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 used. 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. For orthopedic applications, MSCs are typically harvested from a patient's bone marrow or fat tissue, processed, and then injected into the injured area. The therapy is being used for conditions like osteoarthritis, tendon injuries, and cartilage defects.
Key Points to Consider
- Current evidence suggests that MSC therapy has not been cleared by the FDA for human clinical application to musculoskeletal diseases 1.
- The 2019 American College of Rheumatology/Athritis Foundation guideline strongly recommends against stem cell injections for patients with knee and/or hip OA due to concerns regarding heterogeneity and lack of standardization in available preparations and techniques used 1.
- The proposed mechanism involves MSCs reducing inflammation, secreting growth factors that promote tissue repair, and potentially differentiating into needed cell types.
- Treatment typically involves a single injection or series of 1-3 injections spaced weeks apart, with costs ranging from $2,000-$10,000 per treatment, usually not covered by insurance.
- Patients should be aware that while some may experience significant improvement, others may see minimal benefit, and the therapy should be considered alongside conventional treatments rather than as a replacement.
Considerations for Clinical Practice
- The lack of standardization in MSC preparations and techniques used is a significant concern in clinical practice.
- The limited proven efficacy of MSC therapy for orthopedic applications should be carefully considered when deciding on treatment options.
- Conventional treatments should be considered as the primary treatment option, with MSC therapy considered only in specific cases where the potential benefits outweigh the risks.
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.