diverse and can only be evaluated on a case-to-case basis. In other words, one patient might experience pain and inflammation after the procedure, while another presents with no symptoms.
The severity and extent of these symptoms are also dependent on the site of injection, with articulations being the most susceptible to traumatic injuries and side effects.
Recovery by weeks
Weeks 1 & 2
During this phase, you should restrict your movements and physical activity to avoid putting too much tension on your body. However, this doesn’t mean giving up to a sedentary lifestyle as it’s not the best approach.
Expect to experience pain, inflammation, and soreness.
Moreover, remember to avoid running, weight lifting, or any other strenuous exercise. Other activities, such as gentle stretching, are still allowed.
If you experience serious inflammation, consider using ice bags on the affected area , but try to avoid ice and NSAIDS until after the 14 day period. You can also use natural compounds that have potent anti-inflammatory properties, such as turmeric, CBD, and arnica.
Weeks 3 & 4
At this stage, the pain and inflammation should slightly subside, which allows you to practice more intense activities, but do not attempt to lift heavy weights or perform high-impact exercises. An appropriate number would be to keep the intensity of the workouts under 50% of what you’re used to. This will allow the stem cells to implant themselves in the damaged tissue and kick start the healing process.
Weeks 5 & 6
In this stage, focus on core-stabilizing exercises to strengthen your core muscles and give time for the joints to get used to the new routine. Activities such as stationary bike, elliptical, stretching, yoga, Pilates, and swimming exercise are permitted.
Weeks 7 & 8
Inflammation and pain might be gone at this time; however, you should still be careful about the type of exercises you’re performing. For patients who are still dealing with pain and swelling, you can use ice bags to accelerate the healing process.
During this period, stem cells have reached their peak healing potential, which should not get interrupted with intense physical activity. Instead, settle down for less-strenuous workouts that do not involve any compressive, twisting, or pivoting movements. Avoid uneven ground. Contact a Care Coordinator today for a free assessment!
Often caused by the natural wear and tear on the joints that occurs with age, osteoarthritis occurs in millions of people throughout the U.S. and typically develops during or after an individual’s middle ages. While the condition may develop in any joint, it’s particularly common in weight-bearing joints, including the hips. Stem Cell therapy can be an option but How effective is Stem Cell Therapy for hips?
At its best, osteoarthritis in the hip may cause mild discomfort and stiffness. At its worst, it can make daily activities like tying your shoes or taking even short walks near-impossible. Unfortunately, there is currently no cure for osteoarthritis, and treatments such as invasive surgeries come with the risk of complications and long recovery periods.
Now, however, there is a new treatment available to help treat osteoarthritis and other challenging hip issues such as labral tears and bursitis: stem cell therapy for hips.
What Is Regenerative Medicine for Hips?
Stem cells have natural healing properties, along with the unique ability to self-renew and mature into specialized cell types. When strategically injected at the site of the damaged tissue, such as the hip, stem cells can trigger the body’s natural healing processes. As a result, the therapy can restore tissue, relieve inflammation and pain, and enhance mobility — even in injuries or conditions which have responded poorly to prior treatments.
How Effective Is It?
Stem cell therapy has been deemed a simple, affordable, and quick treatment for osteoarthritis of the hip. It’s also minimally invasive and improves a number of key symptoms, including pain, stiffness, and physical function. According to research, injections of mesenchymal stem cell (derived from fat tissue) have significantly improved clinical scores in patients. Results indicate that the regenerative effects of stem cells begin to take hold within two to six weeks.
Osteoarthritis isn’t the only hip condition for which stem cell therapy can be administered, however. Physicians have also been leveraging stem cell treatments in place of hip replacement surgery for conditions such as osteonecrosis. Experts believe the therapy could delay or potentially even eliminate the need for hip replacements in some cases. At the Mayo Clinic, for instance, stem cell treatment has slowed the progression of osteonecrosis by at least two to five years in 80% of patients.
In studies, patients who have received stem cell injections to alleviate hip pain have shown up to a 94% overall improvement in their condition. Reduced pain, improved flexibility, and better sleep were just a few of the results reported by participants. Studies also indicate no treatment-related adverse effects, suggesting that this form of regenerative medicine is safe and well-tolerated by patients.
If you are tired of dealing with the pain associated with your daily activities and you would like to benefit from Stem Cell therapy for the hips then Contact us today!
Virtually everyone will have musculoskeletal pain at some point in their lives. For most, it is a short-lived pain that goes away in a few minutes or a few days. In many, however, musculoskeletal pain is a chronic, daily struggle. They wake up in pain, struggle with pain throughout the day, and pain interferes with their ability to sleep at night. Here is how doctors are using stem cells to treat musculoskeletal pain.
There are surprisingly few good treatments for chronic
musculoskeletal pain. One could take ibuprofen (Advil), naproxen (Aleve), or
acetaminophen (Tylenol) to treat short term musculoskeletal pain. However,
people with chronic musculoskeletal pain need to take these drugs multiple
times a day, every day. Over time, this can damage the liver or the kidneys.
Opioids are powerful painkillers but are not good choices
for treating chronic musculoskeletal pain. People who take opioids for more
than a few weeks for non-cancer, musculoskeletal pain are at great risk of
becoming physically dependent on the drug. Stated another way, they may become
addicted to opioids.
Mesenchymal stem cells are an attractive tool to treat musculoskeletal pain because of two main factors. First, they have the ability to find their way to the site of injury and inflammation. In other words, they collect at the site of musculoskeletal pain. Second, stem cells release a large number of substances into the surrounding area that block or reduce inflammation.
Researchers have been making good progress in initial studies of mesenchymal stem cells for various kinds of musculoskeletal pain. For example, people with musculoskeletal pain caused by osteoarthritis of the knee who received stem cells had profound reductions in pain, even great relief the knee debridement surgery (i.e. orthopedic surgery to remove damaged joint tissue and make the joint surfaces smoother. In separate work, Mesenchymal stem cells reduced knee pain improved physical therapy performance and increased the volume of the knee joint affected by osteoarthritis. Similar results have been obtained in people with musculoskeletal pain and osteoarthritis in the hip and foot.
It is important to note that the procedure is safe. In a review of 844 autologous Mesenchymal stem cells infusion procedures for the treatment of osteoarthritis, there were no major adverse events reported.
Musculoskeletal pain is very common. When people develop chronic musculoskeletal pain, it can be debilitating and dramatically diminish the health-related quality of life. While more work is needed, the results detailed here provide hope to the millions of people who struggle with daily musculoskeletal pain.
Reference: Labusca, L. et al. (2015). Stem cells for the treatment of musculoskeletal pain. World Journal of Stem Cells. 2015, Jan 26; 7(1): 96-105.
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