Regenerative medicine provides the opportunity for a real cure with stem cells, platelet rich plasma, and growth factors to heal damage. A person’s own bone marrow contains a substantial amount of the stem cells and additional biologic materials necessary for regeneration, with the added benefit of being low risk and outpatient.
What are bone marrow derived stem cell injections? The main reason that stem cells are used as therapy for arthritis and other conditions that experience joint pain is that they maintain regenerative properties with the potential to repair and reverse damaged joints. Bone marrow is a spongy tissue contained inside one’s bones, and makes cells that are crucial to existence including platelets, white blood cells, and red blood cells. All of these cells start in the marrow as stem cells, which are basically a “blank slate” type of cell. With a “blank slate”, the cell can then turn into many different types of cells needed in the body including cartilage, tendon, or muscle. There are three types of adult stem cells in the human body. The first type of stem cells turns into blood components, with a second destined to become lining of the endometrium. The third, and most important for musculoskeletal regenerative medicine, are mesenchymal stem cells found in bone marrow. They have been used in animal models to regenerate cartilage and in human models to regenerate bone. The largest and easiest sources of stem cells for concentrated amounts of bone marrow are in the iliac crest of the hip. We use the posterior superior iliac crest for our procedures in an outpatient setting. Below is an MRI of a 33 year old soccer player with a defect of the patella bone of the knee on the left image, and two years following treatment with mesenchymal stem cells on the right image. Note that the defect shows good coverage of the lesion.
How are these injections performed? First the stem cells will be extracted from the patient’s hip bone. The area will be numbed considerable for pain control. With the patient’s ability to quickly make new bone marrow, the harvesting does not present any lasting problem. Approximately 60 ccs of bone marrow is harvested. We use the Harvest BMAC system for our advanced cellular therapies. Once the marrow is harvested, it is placed in a centrifuge and spun until a concentrated substance is obtained consisting of the most important regenerative components. Afterwards, the patient is injected with the substance in the same setting.
Is the procedure painful? Harvesting bone marrow from the iliac crest may produce slight pain. Plenty of Lidocaine numbing medicine will be used during the procedure. There may be some discomfort at the hip area that may persist for a few days until the area heals. The injection of the prepared bone marrow stem cells into the affected joint is no more painful than a typical steroid injection. For a few days afterwards, the joint may have slight increased pain due to the inflammatory reaction generated. This is normal.
Who do bone marrow derived injections help?
As with other types of regenerative medicine, bone marrow derived stem cell injections work better for some cases than for others. There have only been small studies so far looking at bone marrow derived stem cell injections in humans. In a 2011 study out of Beijing Institute of Technology, bone marrow mesenchymal stem cells were shown to have an excellent potential for cartilage production in animals (Li et al, 2011). A recent study in canines showed that bone marrow mesenchymal stem cells were effective in repairing bone defects (Kang et all, 2013). In Dr. Alberto Gobbi’s article on “The Future of Cartilage Repair and Protection”, he notes that knee articular cartilage has a limited intrinsic healing potential due to the presence of very few specialized cells with a low mitotic activity. Furthermore, cartilage is avascular and there is a lack of source of undifferentiated cells that can promote tissue repair. Unlike, highly vascular areas such as the tissues of the face, once injury occurs , knee cartilage, for example, gradually degenerates and predisposed to early osteoarthritis. Therefore it is critical to restore a smooth cartilage surface in order to withstand excessive joint mechanical stresses from shear and compressive load from cartilage to bone. Mesenchymal stem cells harvested from bone marrow showed great potential in cartilage repair in his studies.
With positive results both in animals and humans, we offer bone marrow derived stem cell injections for the following conditions:
- Extremity arthritis including knee, hip, ankle, and shoulders
- Spinal arthritis in facet joints (Cervical and Lumbar areas)
- Sacroiliac Joint Arthritis
- TMJ Arthritis
- Rotator Cuff Tendonitis
- Achilles Tendonitis
- Lateral Epicondylitis (Tennis Elbow)
- Medical Epicondylitis (Golfer’s Elbow)
- Ligament and Muscle Strains
How are these injections different from cortisone shots?
Bone marrow derived stem cell injections have the goal of repairing the damaged tissue while providing pain relief. Cortisone shots simply provide anti-inflammatory medicine to reduce pain, but no reaction that pulls in stem cells or growth factors.
Are there risks with the procedures?
With the procedure being outpatient and minimally invasive, the risks are low. There is the minimal risks of infection, allergic reaction, bleeding, pain at the harvest site, would drainage, and failure to relieve the pain. Any concerns that you might have should be discussed with the doctor. If you are interested in a stem cell injection, contact our office at (818) 360-4949.