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The Future of Stem Cells in Orthopedics

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Though the public is beginning to more readily embrace the notion of stem cell therapy in the treatment of orthopedic conditions, stem cells remain largely unproven. Having clarified that, I do have over three years of experience in studying and using stem cell therapy as an adjunct to non-surgical and surgical management of patients, most of whom are elite athletes with a wide variety of orthopedic conditions.

From my own experience, I have seen great progress in patients treated with stem cell therapy and specifically amniotic stem cell therapy. These stem cells are harvested from the amnion cell layer of the donor placenta. That is, the stem cells that produce amniotic fluid. This type of stem cell harvesting takes more precise harvesting technology using a new laser method. Older, more mechanical harvesting techniques include some chorion layer cells which have been shown to cause more short-term patient recipient reaction immediately after injection. Amnion-only stem cell preps are simply much less overtly reactive even with repeated injections. This type of therapy does potentially provide significant advantages to normal non-stem cell enhanced recovery. So let’s further explore why this may be the case.

First, I have observed that my patients tend to recover faster and perform better significantly quicker than one would otherwise anticipate. In addition, follow up MRIs show a tendency toward more mature changes in the tissue after surgery sooner than one would expect.

At arthroscopy, when stem cells are injected first and a mechanical problem such as a torn flap of meniscus in the knee gets removed, it shows the joint surface and structures to be denser and healthier than what one would otherwise anticipate.

In veterinary medicine, especially in respect to thoroughbred horse care, stem cells are a first line treatment for many maladies. Frankly, if stem cell therapy was covered by insurance companies and costs were equal to cortisone or Platelet Rich Plasma (PRP) therapies, they would almost assuredly be a first line treatment in humans as well.

With the fantastic potential benefits of stem cell therapy in mind, it must be noted that amniotic and other stem cell therapy are very different from PRP.   

PRP involves harvesting a patient’s own blood that is “spun down” and then injected into the affected area. Through this spin-down process, the red cells, which are very irritating and promote reactions that essentially help to delay healing and return to sport, are removed and the plasma layer with platelet and growth factor can be manipulated via technique to either enhance scarring/healing or can reduce inflammatory reaction pending how much the blood and intermediate layer are handled.

But amniotic stem cells represent a completely different cell type and biologic behavior than that of PRP. Not only are the amnion-only preps very non-reactive, but in my experience they enhance healing and muscle development to the area in which they are injected. They directly and often significantly decrease the inflammatory process, the negative effects of which can reduce the time it takes to get back to sport and they enhance/speed recovery protocols.  

For example, if the cuff is missing a torn piece, I don't see that missing piece getting replaced through the use of stem cell therapy. What I do see is that everything that is already present looks subtly but significantly healthier rather than normally degenerating further. That is a polar opposite positive change from any healing process I have ever witnessed before. Normal injection treatments goals are simply to slow down the natural negative degenerative process. Stem cells appear to allow the tissue to take a small but significant step back in time.

In my practice, it’s the recovery rate, return to sport, and performance at return to sport where I believe there is a significant difference between PRP and stem cell therapy. As stem cell therapies of all types in all parts of human medicine continue to increase in frequency of use and appear to improve outcomes as well as the costs continue to drop, I do think the day will come when cortisone-based injection therapies and PRP therapies will be displaced and stem cells will be the first-line treatment for most maladies in orthopedics where injections are used.