Active Sports Medicine offers new, cutting-edge treatment options like amniotic membrane stem cell injections that may be used to successfully treat patients with various musculoskeletal conditions.
For clarification, this type of stem cell comes from amniotic tissue, not an embryo. While some people may have ethical issues with embryonic stem cell therapy, most agree that the use of amniotic stem cell therapy raises no ethical or moral questions.
As individuals grow older and lead more active lifestyles, orthopedic surgeons are increasingly being called on to use their surgical techniques to improve patients’ quality of life. Additionally, individuals who participate in either competitive or recreational sports are looking for treatment options that get them back to activities, quickly and safely. Earlier solutions to orthopedic disorders required the use of instrumentation to improve the mechanical environment for orthopedic tissues. Newer research has aimed to improve the biologic environment for healing. One area that has shown a promising future is the use of stem cells to regenerate or repair tissues.
Stem cells are basic human cells that have potential to give rise to many different cell types in the body. They are simple or undifferentiated cells. Stem cells, in broad terms, are any cells that can self-replicate and differentiate into any cell line in the body. Stem cells may be pluripotent (able to differentiate into any tissue type), or multipotent (able to differentiate into limited tissue types). The three main sources of stem cells are embryos, adults, and umbilical cords.
In general, embryonic stem cells are pluripotent, and adult or umbilical cord stem cells are multipotent. Mesenchymal stem cells (MSC) are nonhematopoietic cells, derived from the mesoderm layer of humans, which are generally committed to differentiating into muscle, bone, ligaments, tendons, fat, etc. Depending on their environment, MSCs can differentiate into a variety of cell lineages. Most orthopedic research has been conducted using adult MSCs to treat musculoskeletal disorders.
Stem cells help to create new cells in existing healthy tissues and may help to repair tissues in those structures that are injured or damaged. They are the basis for the specific cell types that makes up each organ in the body.
When stem cells divide they create progenitor cells. Unlike stem cells, progenitor cells can become cells with more specialized functions, such as brain cells, red blood cells or – of particular interest to orthopedic surgeons—components of specialized tissue such as bone or cartilage.
Orthopedic surgeons have focused their attention on mesenchymal stem cells. Unlike embryonal stem cells, mesenchymal stem cells are obtained from living adult tissue.
At this point, stem cell procedures in orthopedics are still at an experimental stage. Stem cell procedures are being used for treating bone fractures and nonunions, regenerating articular cartilage in arthritic joints, healing ligaments or tendons, and replacing degenerative vertebral disks. It is expected, however, that as more knowledge of tissue engineering is obtained, stem cell procedures will become more common.
Injuries related to disruption of ligaments, tendons, and/or articular cartilage is common and can result in significant morbidity to the active individual. The healing of these disrupted tissues results in an inferior-quality tissue. Cell-based therapy is actively being investigated as a new method of treating these injuries.
MSCs have also been studied in the repair of meniscal injuries. Tears in the inner third of the avascular region of the meniscus have a limited capability to heal. Scientists have been employing a broad-based strategy to repair these defects.
Stem cell procedures are being developed to treat bone fractures and nonunions, regenerate articular cartilage in arthritic joints, and heal ligaments or tendons. These are detailed below.
In bone, progenitor cells may give rise to osteoblasts, which become mature bone cells, or osteocytes. Osteocytes are the living cells in mature bone tissue. Stem cells may stimulate bone growth and promote healing of injured bone.
Traditionally, bone defects have been treated with solid bone graft material placed at the site of the fracture or nonunion. Stem cells and progenitor cells are now placed along with the bone graft to stimulate and speed the healing.
The lining of joints is called the articular cartilage. Damage to the articular cartilage can frequently lead to degeneration of the joint and painful arthritis. Current techniques to treat articular cartilage damage use grafting and transplantation of cartilage to fill the defects. It is hoped that stem cells will create growth of primary hyaline cartilage to restore the normal joint surface.
Mesenchymal stem cells may also develop into cells that are specific for connective tissue. This would allow faster healing of ligament and tendon injuries, such as quadriceps or Achilles tendon ruptures. In this instance, stem cells would be included as part of a primary repair process.
While stem cell therapy has been used for decades to treat a variety of diseases, their application in orthopedic and sports-related procedures is relatively new in the United States. As a result, most insurance companies do not currently cover these procedures, and payment is due in full advance by the patient.