There are many claims made about the effectiveness of stem cell therapy. When offering this treatment the doctor and the patient need to have a realistic expectation of the effectiveness of the treatment and if it will help the person’s elbow problems.
Is there research in support of bone marrow derived stem cell injections?
Many doctors point to a 2008 paper (1) as one of the earliest suggestions that bone marrow derived stem cells could help people with elbow tendinopathy. In this paper doctors suggested that iliac bone marrow plasma injection after arthroscopic debridement of degenerative tissue( in the elbow) will bring along biological healing. The treatment will not only reduce pain but also improve function in patients with resistant elbow tendonitis.
Study points:
- Twenty-four patients (26 elbows) with significant persistent pain for an average of 15 months following surgery
- The doctors applied autologous iliac bone marrow plasma injection following arthroscopic debridement.
- All patients in this study noted improvement both in pain and function. No complication occurred in any patient.
- Conclusion: “Biologic treatments in orthopaedics are just beginning to evolve. In the present investigation, the injection of iliac bone marrow plasma after arthroscopic debridement in severe elbow tendinosis demonstrated early recovery of daily activities and clear improvement.”
Bone marrow aspirate concentrate stem cell injections contain plasma rich in growth factors and mesenchymal stem cells
In a 2014 study in the Journal of natural science, biology, and medicine (2) bone marrow aspirate (containing plasma rich in growth factors and mesenchymal stem cells) injection was found to be an effective treatment for tennis elbow in many patients.
In this research a total of 30 adult patients with previously untreated tennis elbow were administered a single injection of bone marrow aspirate (stem cells and platelets).
- This concentrate was made by centrifugation of iliac crest bone marrow aspirate.
- The researchers concluded: Treatment of tennis elbow patients with single injection of bone marrow aspirate showed a significant improvement in short to medium term follow-up. They suggest that in the future, such growth factors and/or stem cells based injection therapy can be developed as an alternative conservative treatment for patients of tennis elbow, especially who have failed non-operative treatment before surgical intervention is taken.
Let’s point out again bone marrow aspirate contains plasma rich in growth factors and mesenchymal stem cells. No separate PRP treatment was given.
More recently a 2018 study in the Journal of orthopaedics (3) commented on the above study:
“Bone marrow aspirate concentrate (BMAC) is an emerging, novel treatment for various bone and cartilage pathology and injury. Similar to other orthobiologic intra-articular injections like hyaluronic acid and PRP, BMAC gives patients the opportunity to restore the natural microenvironment of their damaged or diseased tissue. Bone marrow concentrate is commonly taken from pelvic bone, and contains mesenchymal and hematopoetic stem cells, platelets, growth factors, cytokines, and anti-inflammatory and immunomodulatory cells. . . Further evaluating the efficacy of bone marrow injections, thirty patients who were untreated for Lateral Epicondylitis were evaluated with the Patient-rated Tennis Elbow Evaluation (PRTEE) prior to and following the treatment of a single administration of Iliac Bone Marrow Aspirate. – This concentrate, composed of iliac bone marrow aspirate. . . was effective in simplicity and safety, avoiding further complications as other modes of treatment. Evaluated at 2, 6, and 12 weeks after administration, these patients showed drastic improvement in the two week evaluations, thus showing the efficacy of this treatment’s recovery time. Although (the authors} explained the limitation of their study in long term treatment, they believe that this treatment, when paired with growth factor and other stem cell treatment, can be an effective alternative in lieu of surgery.”
Additionally, a 2021 study (4) suggested that generally, bone marrow aspirate concentrate injections can have good impact on tendon injury: “Potential evidence has shown that MSC injection improves pain, joint functional, radiological, and arthroscopic parameters in patients with tendon disorders. Although all the included studies had a small sample size, the results clearly presented MSC dose-dependent responses regarding pain relief.”
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References
1 Moon YL, Jo SH, Song CH, Park G, Lee HJ, Jang SJ. Autologous bone marrow plasma injection after arthroscopic debridement for elbow tendinosis. Annals Academy of Medicine Singapore. 2008 Jul 1;37(7):559.
2 Singh A, Gangwar DS, Singh S. Bone marrow injection: a novel treatment for tennis elbow. Journal of natural science, biology, and medicine. 2014 Jul;5(2):389.
3 Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. PMID: 29657450; PMCID: PMC5895908.
4 Cho WS, Chung SG, Kim W, Jo CH, Lee SU, Lee SY. Mesenchymal Stem Cells Use in the Treatment of Tendon Disorders: A Systematic Review and Meta-Analysis of Prospective Clinical Studies. Ann Rehabil Med. 2021 Aug;45(4):274-283. doi: 10.5535/arm.21078. Epub 2021 Aug 30. PMID: 34496470.