Stems Cells, Ortho-Biologics, & Regenerative Medicine

The fundamental goal of the Stem Cell, Ortho-Biologics and Regenerative Medicine Program is to provide cutting edge treatments with a sound scientific foundation. The program is an evolution of the Cartilage Restoration Center that was conceptualized in 1995 and has grown to involve complete knee restoration including articular cartilage, ligaments and menisci. Patients often present for cartilage restoration, but unfortunately the knee is no longer a candidate for knee restoration. However, for knee or personal reasons, arthroplasty (knee replacement) is not considered a current choice.

With the Stem Cell, Ortho-Biologics and Regenerative Medicine Program, we can now offer a potential “bridge” between biologic knee restoration and (artificial) total knee replacement. To be clear, MOST INSURANCE PROGRAMS, MEDICARE AND MEDICAID label these treatments as “experimental/investigational” and with that designation; they DO NOT pay for these treatments. Consult with your Health Savings Account (HAS) adviser, as prescribed medical treatments may be allowed for payments from your HSA account. Prepayment is necessary before the injection.

The available treatments are listed below. Note that PRP and ReNu® can be performed the same day and time as your office visit—if prior arrangements are made. However, LipoGems® and Bone Marrow Aspirate will require specific scheduling; that is a specific prior arrangement for a morning  appointment to verify that these treatments are optimal for you and if so verified, then an afternoon procedure time that has been prescheduled will be available (If you decide the injection is not right for you, the prepayment will be refunded).

Ultrasound optional guidance for knee injections

While experienced knee surgeons and physician assistants can perform accurate knee injections, the option of Ultrasound guidance is available.  This noninvasive technique allows visualization of the injection needle precisely within the joint capsule.

Platelet Rich Plasma (Autologous Conditioned Plasma®) Knee Injection

Platelets are one of the first biologic products to reach an injury. Their first function is to participate in sealing the injury with a clot. During the blood clot formation, they release over 1,000 biologically active proteins, including both growth factors and “signaling” factors (that recruit adult stem cells to aid in the repair process).  Blood can be harvested from a peripheral vein and then centrifuged to separate the blood components to yield a portion high in platelet numbers—thus, the term platelet rich plasma or “PRP”.

There are many ways to prepare the PRP. The type of PRP we use, Autologous Conditioned Plasma®, has been shown in a recent scientific study to diminish symptoms of knee osteoarthritis. It is administered in the same manner as other knee injections with local skin anesthetic.

ReNu Amniotic Fluid Stem Cells and Membrane Knee Injection

Human amniotic fluid and tissue is typically discarded at birth. However, the fluid and tissue are rich with cells and growth factors that have been used successfully for many years to promote wound healing. The fluid and membrane are donated by healthy mothers at birth. The fluid and membrane are then cryopreserved allowing the cells (including stem cells) to return to function upon thawing.

Although amniotic membrane fluid with cells and amniotic membrane alone are promoted by several companies in the United States, there is one product that has been scientifically investigated for knee osteoarthritis: ReNu®. OrthIndy research participated in the original study (published in the Journal of Knee surgery, 2015) and is leading a multicenter trial of this promising product. The trial enrollment is complete, but ReNu® is available outside of the investigational trial for knee osteoarthritis symptoms.

Bone Marrow Aspirated Mesechymal Stem Cell Knee Injection

Bone marrow harvesting for stems cells has been performed for many years. The adult stem cells actually make up a very small number to the cells obtained during aspiration. In the past, much of what was aspirated from within the bone was actually plain blood. To remove the blood products, the entire aspirate was spun at high speeds in a centrifuge.  Unfortunately, when the blood portion was discarded many of the desired stem cells were also “thrown out” with the blood portion.

OrthoIndy utilizes a new tool for harvesting that minimizes the amount of blood within the aspirate. This technique, called Marrow Cellutions®, uses a new patented instrument that allows the harvest to contain such a high number of stems cells that centrifugation is not necessary; thus, no unnecessary loss of stem cells. Aspiration from bone is performed under local anesthetic and allows direct injection of the bone marrow aspiration into the knee without further handling.

LipoGems ® Adipose (Fat) Lipospheres with contained Stem Cell Knee Injections

LipoGems® is one technique of making use of the stem cells that are within adipose (fat) tissue.  The stem cells reside on the microscopic blood vessels within the fat tissues. Some techniques involve enzymatic digestion and centrifugation of fat to obtain the vascular portion. LipoGems®, on the other hand, involves minimal manipulation of the fat tissue that is gently harvested by “lipoaspiration” from a small amount of one’s own abdominal fat--not requiring formal liposuction. (Sorry, no cosmetic side-benefits)

This process is enzyme-free and does not involve centrifugation of the tissue. Through mechanical emulsification (thorough mixing) of the tissue, the size of the fat clusters is reduced. Sterile saline is employed during processing to wash and rinse the tissue, which reduces inflammatory impurities, such as oil residues and blood. This allows maintenance of the native adipose tissue microenvironment containing the microvasculature with attached stem cells.  These small adipose microspheres with their microenvironment can then be injected in a standard manner for the knee.

 

References

Smith PA. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med. 2016;44(4);884-91. doi: 10.1177/0363546515624678.

Riboh JC, Saltzmann BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2016;44(3):792-800. doi: 10.1177/0363546515580787.

Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective double-blind, randomized trial. Am J Sports Med. 2013;41(2):356-64. doi: 10.1177/0363546512471299.

Vangsness CT, Farr J, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. J Bone Joint Surg Am. 2014;96(2):90-8. doi: 10.2106/JBJS.M.00058.

Vines JB, Aliprantis AO, Gomoll AH, Farr J. Cryopreserved amniotic suspension for the treatment of knee osteoarthritis. J Knee Surg. 2015 Dec 18 [Epub ahead of print].

Xia P, Wang X, Lin Q, Li X. Efficacy of mesenchymal stem cells injection for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop. 2015;39(12):2363-72. doi: 10.1007/s00264-015-2785-8.

Wyles CC, Houdek MT, Behfar A, Sierra RJ. Mesenchymal stem cell therapy for osteoarthritis: current perspectives. Stem Cells Cloning. 2015;28(8):117-24. doi: 10.2147/SCCAA.S68073.

Pers YM, Ruiz M, Noël D, Jorgensen C. Mesenchymal stem cells for the management of inflammation in osteoarthritis: state of the art and perspectives. Osteoarthritis Cartilage. 2015;23(11):2027-35. doi: 10.1016/j.joca.2015.07.004.

Ruiz M, Cosenza S, Maumus M, Jorgensen C, Noël D. Therapeutic application of mesenchymal stem cells in osteoarthritis. Expert Opin Biol Ther. 2016;16(1):33-42. doi: 10.1517/14712598.2016.1093108.

Fodor PB, Paulseth DG. Adipose derived stromal cell (ADSC) injections for pain management of osteoarthritis in the human knee joint. Aesthet Surg J. 2016;36(2):229-36. doi: 10.1093/asj/sjv135.