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Centeno CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D. Increased knee cartilage volume in degenerative joint disease using percutaneously implanted, autologous mesenchymal stem cells. Pain Physician (United States), May-Jun 2008, 11(3) p343-53
Dr. Reeves' Notes: 200 ml of blood was drawn from a single patient and spun down to provide platelet rich plasma to support the bone marrow cultures. 10 ml of L post sup iliac spine (PSIS) marrow was obtained and 10 ml of R PSIS marrow in an operating room. 5 passages (culture method with 5 periods of growth to allow enough stem cells to be obtained) were taken to separate and concentrate the MSCs (mesenchymal stem cells or cells that can become ligament, tendon and cartilage cells). Bone marrow aspiration is performed again to obtain 1 ml of fresh nucleated cells, and blood is drawn for a fresh platelet rich plasma component with the latter diluted to 10% platelet solution. The cultured and grown MSCs are injected along with the 1 ml of nucleated cells and 1 ml of platelets into the knee . 1 ml of dilute (10%) platelets were then injected in the knee one week after stem cell injection. 1 ml of dilute (10%) platelets were then injected in the knee two weeks after stem cell injection.
Analysis: In summary the interventions taken included 3 bone marrow aspirations, 4 blood draws for platelet rich plasma, and 3 knee injections. In addition there was a time lag for culture prep and passages of MSCs. This is a lot of interventions and expense, of course. Nevertheless this is an excellent study in that it explains the process with the best of current technology and this was a 6 month followup. Notice that the patient in this study appeared to have some cartilage left.
BACKGROUND: The ability to repair tissue via percutaneous means may allow interventional pain physicians to manage a wide variety of diseases including peripheral joint injuries and osteoarthritis. This review will highlight the developments in cellular medicine that may soon permit interventional pain management physicians to treat a much wider variety of clinical conditions and highlight an interventional case study using these technologies
OBJECTIVE: To determine if isolated and expanded human autologous mesenchymal stem cells could effectively regenerate cartilage and meniscal tissue when percutaneously injected into knees.
DESIGN: Case Study
SETTING: Private Interventional Pain Management practice.
METHODS: An IRB approved study with a consenting volunteer in which mesenchymal stem cells were isolated and cultured ex-vivo from bone marrow aspiration of the iliac crest. The mesenchymal stem cells were then percutaneously injected into the subject's knee with MRI proven degenerative joint disease. Pre- and post-treatment subjective visual analog pain scores, physical therapy assessments, and MRIs measured clinical and radiographic changes.
RESULTS: At 24 weeks post-injection, the patient had statistically significant cartilage and meniscus growth on MRI, as well as increased range of motion and decreased modified VAS pain scores.
CONCLUSION: The described process of autologous mesenchymal stem cell culture and percutaneous injection into a knee with symptomatic and radiographic degenerative joint disease resulted in significant cartilage growth, decreased pain and increased joint mobility in this patient. This has significant future implications for minimally invasive treatment of osteoarthritis and meniscal injury.