Clinical studies evaluating the effects of MSC (stem cell) injections in meniscus repair
A June 2021 paper (1) discusses the possibility of meniscus regeneration with PRP and bone marrow and adipose tissue cell injections. This is a case history.
“Conventional pharmacological and surgical treatments are effective in treating the condition; however, do not result in regeneration of healthy tissues. In this report, (doctors) highlight the role of cell-based therapy in the management of medial and lateral meniscal and anterior cruciate ligament tears in a patient who was unwilling to undergo surgical treatment. (The dioctors) injected autologous mesenchymal stem cells obtained from the bone marrow and adipose tissue and platelet-rich plasma into the joint of the patient at the area of injury, as well as intravenously. The results of (this) study corroborate with those previously reported in the literature regarding the improvement in clinical parameters and regeneration of meniscal tissue and ligament. Thus, based on previous literature and improvements noticed in our patient, cell-based therapy can be considered a safe and effective therapeutic modality in the treatment of meniscal tears and cruciate ligament injury.”
A March 2021 study (2) gave this assessment in a paper titled: “Cell-based treatment options facilitate regeneration of cartilage, ligaments and meniscus in demanding conditions of the knee by a whole joint approach.”
“Overall, cell-based regenerative cartilage therapy of the knee has shown tremendous development over the last years and has become the standard of care for large and isolated chondral defects. It has shown success in the treatment of traumatic, osteochondral defects but also for degenerative cartilage lesions in the demanding condition of early osteoarthritis. Future developments and alternative cell sources may help to facilitate cell-based regenerative treatment for all different structures around the knee by a whole joint approach.”
Researchers at the Osaka University Graduate School of Medicine in Japan teamed with the Mayo Clinic to release a January 2020 (3) paper outlining the current research on stem cell therapy for meniscus repair. In this study they wrote:
“Clinical studies evaluating the effects of MSC (stem cell) injections in the knee joint are limited, but early clinical data suggests encouraging results. Currently, there have not been any reported safety concerns or side-effects in the clinical use of MSC injections.
Randomized double-blind controlled studes to date studying the effects of MSC injections into the knee post medial meniscectomy are rare. A 2014 study (4) contained 55 subjects in 3 groups who underwent a percutaneous injection of allogeneic MSCs with one group receiving 50 × 106 cells another 150 × 106 cells and control receiving only hyaluronic acid. At 12 months follow up, MRI scan findings reported a significant increase in meniscal volume in 24% of patients receiving 50 × 106 cells and 6% receiving 150 × 106 cells. None of the control group patients demonstrated an increase in meniscal volume. The study is limited to MRI scan being the only objective outcome measure, but the study methodology is rigorous in that it has the advantage of being blinded and randomized.”
In December 2021, doctors published a summary understanding of using stem cells in meniscus repair, based on the current research of stem cell repair of a meniscus tear. (5) According to the study authors:
“Due to the special anatomical features of the meniscus, conservative or surgical treatment can hardly achieve complete physiological and histological repair. As a new method, stem cells promote meniscus regeneration in preclinical research and human preliminary research. We expect that, in the near future, in vivo injection of stem cells to promote meniscus repair can be used as a new treatment model in clinical treatment.”
“The treatment of animal meniscus injury, and the clinical trial of human meniscus injury has begun preliminary exploration. As for the animal experiments, most models of meniscus injury are too simple, which can hardly simulate the complexity of actual meniscal tears, and since the follow-up often lasts for only 4-12 weeks, long-term results could not be observed. Lastly, animal models failed to simulate the actual stress environment faced by the meniscus, so it needs to be further studied if regenerated meniscus has similar anti-stress or anti-twist features.”
“Despite these limitations, repair of the meniscus by MSCs has great potential in clinics. MSCs can differentiate into fibrous chondrocytes, which can possibly repair the meniscus and provide a new strategy for repairing meniscus injury.”
For many people, the long rehabilitation, possible need for secondary surgery, and other post-surgical factors weigh heavily in their decision making process as to how to proceed to fix their meniscus tear. For many people, regenerative medicine in the form of bone marrow aspirate concentration stem cells may be something to be explored.
Let’s look at an October 2020 study (6) that made some interesting observations. What the research team wanted to do was assess Bone marrow-derived mesenchymal stem cells’ potential to engineer meniscus-like tissue. The researchers pointed out that “Bone marrow-derived mesenchymal stem cells have the potential to form the mechanically responsive matrices of joint tissues, including the menisci of the knee joint.” So to test how good these stem cells were at re-engineering meniscus tissue, they compared the bone marrow stem cells taken from the iliac crest versus the meniscus fibrochondrocytes cells (cartilage cells) isolated from castoffs of partial meniscectomy from non-osteoarthritic knees.
To simulate conditions that may occur in the human body after cell transplantation, the bone marrow-derived mesenchymal stem cells were cultured in type I collagen (the stuff that cartilage is made of) scaffolds. What they found was that the bone marrow-derived mesenchymal stem cells produced functional replacement meniscus tissue better than meniscus tissue did. This study is not definitive in the way bone marrow derived stem cells may heal and regenerate meniscus tissue. What it does show however is what could be possible in the right setting.
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References
1 Mahajan PV, Subramanian S, Parab SC, Mahajan S. Autologous Minimally Invasive Cell-Based Therapy for Meniscal and Anterior Cruciate Ligament Regeneration. Case Reports in Orthopedics. 2021 Jun 25;2021.
2 Angele P, Docheva D, Pattappa G, Zellner J. Cell-based treatment options facilitate regeneration of cartilage, ligaments and meniscus in demanding conditions of the knee by a whole joint approach. Knee Surgery, Sports Traumatology, Arthroscopy. 2021 Mar 5:1-3.
3 Jacob G, Shimomura K, Krych AJ, Nakamura N. The Meniscus Tear: A Review of Stem Cell Therapies. Cells. 2019 Dec 30;9(1):92. doi: 10.3390/cells9010092. PMID: 31905968; PMCID: PMC7016630.
4 Vangsness Jr CT, Jack Farr II, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. JBJS. 2014 Jan 15;96(2):90-8.
5 Dai TY, Pan ZY, Yin F. In Vivo Studies of Mesenchymal Stem Cells in the Treatment of Meniscus Injury. Orthopaedic Surgery. 2021 Nov 8.
6 Elkhenany HA, Szojka ARA, Mulet-Sierra A, Liang Y, Kunze M, Lan X, Sommerfeldt M, Jomha NM, Adesida AB. Bone Marrow Mesenchymal Stem Cell-Derived Tissues are Mechanically Superior to Meniscus Cells. Tissue Eng Part A. 2020 Oct 30.