Are stem cell injections an effective treatment for knee osteoarthritis?
Osteoarthritis of the knee is a degenerative disease of articular cartilage resulting in pain and disability that can get in the way of your active lifestyle and simple daily activities. Knee osteoarthritis alone is a leading cause of disability in the U.S., with a recent increase of occurences in young athletes following a sports-related injury. The cartilage may erode completely over time, creating bone-on-bone friction exhibited by a cracking or popping sound, inflammation, and severe discomfort.
Current Non-Surgical Treatments for Knee OA
Current efforts to alleviate mild to moderate cases of osteoarthritis include physical therapy, weight loss and low-impact cardiovascular exercise, coupled with pharmacologic agents in order to reduce inflammation and discomfort. Pharmacological agents include the use of non-steroidal anti-inflammatory drugs (NSAIDs), viscosupplementation with hyaluronic acid, corticosteroid injections, and now stem cells and biologics. Cartilage cannot readily repair itself when damaged; the injection of stem cells and other biologics (i.e. Platelet Rich Plasma) from the body may solve this dilemma.
More on Biological Interventions for Knee OA
Historically, as the disease progresses, the efficacy of non-surgical treatments decrease, usually leaving a partial or total joint replacement as the only curative treatment for end-stage disease. In recent years, however, mesenchymal stem cells (MSCs) have been a topic of great interest as a biological intervention to regenerate damaged knee cartilage from OA. MSCs can differentiate into many types of connective tissues, including chondrocytes (the cartilage-building cells) as well as the capacity to self-renew, migrate toward injured tissues to repair them, an inhibit inflammation. Sources of MSCs include the bone marrow, fat tissue, umbilical-cord blood and amniotic fluid. Current debate exists in which source is the best to use in the regenerative scope of orthopedics and sports medicine. Many animal and early clinical studies show the effectiveness of MSCs in suppressing the pain and a possibility of regenerating cartilage, though further investigation is needed.
Is it Covered by Insurance?
For insurance to cover a medical intervention, the U.S. Food and Drug Administration (FDA) must first approve the treatment. Currently, there is no FDA approval for “Stem Cell” injections or treatments. This is an ongoing problem due to stem cells being considered a pharmacological treatment and currently lacks a consistent means of acquiring, culturing and administering to patients. Because of this, MSC therapy is very expensive with out of pocket expenses ranging from $450-$3,000. Therefore, current research aims to find the most feasible source of MSCs that creates the least amount of discomfort for the patient and increases cost-effectiveness, and also to further study the ability of the MSCs to efficiently differentiate and expand into a cartilaginous lineage. Our goal is to keep our active South Floridian out of the operating room and out in the sun.
Frank McCormick, MD is an orthopedic sports medicine surgeon who specializes in biological approaches to joint preservation. For more information on Dr. McCormick, visit his online physician profile: Francis McCormick, MD. To discuss your options in the treatment of osteoarthritis, Dr. McCormick may be reached for an appointment at 954-958-4800.
Co-Author: Emmanouil Kiriakopoulos, BS, research volunteer at the Holy Cross Orthopedic Institute.