Stem Cell Injection Therapy

One of the most exciting recent developments in the treatment of chronic musculoskeletal conditions is the use of adult mesenchymal stem cells (MSCs).

What are Adult Mesenchymal Stem Cells?

Stem Cells are undifferentiated cells that have the potential to become other, more specialized types of cells.  Stem cells are broadly categorized as either "embryonic" or "adult."  As the name implies, embryonic stem cells are derived from human fetuses, whereas adult stem cells are obtained from, well, adults! 

Currently there are over 70 proven therapies using adult stem cells, while there are none using embryonic stem cells.  This is in part because scientists have had tremendous difficulty controlling how embryonic stem cells differentiate; they have a nasty habit of causing tumor formation, including teratomas.  Adult stem cells, on the other hand, do not suffer from this pitfall.

Mesenchymal stem cells, or MSCs, are multipotent stem cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells) and adipocytes (fat cells). This has been demonstrated in ex vivo cultures and in vitro or in vivo.  MSCs are obtained from the bone marrow, most commonly the back of the iliac crest (the "hip bone"), and less commonly from the tibia (the shin bone).




MSCs can differentiate into many different cell types, as indicated in the diagram below.





How Are MSCs Obtained?

Harvesting MSCs for injection therapy is done right in the office.  The skin is numbed first with a little Novocain.  Next, the hip bone is numbed with more Novocain.  A special needle is then passed through the cortex of the bone into the marrow cavity.  This is a painless procedure in most cases.  The liquid marrow is then very slowly drawn into a syringe.  Once an adequate amount of liquid marrow is obtained, the needle is removed and a bandage applied.

The syringe containing the liquid marrow next is placed in a special centrifuge.  The marrow is spun and the stem cells are highly concentrated and passed into a new syringe, from which the injection(s) are given.

The entire procedure takes about an hour and is minimally uncomfortable.

How Are Stem Cell Injections Given?

All of our stem cell, PRP, and prolotherapy injections are given under direct ultrasound guidance.  We first numb the skin with a little Novocain.  Then, using ultrasound, we guide the needle to the precise location and inject the stem cells.  The ultrasound guidance insures both accurate and safe injections.

Following injection, the area needs to be immobilized for the next 18-24 hours to allow the stem cells to "set up" and adhere to the damaged sites.  Crutches, slings, splints or braces may be used to facilitate this.

Treatment Protocol

In our office, in cases where the stem cells will be injected into a joint, we prefer to perform a dextrose Prolotherapy treatment first, 3-4 days before the stem cell procedure.  The prolotherapy helps prepare the joint biologically for the healing process generated by the stem cells. 

About 2 weeks after the stem cell procedure, a PRP injection is commonly given.  This helps keeps the stem cells active.  Another PRP treatment may then be given about 2 months later.

How Often are Injections Given?

In most cases, patients respond very well to just one round of treatment. However, 2-3 treatments may be needed in very severe cases.

What Conditions Might Benefit From Stem Cell Injections?

Stem cell injections are most commonly used for the treatment of conditions that have failed or responded incompletely to other more conservative treatments.  Conditions include, but are not limited to:

  • Osteoarthritis of the joints
  • Chronic partial Rotator Cuff tears
  • Persistent partial tendon tears, such as tennis elbow, plantar fasciitis, quadriceps and patellar tendon tears.
  • Partial muscle tears
  • Meniscal (cartilage) tears in the knee
  • Chondromalacia patella (patellofemoral syndrome)

Are There Risks Associated With Stem Cell Treatment?

Any injection is potentially at-risk for causing infection, bleeding, nerve damage.  Risks will also vary depending on the structure(s) being injected.  However, because we are using your own cells, you cannot be allergic to the treatment!  Also, because the injections are done under ultrasound guidance, the risks of damaging surrounding structures, or of injecting the wrong location, are almost completely eliminated.  Your doctor will review the complete risks of treatment with you.  Nonetheless, the risks of treatment are extremely low.

Are Stem Cell Treatments Covered by Insurance?

Currently stem cell injections are still considered experimental.  Most insurance plans, including Medicare, do NOT pay for stem cell injections.