What is a Stem Cell?

Stem cells are found in various tissues throughout the body. Stem cells can remain inactive in host tissues for long periods of time. They are activated by disease, injury or demands on the body that stimulate the body to mobilize healing cells to an injured area of the body. Harvesting stem cells provides the basis for the development of stem cell therapy. Stem cells are found in higher concentrations in certain tissues such as:

  • Embryonic tissue
  • Bone marrow
  • Adipose or fat tissue

Stem cells have unique characteristics. As defined by the U.S. National Institutes of Health (NIH), all stem cells have 3 general properties: (1) they are capable of dividing and renewing themselves for long periods, (2) they are unspecialized, and (3) they can give rise to specialized cell types. An example of a stem cell is an embryonic stem cell derived from an early human embryo. Currently, it is illegal for physicians in the U.S. to utilize embryonic stem cells to treat medical conditions. However, physicians in the U.S. can obtain cells from bone marrow or adipose tissue. These cell preparations are called “stem cells,” but this is truly a misnomer, as stem cells are the least abundant cell type in these cell preparations. For every 1 million cells obtained from bone or fat from an adult for example, there is anywhere from 1 to 1000 stem cells present.  Thus, the majority of the cells contained in a cell preparation do not meet the definitions of a stem cells as outlined above. Furthermore, it is illegal for physicians in the US to manipulate these cells that are obtained beyond centrifuging them. We cannot isolate the stem cells and apply growth factors to them in an effort to stimulate them to differentiate into a certain cell type such as cartilage. We can only inject a minimally manipulated cell preparation containing a small number of stem cells into an injured area.

Dr. Cunningham is a shoulder and knee specialist at Vail Summit Orthopedics and Neurosurgery. When indicated, he utilizes stem cell therapy for patients suffering from various knee and shoulder injuries.

How Does Stem Cell Treatment Work?

Known as a Regenerative Medicine, stem cell therapy works by trying to promote, support, and accelerate the natural repair processes of the body. Conditions that currently show some promise in responding to stem cell therapies include osteoarthritis and chronic tendonitis.

After harvesting stem cells, they are injected directly into the injury site. For a patient undergoing a rotator cuff tear repair surgery, stem cells from bone marrow may be injected at the site of the repair, although the evidence to support this is currently conflicting. Placing the cells into the tissue may help trigger improved tissue healing.

What Does Stem Cell Injections Treat?

Stem cell therapy is a relatively new innovative treatment option. It is a field that is growing and has exciting potential. Currently, in orthopedic sports medicine, there is some good evidence to consider stem cells for helping decrease symptoms associated with osteoarthritis, or “wear and tear” arthritis in the knee and shoulder. However, we currently do not have the ability to have stem cells form new cartilage in an arthritic joint, as we cannot manipulate stem cells to differentiate into one certain cell type per the FDA. There is also some evidence supporting stem cell use in chronic tendonitis about the shoulder or knee and in certain tendon repair surgeries.

What is the Recovery After Stem Cell Therapy?

A patient may experience pain from where the cells were harvested. There is also typically some pain at the injection site, swelling, and discomfort for several days. Most patients can resume normal daily activities in 2-3 days following treatment. The timeline for the full benefit of the treatment depends on the diagnosis, but most patients should experience pain relief from their condition within 6 weeks.

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Do Stem Cell Treatment Work?

Stem cell treatment is a relatively new treatment procedure and results may vary from patient to patient. A great deal of research is going on with stem cell therapy, and the use of stem cells has great promise, but currently the field is still in its infancy.

Because physicians can only inject minimally manipulated cell collections, this sort of stem cell usage is not currently regulated by the FDA. Because of the lack of stem cell regulation, various clinics and providers have made unfounded claims that stem cells are capable of curing just about any condition. Furthermore, because stem cell treatments are not covered by insurance companies when used in the office setting, patients are having to pay cash to providers to receive stem cell treatments. This creates a precarious situation for patients who are desperate for a cure of their chronic condition as they may be told that stem cells can help them, when the science would currently show that they are not proven to be helpful for that particular condition. Unfortunately, some unethical medical providers may be taking advantage of patients by collecting large payments to administer stem cell treatments that have not been shown to be helpful for their condition. As such, Dr. Cunningham recommends current stem cell therapy in some cases of managing knee or shoulder arthritis symptoms or possibly for chronic tendonitis. Furthermore, patients who wish to do their homework should pay closest attention to scientific studies published in reputable scientific journals that are high level (Level 1 or 2) studies. One could also look to read position statements from the various national medical professional organizations such as the American Academy of Orthopedic Surgeons (AAOS). In most cases, stem cell injections will not hurt a patient, but unfortunately current evidence would suggest that they are only helpful for a small number of orthopedic conditions. However, with time the indications for the use of stem cells will increase as more scientific studies are conducted.

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