Injection

Are stem cell injections an effective treatment for knee osteoarthritis?

Author: Frank McCormick M.D. and Emmanouil Kiriakopoulos B.S.

Osteoarthritis (OA) of the knee is a degenerative disease of articular cartilage resulting in activity limiting pain and disability. Knee osteoarthritis alone is one of the nation’s leading cause of disability, with a concerning recent increase in young athletes following a sports-related injury. Being a progressive condition, the cartilage may erode completely over time, eventually creating bone on bone friction exhibited by a cracking or popping sound, inflammation, and severe discomfort. Due to the avascular nature of cartilage, it cannot readily repair itself when damaged. The injection of stem cells and other biologics (i.e Platelet Rich Plasma) from the body may solve this dilemma.

Current efforts to alleviate mild to moderate cases of osteoarthritis include non-pharmacologic means (physical therapy, weight loss, low-impact cardiovascular exercise) coupled with pharmacologic agents in order to reduce inflammation and discomfort. Pharmacological agents include the use of non-steroidal anti-inflammatory drugs (NSAIDs), viscosupplementation with hyaluronic acid, corticosteroid injections, and now stem cells and biologics. As the disease progresses the efficacy of these treatments decrease, usually leaving a partial or total joint replacement as the only curative treatment for end-stage disease.

In recent years, mesenchymal stem cells (MSCs) have been a topic of great interest as a biological intervention to regenerate damaged knee cartilage from OA. MSCs have the ability to differentiate into many types of connective tissues, including chondrocytes (the cartilage-building cells) as well as the capacity to self-renew, migrate toward injured tissues to repair them, and can inhibit immune responses like inflammation. There are many different sources of MSCs including the bone marrow, fat tissue, umbilical-cord blood, and amniotic fluid. Current debate exists in which source is the best to use in the regenerative scope of orthopedics and sports medicine. Many animal and early clinical studies show the effectiveness of MSCs in suppressing the pain and a possibility of regenerating cartilage, though further investigation is needed.

In order for insurance companies to cover a medical intervention, the U.S. Food and Drug Administration (FDA) must first approve the treatment. Currently, there is no FDA approval for “Stem Cell” injections or treatments. This has been an ongoing problem due to stem cells being considered a pharmacological treatment and currently lacks a consistent means of acquiring, culturing, and administering to patients. Because of this, MSC therapy is very expensive with individuals having to pay out of pocket ($450-3000). Therefore, current research aims to find the most feasible source of MSCs that creates the least amount of discomfort for the patient, increases cost-effectiveness, but also the ability of the MSCs to efficiently differentiate and expand into a cartilaginous lineage. Our goal is to keep our active South Floridian out of the operating room, and out in the sun.

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