Jason L. Dragoo
KOLOA, Hawaii — Although it may be tempting to consider stem cell treatment in patients with painful knee osteoarthritis after a key proof-of-concept study showed mesenchymal stem cell injections improved knee OA symptoms, a presenter at Orthopedics Today Hawaii cautioned orthopedic surgeons to not jump on the stem cell bandwagon and claim such results can be achieved in all patients.
Regarding stem cell use in osteoarthritic knees, or what Jason L. Dragoo, MD, said in his presentation he prefers to call OA cellular therapy, adipose tissue is proving to be an optimal source of progenitor cells that can be beneficial in the large joints. However, level 1 studies have not yet been completed into the efficacy of adipose-derived stem cells for use within orthopedics, he said.
“I think in 2019 and 2020 we can come to the following conclusions: Number one, that these ‘stem cells’ that we are using with the different techniques have been shown in virtually every study to improve the patient’s pain.”
Pain relief occurs due to the factors eluded from the stem cells. These factors activate mu-opioid receptors, he said. “So, it is now thought that is the reason for their pain-relieving capacity.”
Dragoo’s second conclusion in support of using adipose-derived cells was “they are strongly anti-inflammatory.”
As recent literature reports showed no difference between results of injection of bone marrow aspirate concentrate (BMAC) and saline, “the summary statement is do not use BMAC yet. But the problem is, we just don’t know how to formulate it,” he said.
The “holy grail” or proof-of-concept study of adipose-derived stem cells by Yong-Gon Koh, MD, and colleagues published in 2013, “shows grade 4 arthritis with some new laying down of cartilage over the top,” Dragoo said.
However, he said surgeons cannot “say that we can do this in all of our patients, because it has to be recreated.”
Dragoo discussed the needle extraction and arthroscopic adipose-tissue harvest techniques that are currently used to extract adipose tissue in the clinic.
“Whenever you harvest fat, you must do something else with it. You cannot just inject fat when you get it from the body,” he said. – by Susan M. Rapp
Dragoo JL. Update on PRP and stem cells. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Koh YG, et al. Arthroscopy. 2013;doi:10.1016/j.artho.2012.11.017.
Disclosure: Dragoo reports he is a paid consultant for Beckman Dickenson, Breg, DePuy Synthes, DJO, Genzyme, Flexion Therapeutics, Joint Restoration Foundation, KCRN Research, Moximed, Regeneration Technologies, RNL Bio, Sideline Sports Docs LLC; he is a paid consultant for and receives research support from CONMED Linvatec; receives other financial and material support from Emcyte; is a paid consultant for and receives other financial or material support from Harvest Technologies; is a paid consultant and paid presenter or speaker for and receives research support from Ossur; receives other financial and material support and research support from RTI; and is a paid consultant for and receives research support from Zimmer Biomet.