Cartilage regeneration with stem cells

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About Stem cell therapy

Human mesenchymal stem cell (MSCs) is a magical cell which is responsible for our body's reparation and can turn into specialized bone, cartilage and adipose tissue cell. Sometimes, because of the big injuries or ageing process we cannot get enough of these repair cells and the body does not recover independently.

Stem cell therapy has resolved this problem. The main goal of this therapy is to re-grow the amount of stem cells which later may be re-injected to the area of lesion in order to help the body get on its own natural regeneration.

When knee cartilage repair is required?

Knee cartilage acts as a buffer which protects the knee from shocks and allows moving freely. However, cartilage gets weakened because of the age or having particular disorders like osteoporosis, unhealed bone fracture, osteoarthritis and other injuries. These lesions lead to limited and painful knee movements. Then the only solution is the operation of knee cartilage replacement. Many years ago the only way of treatment was prosthesis of the knee or similar operations. At this moment there are new and modern methods such as stem cell injection therapy and knee plastic surgery. These therapies were firstly performed in the USA  in 2005 – 2006 and became very popular in orthopedics due to quick technique and great results.

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Knee cartilage repair with stem cells

Knee cartilage repair with stem cells is one of the most frequently performed reparative surgery operations. It consists of three phases: harvesting mesenchymal stem cells from the areas which are rich of these cells (bone marrow, adipose tissue); concentrating and cultivating them in a special lab and finally re-injecting them into the affected parts of the body.

Firstly, a doctor nubs thoroughly the back of the hip and takes a sample (aspirate) of bone marrow by using special needle. Stem cell collection procedure is painless and usually does not cause any discomfort to the patient. The blood sample from the arm vein is also taken. All these samples are sent to the laboratory. The procedure takes about 5 minutes.

The second step is to concentrate and multiply the number of stem cells which are taken from the bone marrow aspirate. There are two main types of procedures: Same day therapy and Cultured therapy.

Same day therapy isolates the mesenchymal stem cells which contain a fraction of the aspirate sample. Usually for this purpose special bedside centrifugation is used. It can last for 1-2 days. This type of procedure is suitable for joints, bones, ligaments or tendons treatment.

Cultured therapy is very important to people who have severe knee lesions. The main point of this therapy is that a part of mesenchymal centrifuged cells is cultivated and amplified for a 6 months and then re-injected into cartilage. This method fits perfectly if the doctor believes that the re-growth of cartilage may need more cells.

Finally, the same or the other day after MSCs centrifugation stem cells are re-injected into the cartilage tissue. Before this procedure, purified cells are mixed with platelet rich plasma. Platelets are blood cells which are important not only for coagulation but also for acting in the reparation processes. These cells have growth factors which create the conditions for stem cells to differentiate into cartilage cells. Using ultrasound or fluoroscopy stem cells and platelet plasma mixture is injected into particular area which needs to be repaired. The procedure is done under local anaesthetics which are injected thoroughly to the knee.

Recovery after knee cartilage repair with stem cells

People after knee cartilage repair with stem cells usually feel great and can go home the same day or the day after. A few days later they may have fever, swollen knee, feel general fatigue or weakness. Generally 3-4 injections are required to achieve good results. The second one is done after 6 weeks. Usually rehabilitation takes from 4 to 6 months. In order to get better results doctors always advise to have a special massage and customized training programme.

The result is visible within a 1 month and after a half a year patients feel relief of the pain, decreasing joint stiffness and disappearing the symptoms of arthritis.

Possible risks

Risk of complications is minimal. It is because of using the same body’s stem cells which cannot be rejected. On the other hand there is one hypothesis declaring the potential risk of getting a knee tumor after such a procedure. Tumor can appear if the stem cells division and differentiation disorders happen. However, a lot of research with animals has been done and final results totally deny this hypothesis.

Alternative to stem cells procedure

An alternative operation to stem cells injection therapy is knee cartilage plastic surgery. This procedure is usually performed for 15-60 years male and female patients with knee osteoarthritis. It also can be done for patients who complain about intensive pain or because of the physician suspicion of joint degeneration.

Knee cartilage plastic surgery begins similarly as the stem cell injection procedure. A doctor takes a sample of bone marrow from the hip. Later mesenchymal cells are purified and mixed with platelets rich plasma and adding certain substances finally a small collagen membrane is formed. Membrane is implanted in the affected area. It acts as a soil that helps stem cells to naturally grow and develop into cartilage tissue. After 3 - 4 months due to body's ability to regenerate a new, strong, solid cartilage forms. Meanwhile, implanted membrane disintegrates spontaneously. Incision area remains a small scar. Every few weeks the knee should be injected with platelet growth factors to get better and faster reclamation of cartilage.

Cartilage plastic surgery vs Cartilage repair with stem cells

Cartilage plastic surgery is performed in many countries around the world but because of the stem cells injection procedure advantages, it is becoming increasingly rare. While the results of both operations are equally great, the technique is quite different.

Collagen membrane required for cartilage plastics is grown in a few months and the surgery itself takes about 40 minutes with epidural anaesthesia, meanwhile cartilage repair stem cell injection can be performed on the same day of taking bone marrow samples.

Cartilage plastic surgery cannot be done for people with active inflammatory or connective tissue disease (lupus, RA), active non-corrected endocrine disorder (hypothyroidism, diabetes), active neurologic disorder (peripheral neuropathy, multiple Sclerosis), severe cardiac disease, pulmonary disease with a history of dyspnea or other reactions to transfusion of homologous blood products. Furthermore, it cannot be performed on people who are older than 60 years of age because of their too worn cartilage. In these cases the best choice is a stem cell injection, which has no restrictions. Both of these operations have the same goal to multiply stem cells and stimulate the body's natural regenerative functions. They are only suitable for the knee injury but also can be performed on people suffering from hip, elbow, shoulder osteoarthritis and its symptoms.

These operations are completely safe, painless and effective. A method which stimulates natural body’s regeneration by using stem cells allows quickly eliminate problems associated with the movement and also helps to restore the lost quality of life.

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