![]() ![]() Studies describing MSC for knee cartilage regeneration applications are numerous and varied in quality. More recently, clinical and translational literature has grown more convincing from early descriptive case series to randomized controlled trials showing promise in efficacy and safety. Over the last several years, in vitro and animal studies have elucidated the use of MSCs in isolation as injectables, in combination with biological delivery media and scaffolding, and as surgical adjuvants for cartilage regeneration and treatment of knee degenerative conditions. In theory, MSC therapy may help restore cartilage focally or diffusely where nascent regenerative potential in the intra-articular environment is limited. MSCs derived from bone marrow, adipose, and umbilical tissue have the capacity for self-renewal and differentiation into the chondrocyte lineage. ![]() Another more likely mechanism of action is the role of the MSC as a paracrine regulator, releasing of local anti-inflammatory mediators such as Interleukin.To review the current basic science and clinical literature on mesenchymal stem cell (MSC) therapy for articular cartilage defects and osteoarthritis of the knee. ![]() By injecting the MSC’s into the knee, it is hoped the MSC “differentiates” into a chondrocyte, but it depends on the local environment or matrix to form onto, hence micro-drilling is often undertaken simultaneously. The primary roles of adult stem cells in a living organism are to maintain and repair the tissue in which they are found. The use of MSC’s is currently investigational, however patients with focal Grade IV osteoarthritic lesions, low BMI’s and correctable malalignment appear to be the best candidates in published studies. MSC therapy currently remains investigatory in use in Australia. It is performed with arthroscopy subchondral micro-drilling and osteotomy if required. Infection would be the most severe complication, but is fortunately rare.Ģ. MSC’s separation/ concentration in an sterile lab / device The risks appear to be relatively low as the injection consists of the patients own concentrated cells. Adipose Derived Stem Cell Injections are not and have never been offered at OSSM due to a lack of evidence suggesting benefit over placebo. Iliac Crest Bone Marrow Concentrate injections remain investigational and their benefits remains uncertain. The expansion of Bone Marrow Derived MSCs remains investigational and not performed in Australia. Adipose Derived Stem Cell injections have not been shown to benefit patients in recent studies at the Royal North Shore.Īt this stage, the harvest and separation of MSC’s is not covered by either Medicare or Private Health Insurance. Bone Marrow Derived Stem cells have been shown to mildly benefit patients undergoing microfracture and osteotomy in studies. The best source of MSC's remains uncertain at this stage. Mesenchymal stem cells can be derived from a number of sources, including the bone marrow and finally adipose tissue via liposuction. MSC’s can only differentiate into mesodermal cells lines, which fortunately produces all musculo-skeletal tissues, making them a powerful potential joint regeneration tool. MSC’s differ from embryonic stem cells, as embryonic stem cells can differentiate into any cell type. Mesenchymal stem cells (MSC’s) are partially committed mesodermal stems cells, which usually surround small blood vessels, that can differentiate to create bone as osteoblasts, adipose tissue as adipocytes and cartilage as chondrocytes. Mesenchymal Stem Cells maybe an emerging cellular management tool in the future for managing osteoarthritis, with the exact mechanism of actions and best source of MSCs remaining unclear. Other forms of MSC's, such as Adipose Derived MSCs, unfortunately have shown no benefit when directly injected into the joint. Recent studies have suggested injections of Bone Marrow Derived MSCswith PRP, hyaluronic acid injections, subchondral micro-drilling techniques and limb mal-alignment correction by way of osteotomy improves patients outcomes when compared to those who did not receive them in a randomized controlled trials. Fibrocartilage has poor loading capabilities & limited survival of 4-5 years. Currently, micro-drilling or autologous chondrocyte implantation of Grade IV osteoarthritic lesions only allows healing with fibro-cartilage. ![]() The creation of Hyaline Cartilage remains the “holy grail” of regenerative musculoskeletal medicine. However the the techniques remains currently invesitgational. Recently, novel therapy options have become available for the injectable management of knee osteoarthritis, which when combined with existing operative techniques and may offer a potential alternative to joint replacement. Adult Mesenchymal Stem Cell Therapy Remains Investigational or of Uncertain Benefit Currently. ![]()
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