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Is Stem Cell Treatment effective in Treating Knee Osteoarthritis?

Science continually advances and in recent years the popularity of regenerative medicine treatments for musculoskeletal conditions has risen.  For issues such as knee osteoarthritis, this treatment theoretically offers the ability to restore and rebuild cartilage that would otherwise be lost forever.  Thereby, potentially avoiding a joint replacement surgery.  When one suffers from knee osteoarthritis, the cartilage that covers the ends of the femur, tibia, and/or patella becomes worn down, cracked, and fails to provide protection and congruency to the joint.  This can result in pain and lost joint motion, and eventually, losses in strength and functional mobility.

Advances in regenerative medicine have made it possible to harvest adult stem cells from an individual, typically from adipose (fat) tissue or from bone marrow, and inject or implant these stem cells into the arthritic joint.  The two most commonly used stem cells with regards to musculoskeletal injections are hematopoietic and mesenchymal.  Each is harvested from different sites and has different capabilities with regards to their differentiation (how they develop/change) once implanted.  The simplified version of what theoretically happens next is that these stem cells differentiate into the cells that are damaged or lacking, and then form or improve the tissue (specifically cartilage in the case of knee osteoarthritis).  Ideally, the procedure allows this stem cell differentiation to successfully build cartilaginous protection of greater quality and thickness to the joint surface.  The level of success with such an intervention is highly dependent on the potency of the stem cells and the cellular environment in which they are expected to differentiate.

In the meta-analysis cited below, efforts were made to find studies that would meet the necessary inclusion criteria to evaluate the effectiveness of mesenchymal stem cell injection/implantation for the treatment of patients with knee osteoarthritis.  The authors suggest that more high-quality randomized control trials are needed to further investigate this treatment as the evidence that was presented for these outcomes was considered “very low” to “low” based off several factors including poor study design, high risk of bias, and large heterogeneity.  What was found is that the injection or implantation intervention did significantly improve knee pain and cartilage quality.  However, the effectiveness of cartilage volume was lacking. They did find that performing rehabilitation in conjunction with the primary intervention did result in better self-reported outcomes in the subjects’ physical function.  This finding did lead the authors to suggest that additional research is needed into rehabilitation-driven benefits in association with these procedures.

Take home point:  Mesenchymal stem cell injection/implantation has been shown to have some positive impact on knee pain and cartilage quality but studies have not shown improvements in the actual volume of cartilage in the knee joint.  Better quality research is needed as the current research is not convincing for using stem cells in the treatment of knee osteoarthritis.

Matt Vetter, PT, CSCS

If you have been told you have osteoarthritis, do not worry!  It’s a normal part of life and you CAN find comfort despite having osteoarthritis!  There are other ways to address your persistent pain that do not involve surgery or injections.  Call Omaha Physical Therapy Institute today to learn more about how to manage your osteoarthritis!

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Kolber MJ, Purita J, Sterling B,Stermer J, Salamh P, Masarachhio M, Hanney WJ, Reuter B.  Stem Cell Injections for Musculoskeletal Pathology: An Overview for the Sports Medicine Professional. Strength and Conditioning Journal: Dec 2019- Vol 41 – Issue 6 – p 75-86.

Iijima H, Isho T, Kuroki H, Takahashi M, Aoyama T. Effectiveness of mesenchymal stem cells for treating patients with knee osteoarthritis: A meta-analysis toward the establishment of effective regenerative rehabilitation. NPJ Regen Med 3: 15, 2018