Stem cells in orthopedic care: Science or snake oil?

Joint Health

by Christopher W. Miars, DO

Oct 1, 2020

Over the last decade, several high-profile professional athletes have turned to what has widely been referred to as stem cell therapy to recover from injury and attempt to return to top form. Ten years ago, many of these therapies were based more on scientific theory rather than medical fact. 

But what about now? As a sports medicine subspecialist, stem cell therapy is a topic — and treatment — I’ve spent a lot of time exploring. 

The first thing to know is that many of the orthopedic therapies being marketed as stem cell treatments are either not technically stem cell therapies or have recently been reclassified. 

Some of these “stem cell” treatments do not use viable stem cells, and those that do are now commonly referred to as “biologics” in the medical community. That’s because we now understand that these viable cells function as signaling agents to promote healing rather than cells that transform into new tissue.

The second thing to know is that some of these treatments are effective in addressing certain orthopedic conditions, even if the way they work is not as initially theorized.

What are stem cells? The theory

Stem cells are special cells that can develop into many different types of tissue — brain tissue, heart tissue and, for orthopedic purposes, bone, muscle, tendons, ligaments and cartilage. 

For orthopedics, the theory was that these stem cells could be harvested and then reinjected into damaged or worn areas of the tendons or joints, and they would regenerate into healthy tissue. 

If you are dealing with arthritis due to cartilage in your knee being worn down, for example, the hope was that stem cells injected into the joint would develop into new cartilage, thereby “curing” your arthritis. 

What are stem cells? The reality 

Although stem cells, or biologics, may never develop into new orthopedic tissue as hoped, that’s not to say they are not producing real and positive results for people with certain conditions. 

The cells, which are typically extracted from a patient’s own body, have signaling agents that trigger a biochemical response that bring in healing factors from other parts of the body. These healing factors can help lessen pain, increase function and slow wear and tear on the body site where they are introduced. 

In short, when used appropriately, it can be a highly effective treatment option.

Are biologics right for you?

For athletes — both male and female of all ages — biologics have proven effective in helping recovery from tendon injuries such as plantar fasciitis and patellar tendonitis. In addition, limited research shows promising results for aiding the healing of other soft tissue problems. They also can be an effective treatment option for arthritis, particularly of the knee.  

Some of the top reasons to consider biologics for addressing orthopedic issues is that the treatment process takes less than an hour, can be done in your doctor’s office and involves very little discomfort or recovery time. 

Here are a few of the most widely used types:  

Platelet-rich plasma (PRP):

This involves drawing a patient’s blood into a tube and then processing it, utilizing a centrifuge to separate and concentrate the platelets (which help the body repair damage), thus creating platelet-rich plasma. The PRP is then injected into the injured ligament, tendon or joint.

Bone marrow aspirate:

A small incision is made in the back of the hip (usually) to harvest bone marrow. The bone marrow is then injected into the site of the damage. You may experience minor discomfort at the harvest and procedure site for a couple of days.

Adipose graft:

The skin and underlying fatty tissue of the belly or hip region is numbed, so that fat cells can be suctioned out (think mini-liposuction). These cells are processed and, as with the other methods, reinjected to the patient at the site of the issue. 

Unlike a steroid injection for orthopedic issues, you will not receive immediate relief from biologics. In fact, it may take six weeks before you notice any improvement. 

However, between six to 12 months, people often report increasingly positive results. Additionally, there is substantial evidence showing that biologics can slow the rate of cartilage degeneration in arthritic joints and promote the growth of healthy new tendon tissue. 

In other words, using biologics is more about winning a marathon than a sprint. 

Ready to move better? Talk to an orthopedic expert about whether biologics are the right treatment for you.

About the Author

Christopher W. Miars, DO, is a sports medicine specialist with subspecialty expertise in minimally invasive, musculoskeletal ultrasound-guided procedures at Baylor Scott & White Southwest Sports Medicine and Orthopaedics in Waco. He has more than a decade of experience performing ortho-biologic therapies to help his patients. An avid weekend warrior, Dr. Miars has a passion for helping athletes of all abilities get back to the sports they love.

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