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Stem Cells for Articular Cartilage Defects
Consider before getting the MACI procedure
Cartilage defects can be a devastating injury for an individual as cartilage
does not heal spontaneously.  Pain, swelling, mechanical symptoms, loss
of function, and inability to participate in activity are common.

Autologous Chondrocyte Implantation (ACI) or the
MACI procedure for
cartilage defects involves one surgery to harvest or remove a portion of
healthy cartilage from a joint in your body, usually your knee, and then
after culturing them in a lab and seeding them on a membrane, they are
implanted back in a second surgery into the articular defect of your
injured joint.  The MACI procedure is not without failure, cost, or risks,
one of which has been repeatedly reported in the literature, that of donor
site morbidity present at one year.  In other words, the healthy site
where cartilage was removed for the MACI procedure now becomes a
painful damaged arthritic site.

The decision to harvest cartilage to perform a repair procedure such as
ACI should be taken with extreme caution is the conclusion from
Donor
site morbidity after articular cartilage repair procedures: a review.
Acta Orthop Belg. 2010 Oct;76(5):669-74.

Stem cell injections are a viable, non-surgical alternative to treat cartilage
defects or cartilage injuries and should be tried prior to any operative
intervention such as ACI or the MACI procedure.  Remember surgery
can never be undone.

Intra-articularly injected mesenchymal stem cells have been found
to
promote cartilage regeneration.  Satué, M., Schüler, C., Ginner, N. et al.
Intra-articularly injected mesenchymal stem cells promote cartilage regeneration, but do not
permanently engraft in distant organs. Sci Rep 9, 10153 (2019)

Dr. Silberman recently treated a cartilage defect in an individual's knee
with bone marrow stem cell aspirate
, who had been seen at The Hospital
for Special Surgery in anticipation of having the MACI procedure
performed, having already had the biopsy taken.  In the interim prior to
re-implantation, the patient was seen by Dr. Silberman and chose to
have a bone marrow aspirate stem cell injection by Dr. Silberman
performed on 2/21/20.

MRI of his right knee on 11/17/2018 compared to an MR 3/11/2016:  
"No substantial change in a small shallow partial-thickness cartilage
defect along the lateral patella facet.  There are new horizontal oriented
articular cartilage fissures extending from the medial patella facet to the
median ridge."

On 2/21/20, Dr. Silberman performed a bone marrow aspirate stem cell
injection into his right knee.  Several month later after having pain for
more than 4 years,
the patient's pain was gone and a repeat MRI was
performed
:

MRI right knee 9/2020 performed at The Hospital for Special Surgery
HSS:  "Comparison is made to the prior outside study from 11/17/2018.  
The cartilage over the patella is minimally heterogenous without
prominent fibrillation. There is no chondral defect."

Upon follow-up with his surgeon at HSS, who himself read the films
personally, his surgeon reported to the patient he was NO LONGER A
CANDIDATE FOR MACI as there WAS NO LONGER A
CARTILAGE DEFECT SEEN.

To learn more about Bone Marrow Aspirate Stem Cell Injections please
call to schedule an appointment with Dr. Silberman at New Jersey Sports
Medicine and Performance Center by calling (908) 647 - 6464.

This is just one case study of many success stories with stem cell
injections. More rigorous scientific studies are needed.

References:
Satué, M., Schüler, C., Ginner, N. et al. Intra-articularly injected
mesenchymal stem cells promote cartilage regeneration, but do not
permanently engraft in distant organs. Sci Rep 9, 10153 (2019). https:
//doi.org/10.1038/s41598-019-46554-5

Andrade R, Vasta S, Pereira R, et al. Knee donor-site morbidity after
mosaicplasty - a systematic review. J Exp Orthop. 2016;3(1):31. doi:
10.1186/s40634-016-0066-0

Matricali GA, Dereymaeker GP, Luyten FP. Donor site morbidity after
articular cartilage repair procedures: a review. Acta Orthop Belg. 2010
Oct;76(5):669-74. PMID: 21138224.
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