From the Guidelines
Mesenchymal stem cell (MSC) therapy is not recommended for orthopedic applications due to limited proven efficacy and concerns regarding heterogeneity and lack of standardization in available preparations and techniques. MSCs are adult stem cells found in bone marrow, adipose tissue, and other sources that can differentiate into various cell types including bone, cartilage, and muscle cells. In orthopedics, MSC therapy typically involves harvesting cells from the patient's bone marrow or fat tissue, processing them, and then injecting them into injured areas such as joints, tendons, or ligaments. The treatment aims to reduce inflammation, promote tissue regeneration, and improve function.
According to the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1, stem cell injections are strongly recommended against in patients with knee and/or hip OA due to concerns regarding the heterogeneity and lack of standardization in available preparations of stem cell injections, as well as techniques used. This recommendation is also supported by another study published in Arthritis and Rheumatology in 2020 1, which states that stem cell injections are strongly recommended against in patients with knee and/or hip OA.
The mechanism behind potential benefits of MSC therapy includes anti-inflammatory effects, secretion of growth factors, and direct cellular differentiation to repair damaged tissues. However, the evidence remains inconsistent, and most treatments are considered experimental, may not be covered by insurance, and costs can range from $2,000-$10,000 per treatment. Recovery typically involves limited activity for 24-48 hours post-injection, followed by gradual return to normal activities over 1-2 weeks.
Some key points to consider when evaluating MSC therapy for orthopedic applications include:
- Limited proven efficacy for most conditions
- Concerns regarding heterogeneity and lack of standardization in available preparations and techniques
- Experimental nature of the treatment
- Potential costs and lack of insurance coverage
- Need for further research to fully understand the benefits and risks of MSC therapy. As noted in a study published in The Journal of the American Academy of Orthopaedic Surgeons in 2019 1, no MSC therapies have yet been cleared by the FDA for human clinical application to musculoskeletal diseases.
From the Research
Mesenchymal Stem Cell Therapy
- Mesenchymal stem cells (MSCs) are derived from adult stem cells and are multipotent, exerting anti-inflammatory and immunomodulatory effects 2.
- They can differentiate into multiple cell types, including osteoblasts, chondrocytes, and fibroblasts, making them a promising treatment approach in orthopedic surgery 2.
Efficacy in Orthopedic Applications
- The use of MSCs in orthopedics may transition the practice from surgical replacement and reconstruction to bioregeneration and prevention 2.
- Early studies have demonstrated potential clinical benefit of utilizing bone marrow-derived mesenchymal stem cell therapy in the management of knee osteoarthritis, focal chondral lesions, and degenerative disk disease in the spine 3.
- MSCs have been successfully utilized in pre-clinical OA animal models and clinical studies for cartilage repair, which had not previously been achieved using classical treatments 4.
Current Status and Future Opportunities
- MSC therapy has been identified as the most effective intervention for pain reduction in orthopedic care, with PRP and peptide-based therapies showing moderate improvements 5.
- MSC therapies have demonstrated cartilage regeneration and early osteoarthritis improvement, but high costs and ethical concerns remain barriers to widespread adoption 5.
- Further research is needed to establish long-term efficacy and improve clinical translation for broader adoption of MSC therapies in orthopedic care 5, 6.
Orthopedic Conditions Treated with MSCs
- MSCs have been applied to various orthopedic conditions, including orthopedic trauma, muscle injury, articular cartilage defects, osteoarthritis, meniscal injuries, bone disease, and nerve, tendon, and ligament injuries 2.
- MSCs have also been used in the treatment of osteoarthritis, with studies demonstrating their potential to promote regeneration of degenerated tissues 4, 6.