Bone Marrow Derived Stem Cell Injections

What are bone marrow derived stem cell injections?

The main reason that stem cells are used as therapy for arthritis and other conditions that experience joint pain is that they maintain regenerative properties with the potential to repair and reverse damaged joints.

The bone marrow is a spongy tissue contained inside one’s bones, and makes cells that are crucial to existence including platelets, white blood cells and red blood cells. All of these cells start in the marrow as stem cells, which are basically a “blank slate” type of cell. With a “blank slate”, the cell can then turn into many different types of cells needed in the body including cartilage, tendon or muscle. There are three types of adult stem cells in the human body. The first type of stem cell turns into blood components, with a second destined to become lining of the endometrium. The third, and most important for musculoskeletal regenerative medicine, are mesenchymal stem cells found in bone marrow. They have been used in animal models to regenerate cartilage and in human models to regenerate bone. (Centeno et al, 2008)

The largest and easiest sources of stem cells are in the iliac crest of the hip and the bones of the spine. For the easiest process, the iliac crest is used for the procedures in an outpatient setting. 

How are these injections performed?

Dr. Jagodowicz will extract bone marrow from the patient’s hip bone at the posterior-superior iliac crest. The area will be numbed considerably for pain control. With the patient’s ability to quickly make new bone marrow, the harvesting does not present any lasting problem.

Approximately 30 to 60 cc’s of bone marrow is harvested, and it is processed to concentrate down the stem cells and growth factors using a Harvest centrifuge. The resulting substance consists of the most important regenerative components of stem cells. Afterwards, the centrifuged concentrate is injected into the patient’s joint or tissues in the same setting.

Is the procedure painful?

Harvesting bone marrow from the iliac crest may produce slight pain. Plenty of numbing medicine will be used during the procedure though and it is very tolerable.  The discomfort may persist for a few days to weeks and slowly subside as the area heals up. The injection of the prepared bone marrow into the affected joint is no more painful than a typical steroid injection. For a few days afterwards, the joint may have slight increased pain due to the inflammatory reaction generated. This is normal.

What are some conditions that stem cell therapy can be used for?

Knee Injury and Osteoarthritis

Patients with meniscal tears of the knee are usually recommended to undergo a surgical procedure known as a meniscectomy, the removal of partial or the entire meniscus of the knee. Some orthopedic physicians believe that the meniscus does not have the ability to be repaired, either by regular body repair mechanisms or surgery. So it is shaved, smoothed, or partially removed.  Meniscal resection may lead to a long-term destabilization and degradation of the articular surfaces of the knee. Years ago, many of these patients are forced to have knee replacements because of continued severe pain.

The meniscus or menisci are the thick, strong, cartilage-like shock absorbers that cushion and pad the knee between the thigh (femur) and shin (tibia) bones. Shaped like the letter “C,” the meniscus of each knee provides stability in carrying the weight of the body or in gliding through the knee’s many range of motions. The meniscus can become problematic either through traumatic injury, or age and wear and tear. Wear and tear can occur in runners, people who have jobs that require a lot of physical activity where stresses to the knees are applied, or in older people where the degeneration of the cartilage causes tearing in the meniscus.

Meniscus injuries in sports are often caused by impact or in sharp cutting or turning when the meniscus can become trapped between the femur and the tibia. Typically an injury to the meniscus will occur in combination with ligament injuries, especially the MCL (medial collateral ligament).  Stem cell therapy may be instrumental in avoidance of needless knee surgeries.

Shoulder Injury and Osteoarthritis

The shoulder is a common source of disability resulting from traumatic and degenerate tears of the rotator cuff, subacromial impingement, and osteoarthritis. Nonoperative management has focused treatment on analgesics, anti-inflammatory medications and steroid injection into the joint.  Doctors in Germany have looked at the options for repairing cartilage defects and soft tissue injury in the shoulder before it leads to osteoarthritis. They concluded that stem cell therapy for cartilage regenerative was a minimally invasive approach for shoulder joint preservation and an alternative to shoulder replacement. 

Arthritis of the shoulder is usually triggered by an injury such as a dislocation or separation that has not healed properly. In these cases or even in the cases of past surgical intervention, connection soft tissues–the ligaments, tendons, and cartilage, have not completely healed or have become overstretched (ligament and tendon laxity).  This causes an excessive amount of “play” in the joint resulting in the previously mentioned chronic shoulder instability. When bones rub against bones or against soft tissue, inflammation, swelling and pain occurs. Over time, painful bone spurs may form.  Often people will react by instinctively limiting their shoulder movements in order to lessen the pain. This can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in yet further pain and restriction of motion. In the worst case, adhesive capsulitis may occur.

A proper diagnosis of shoulder pain is essential to determine the root cause of the problem and the proper method of treatment because many shoulder conditions are caused by specific activities, such as over use caused by excessive workouts, a detailed medical history is an invaluable tool. A physical examination should also include screening for physical abnormalities—swelling, deformity, muscle weakness, and tender areas—and observing the range of shoulder motion—how far and in which directions the arm can be moved.

Although x-rays may be helpful in defining problems, more elusive ones may require computerized tomography (CT scan), which provides a more detailed view of the bones. Electrodiagnostic studies such as the electromyogram (EMG) and a nerve conduction study can indicate whether pain or weakness in the area is coming from a pinched nerve in the neck, or a peripheral nerve injury away from the neck, or down the arm. Magnetic Resonance Imaging (MRI) and ultrasound are other safe and effective diagnostic tools, providing images of the soft tissues.

Hip Dysplasia and Osteoarthritis

Can bone marrow derived injections help me?

As with other types of regenerative medicine, bone marrow derived stem cell injections work better for some cases than for others. There have only been small studies so far looking at bone marrow derived stem cell injections in humans. In a 2011 study out of the Beijing Institute of Technology, bone marrow mesenchymal stem cells were shown to have an excellent potential for cartilage production in animals (Li et al, 2011). A recent study in canines showed that bone marrow mesenchymal stem cells were effective in repairing bone defects (Kang et al, 2013).

With the positive results seen in animals, the treatments have been introduced for humans. Dr. Jagodowicz offers Bone Marrow Derived stem cell injections for quite a few conditions such as:

• Spinal Arthritis in facet joints (neck and back)

• Extremity arthritis including knee arthritis, hip arthritis, ankle and shoulder arthritis

• Sacroiliac Joint Arthritis

• Rotator Cuff Tendonitis

• Achilles Tendonitis

• Degenerative Disc Disease

• Lateral Epicondylitis (Tennis Elbow)

• Medial Epicondylitis (Golfer’s Elbow)

• Ligament Sprains

• Muscle Strains

How are these injections different from cortisone shots?

Bone marrow derived stem cell injections have the goal of repairing the damaged tissue while providing pain relief. Cortisone shots simply provide anti-inflammatory medicine to reduce pain. In most cases, the inflammatory process recurs after a few months.

Are There Risks With the Procedure?

With the procedure being outpatient and minimally invasive, the risks are low. But there is a minimal risk of infection, allergic reaction, bleeding, and pain at the harvest site, wound drainage and failure to relieve a person’s pain. 

What Are My Options?

Dr. Jagodowicz offers several treatment opportunities with bone marrow derived stem cell injections for both extremity and spinal joint pain and arthritis. Since these procedures are relatively new, medical insurance may not cover the cost of the PRP or Stem Cell Injections.  For additional information, contact our office at (818) 360-4949