Surgery Augmented with Regenerative Medicine
There are times when surgical repair may be enhanced and improved with the addition of stems cells or platelet rich plasma (PRP). There is emerging evidence that full rotator cuff tears, full ACL tears, and meniscal tears (that are causing mechanical symptoms) heal better and faster with surgery and the addition of stem cells/PRP.
Hernigou et al. reported 10 year follow up on 90 patients who underwent surgery to repair the rotator cuff. 45 patients were injected with bone marrow aspirate concentrate(BMAC)at the time of surgery and 45 patients did not receive an injection. Mean age was 61. Patients were matched for age, sex tear size and location and hand dominance. Rotator cuff healing was determined by MRI or CT arthrogram at monthly intervals for the first 2 years and at 10 years. 100% of the shoulders receiving BMAC injection and 67% of the shoulders that did not were healed at 6 months. At ten years, 87% of the BMAC shoulders and 44% of the control shoulders were healed.
Hernigou P, Lachaniette CHF, Delambre J, Zilber S, Deffiet P, Chevallier N, Rouard H. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscpy improves healing and prevents further tears: a case controlled study. International Orthopaedics (SICOT).
Gomes et al. performed rotator cuff repair on 14 patients with a mean age of 59 and injected BMAC during the procedure. MRI performed 12 months postoperatively demonstrated intact repair in all 14 patients. At the one year followup, pain and function was significantly improved.
Gomes JL, Canquerini da Silva R, Silla LMR, Abreu MR, Pellanda R (2012) Conventional rotator cuff repair complemented by the aid of mononuclear autologous stem cells. Knee Surg Sports Traumatol Arthrosc (20): 373-377
In a study published in the Journal of Bone and Joint Surgery, Vangsness et al. reported results in 35 patients who underwent partial meniscus removal and were randomized to either receive stem cell or sodium hyaluronate injection (control group). Patients in the stem cell group regenerated new meniscus, where no patients in the sodium hylauronate group formed new meniscus. Patients who received stem cell injection also had a significant decrease in pain compared to the control group.
Vangsness CT, Farr J, Boyd J, Dellaero DT, Mills CR, LeRouxWilliams M (2014) Adult human mesenchymal stem cells derived via intra-articular injection to the knee following partial medial meniscectomy: a randomized, doubleblind controlled study. J Bone Joint Surg Am (96)2: 90-98.
Buda, R, F. Vannini,M. Cavallo, B. Grigolo, A. Cenacchi, and S. Giannini, “Osteochondral lesions of the knee: a new one-step repair technique with bone-marrow-derived cells,” Journal of Bone and Joint Surgery—Series A, vol. 92, no. 2, pp. 2–11, 2010.
Gobbi, A, G. Karnatzikos, C. Scotti, V. Mahajan, L. Mazzucco, and B. Grigolo, “One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up,” Cartilage, vol. 2, no. 3, pp. 286–299, 2011.
Gobbi, A, G. Karnatzikos, and S. R. Sankineani, “One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee,” The American Journal of Sports Medicine, vol. 42, no. 3, pp. 648–657, 2014.