Evidence for Stem cell treatment knee osteoarthritis India

Evidence for Stem cell treatment knee osteoarthritis Chennai

See the evidence for Stem cell treatment of knee osteoarthritis Chennai discussed in this video. I read from a recently published paper in the Journal of Arthritis Research.

Here’s the video. If interested learn more at www.orthobiologicsurgeryindia.com. 

I perform knee replacements, and Orthobiologic procedures.

Stromal vascular fraction (SVF) is a concentrated cell-packed portion of adipose tissue that has been used to treat knee osteoarthritis (OA) 1. SVF is known for its anti-inflammatory characteristics and has been shown to decrease pain and improve function in patients with knee OA 1 2.

In a single-center, non-randomized, phase I/II trial, 33 patients with KL (III) knee osteoarthritis were evaluated. The study aimed to evaluate the improvement in knee pain, function, and cartilage restoration. The results showed that joints treated with SVF provided a better quality of life to patients 1.

Other frequently found interventions include cultured adipose-derived stem cells (ADSCs), and the micronized/microfragmented adipose tissue-stromal vascular fraction (MAT-SVF) 1. Clinical data reported that joints treated with MAT-SVF provided a better quality of life to patients 1.The mechanism of action of SVF is also not fully understood. However, the current hypothesis indicates a direct adherence and integration with the degenerative host tissue, and/or trophic effects resulting from the secretome of constituent cells 1.

In conclusion, there is evidence of efficacy in the use of stromal vascular fraction and related therapy for the treatment of osteoarthritis of the knee. However, more research and clinical patient follow-up are needed to determine the proper place of these therapies in the treatment of osteoarthritis of the knee 1.

Source(s)

1. Stromal Vascular Fraction for Osteoarthritis of the Knee Regenerative …

2. Cartilage lesion size and number of stromal vascular fraction (SVF …

3. Autologous Adipose-Derived Tissue Stromal Vascular Fraction (AD-tSVF …

Stem cell treatment knee arthritis Chennai

Stem cell treatment knee arthritis Chennai

Stem cell treatment knee arthritis Chennai
To know what is stem cell treatment for knee arthritis in Chennai, see this video presentation that was delivered at a medical college in Chennai, India three years ago.

What are stem cells?

Cells that are capable of regenerating and replicating and repairing tissues are known as stem cells. They are present in every organ and tissue in the human body like skin, fat, bone marrow, muscle, and heart, everywhere, but they are dormant and can be kicked into action by external methods either by the response to a trauma or by seeding the damaged area with stem cells by injection or open procedure.

This is the classification of stem cells. At the top, you have the totipotent embryonic stem cell which is formed by the fusion of the sperm to the ova. This results in a zygote and the formation of a blastocyst which further differentiates into two cells four-cell then the embryo and the fetus and so on. The totipotent embryonic stem cell gives rise to pluripotent embryonic stem cells which form various tissues. These pluripotent stem cells then give rise to multipotent stem cells which are present in every tissue like the lung, pancreas, heart muscle, red blood cells skin muscle bone marrow, and every other tissue. These are not confined to the mesenchymal space.

How do we isolate stem cells?

We aspirate them from fat by liposuction. Then we manipulate them by centrifuging. Then they are ready for injection.

Stem cell treatment for knee arthritis in India by Dr.A.K.Venkatachalam is done as an outpatient procedure. The patient can return home within a few hours. If spinal anesthesia is given, then discharge takes longer.

The cells can also be isolated like before and sent off to a tissue bank where they are cultured and stored.  By this, their number is expanded to several million and they can be kept in cold storage for longer periods. Certain tissues have got a half-life but some tissues can be stored for a long time.  Their potency decreases after one year. So, when these cells are expanded, they can be returned to the doctor to be re-injected into the patient.

How do I apply or treat damaged areas of cartilage and bone?

See this procedure here 

One can apply it to the cartilage lesion by arthroscopic or open surgery. Here the joint is inspected through an arthroscope, and the area of damage is prepared by shaving and microfracture. Then the cells are made into a paste with fibrin glue and applied to the cartilage lesion. It is shaped with a spatula. Then the joint is put through a range of movements for the glue to set in five minutes. Then the patient is returned to the ward for observation. He/She will remain non-weight bearing and can resume activities full weight-bearing activities after six weeks. This procedure is usually done for single or one or two cartridge lesions.  It does not apply to osteoarthritis wherein I use fluoroscopy or ultrasound guidance for injections.

This is a picture of a slide with seeded chondrocytes

What is the mechanism of action for stem cell treatment of knee arthritis in Chennai?

They have a trophic effect which means they stimulate growth via the secretion of cytokines and growth factors that is when the cells are injected into a joint these growth factors are released and they have the potency or capability of stimulating adjacent cells in the joint to differentiate and form cartilage. These differentiating cells, when stimulated by growth factors, will go ahead and repair areas of damaged cartilage, and limited cartilage repair are possible; not a complete repair in the case of bone on bone.

The cells possess an immune modulatory effect even when injected even from an allergenic source. They erect a barrier between themselves and the native person’s immune system and perform their function without any interference from the destructive and deleterious effects of the immune system like T cells. They have an anti-inflammatory effect. When injected into swollen inflamed joints, they put a brake on inflammation.

After that, there will be continuous improvement.

Antibiotic effect – There is no need for a person to worry when stem cells are injected. They are not at risk of developing a joint infection like septic arthritis of the knee. This is because of the antibiotic effect present in the stem cells themselves.

Self-replication effect- they can replicate as themselves or replication differentiate into further cell types.

They have an anti-aging effect.

What is the role of Stem cells in orthopedic surgery?

The commonest indication is nonunion.  In small non-unions stem cells can be injected which can promote union.

Articular cartilage damage in the knee, shoulder, hip, and ankle joints can be treated with stem cells.  When stem cells are injected into areas of cartilage damage, they can repair cartilage. They can also repair osteochondral defects when inserted in the form of a bone plug.

Osteoarthritis -When there is widespread cartilage of ICRS grade 3 grade or 2, stem cells can help to halt the ongoing osteoarthritis process and lead to limited repair. Patients can get sustained pain relief for a few years.

Avascular necrosis is commonly seen in the hip joint, and it is bilateral. It can result from steroid intake, alcohol, Gaucher’s disease, and deep-sea diving. Blood disorders like sickle cell anemia can result in avascular necrosis. Avascular necrosis in the early stages can be treated with stem cells.

Stem cells can also promote wound dealing like in diabetic ulcers or chronic ulcers

Advantage of fat over bone marrow.

I injected Stromal vascular fraction (SVF) derived from fat.  Earlier I used bone marrow. Fat has several advantages over bone marrow enumerated here.

Bone marrow has fewer stem cells than fat, Fat contains 500 to 2000 times more MSCs than the same volume of bone marrow. Fat cells have the highest proliferation potential, and the cells are younger than bone marrow. in old older people, it may be difficult to obtain cells from the bone marrow because there is osteoporosis. In addition, fat also contains numerous other regenerative cells that are important to the healing process.

A further advantage of fat is that it is less painful. I can aspirate it from the thigh and the patient can go home within a few hours,

Anticoagulants are not required. If you take bone marrow, then you have to treat it immediately with heparin and inject heparin into the bone to prevent it from clotting while being aspirated. This can result in an overdose or leakage of the anticoagulant solution into the adjacent tissue. Bone marrow aspiration from the posterior part of the iliac crest can result in penetration and spread of the heparin in retroperitoneal space, leading to retroperitoneal hematoma.

Cells derived from fat are a better source for articular cartilage repair.

What is the benefit of stem cell treatment for knee arthritis in Chennai?

Some patients have been able to get prolonged pain relief and have postponed knee replacement. The longest follow-up stem cell treatment for the knee is seven years.

See a patient’s testimonial here-

In the short term, they can avoid taking NSAIDs, painkillers, and opioids. They will lead a better quality of life.

So, if you want Stem Cell Treatment for Knee arthritis in Chennai India Dr.A.K.Venkatachalam, click the form, fill it out, and post. You can locate my practice by clicking on this link

Call – 7824003400 or the hospital – 044 42938938

Email -drvenkat@kneeindia.com

 

Stem cell treatment knee arthritis Chennai

Stem cell treatments knee arthritis Chennai India

Stem cell treatments knee arthritis Chennai India by Dr.A.K.Venkatachalam. In this video stem cells are derived from the patient’s own body, prepared, mixed with PRP, and injected into the patient’s knee joint under local anesthesia. The patient can walk normally after the procedure and can return home within a few hours. No keyhole or open surgery is needed. The stem cells injected are more numerous than other sources. See here for more details.

 

Stem cell ACL, Cartilage repair India

Stem cell ACL, cartilage repair India relieved this young lady’s pain. Partial tears of the ACL can be treated and healed with stem cells, avoiding an ACL reconstruction. Cartilage defects can be healed with stem cells through key hole surgery. This procedure was done for the first time in India. If you have a recently diagnosed ACL tear, this can be treated with stem cells. E mail drvenkat@kneeindia.com

 

Orthopaedic Stem cell treatment India Dr.A.K.Venkatachalam

Stem Cell ACL, Cartilage repair India may be game changer

Stem cell ACL, cartilage repair India may be game changer

A young lady with combined anterior cruciate ligament and cartilage injury of her knee was treated with her own cells in Chennai through key-hole surgery. This is the first time that a patient’s own cells were used to repair a partial tear of the anterior cruciate ligament (ACL). A cartilage lesion under her knee cap was also simultaneously repaired using cells.

Stem cell ACL & cartilage repair India
Mrs. AR who had a single stage partial ACL and cartilage repair with stem cells is seen with Dr. A.K.Venkatachalam

Case report– A 25-year-old AP housewife injured her right knee in a domestic fall two years ago. Following this, her knee would give way while descending stairs. She also felt pain on sitting. She sought treatment in Chennai from Dr.A.K.Venkatachalam. An MRI scan showed a partially torn anterior cruciate ligament (ACL) and cartilage damage underneath her knee cap. A key-hole surgery clearly identified the problem.  One of the two bundles of the ACL was partially torn. The other bundle was still attached. There was loss of cartilage under the knee cap. It was decided to repair the ligament and cartilage with her cells through key-hole surgery.  An intra-ligamentous injection of cells into the torn ligament was done and the cartilage lesion was treated with a cell gel technique in an one and half hour long key hole surgery procedure.
The patient is recovering with therapy and has been relieved of pain. The final result will be known by an MRI scan in future and its result too will be presented.

Discussion– The anterior cruciate ligament is the major internal ligament.  It stabilizes the knee joint in a front- back direction. Tears of this ligament occur in sports, road accidents and domestic falls. This injury invariably leads to degenerative changes in the knee and hence orthopedic surgeons advice surgical reconstruction.  Surgery for ACL tears involves taking down the torn ligament and replacing it with a ligament harvested from another part of the body. This is called an ACL reconstruction and it is the gold standard of ACL surgery.

Disadvantages of standard ACL reconstruction

  1. Recovery can take as long as one-year before return to sports is possible.
  2. High risk of graft failure- A study published in the American Journal of sports medicine in 2014 showed that young patients had a risk of graft rupture2.
  3. Lack of stretch sense – Proprioceptive sense inherent in the native ligament is gone forever whatever the physical therapy input be.
  4. Lack of full recovery in the donor tissue- The hamstring muscle from which the graft is harvested rarely regains its strength.
  5. Risk of degenerative changes. This occurs invariably and more commonly in women.

So how does one avoid degenerative changes and additional morbidity associated with ACL reconstruction while retaining stability? This has sparked an interest in ACL repair with or without biologics.
A further development is the injection of biological cells into the torn ACL to make it heal. There is evidence that partial and in some early cases, even full thickness ACL tears can be healed with cell therapy. This is based on experimental evidence in both animals and humans.
A small case series in humans is available for treatment of ACL injuries with precisely targeted cell injections without key-hole surgery1.

What are the benefits of cell repair of ACL tears over standard ACL reconstruction?

  1. Morbidity associated with graft harvest from another body source is avoided. The risk of infection from a cadaveric allograft is also eliminated.
  2. The recovery time with cell repair is much less than with a full ACL reconstruction. Recovery begins right away and takes about six to twelve weeks as against the six to nine months required for a full ACL reconstruction surgery. This is of great value to professional sports person as well as others. Everybody wants to recover faster from their ailments and lead normal lives.
  3. The cost too is far less when you consider the surgical cost, rehab cost, time required off work and costs involved in inability to return to sports.

What is the benefit of key-hole surgery in this condition?

  1. Key-hole surgery allows the surgeon to visualize the whole of the ligament including its bony attachments at both ends, tug at it to check its integrity and take the appropriate decision based on intra operative findings. This is what was done for this young lady. As the ligament was only partially torn, cells were injected into the torn portion to induce a biological healing response in accordance with evidence.
    Direct visualization of the other structures like cartilage and menisci is possible. In this case the MRI documented area of cartilage loss under the knee cap was reconfirmed. This too could be treated with cells.

Both the problems were treated with the patient’s own bone marrow derived cells in a one and half hour long procedure.

Who would benefit from cell treatment of ACL tears?

  1. It would mainly benefit those patients with partial ACL tears in which part of the ligament is still attached to bone or there is a mid-substance partial tear.
  2. Also it could contribute to patients who undergo surgical repair of un-retracted tears as opposed to reconstruction.
  3. There is evidence that it also improves the healing of standard ACL reconstruction by improving the quality of ligament tissue and ligament-bone interfaces.

To benefit from cell mediated ACL repair, patients should seek medical help soon after a knee injury.
Not all patients with a knee injury seek help immediately. Case selection is very important. Delay in diagnosis and treatment leads to wide separation of the torn ends and results in additional damage to cartilage and menisci. These patients may well need an ACL reconstruction.
Patients with a partially torn ligament and minimal retraction of the ACL ends are most likely to benefit from this treatment. This would be possible only if patients sought medical attention soon after injury. Earlier MRI diagnosis would identify suitable cases for cell treatment. It would allow minimally invasive repair or stem cell treatment and avoid further damage to the menisci and articular cartilage.

To sum up, this novel key-hole cell mediated ACL; cartilage repair is likely to be a game changer. It will allow patients to retain their own ACL, preserve joint sensation, hasten recovery and lower costs. Biological treatments are finding an increasing role in orthopedic ailments.

References-

  1. http://www.regenexx.com/wp-content/uploads/2015/08/anterior-cruciate-ligament-tears-treated-with-percutaneous-i_073115_26261.pdf
  2. http://ajs.sagepub.com/content/42/3/641.abstract

See the video of the procedure Stem cell ACL,cartilage repair India .