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|Stem Cells for ACL Tear
|Can bone marrow aspirate stem cell injections heal some ACL ligament
In a recent 2018 article by Centeno et al., Symptomatic anterior
cruciate ligament tears treated with percutaneous injection of
autologous bone marrow concentrate and platelet products: a non-
controlled registry study, the authors have documented the use of bone
marrow aspirate injections with stem cells for ACL tears with pre- and
post- MRI images depicting healed appearances of previous documented
torn ACL ligaments with symptomatic improvement of patient symptoms
and exam after bone marrow stem cell injection.
Dr. Silberman of New Jersey Sports Medicine has found similar findings
and it appears bone marrow aspirate injections which contain stem cells
may heal some ACL tears. Dr. Silberman too has seen post treatment
MRIs of ACL tears treated with bone marrow aspirate stem cell
injections depicting healed appearances of previous documented torn
ACL ligaments, with the more important clinical measurement of
improvement of patient symptoms, exam, and function with no surgery.
Below is an image of an MRI brought to Dr. Silberman of a patient with
a symptomatic ACL partial tear, read by the radiologist as "diffuse
mucoid degeneration of the ACL". As you can see the ACL is torn on
the MRI with the insertion of the ACL on the tibia torn with fiber
retraction, thickening, with a wavy non linear architecture. Patient was
symptomatic with pain, instability, lack of motion, and laxity on exam.
Below is an MRI image of the same patient's knee seen above, 2 months
post bone marrow aspirate stem cell injection by Dr. Silberman depicting
an MRI of an intact ACL ligament reported by the radiologist as "The
ACL and PCL are within normal limits. The ACL is linear, intact
distally, without the previous wavy detached appearance. More
importantly,post bone marrow aspirate stem cell injection the athlete has
no knee pain, no instability complaint, with improved motion. While Dr.
Silberman always teaches, "Treat the patient, not the film" it is exciting
as a scientist when the practice of medicine produces solid appearing
evidence that what we are doing is not just anecdotal.
Dr. Silberman's procedure with Marrow Cellution requires just one
harvest site injection and aspiration of 10cc of bone marrow aspirate
from the athlete's iliac crest versus other regenerative providers who may
require 6 to 10 injections and aspiration sites in the iliac crest as
performed in the article quoted above. And no large blood draw for
platelet rich plasma (PRP) is required to be isolated when using the
Marrow Cellution system. Dr. Silberman skilled in ultrasound guided
injections is able to inject the ACL with bone marrow aspirate stem cells
under ultrasound guidance which carries no radiation risk as fluoroscopy
does that some other providers may use. The entire procedure from
aspiration of bone marrow stem cells to injection into the knee and ACL
ligament may take less than 30 minutes.
There is basic science evidence that supports bone marrow aspirate stem
cell injection could accomplish ACL ligament healing. Animal models
with stem cells found in bone marrow have demonstrated ligament and
ligament-bone interface healing. Mesenchymal stem cells have been
found in injured ACLs, suggesting that stem cells are involved in ACL
healing. Randomized clinical control studies of stem cell injections for
ACL ligament tears are needed.
Another common teaching by Dr. Silberman is "You can't undo surgery"
and "elective surgery is elective". And this is especially true when
cutting and removing your normal uninjured patella tendon or hamstring
tendon to reconstruct your ACL ligament. So while some athlete's may
require ACL reconstruction, bone marrow aspirate stem cell injections
appear to be a viable option for some ACL ligament tears.
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