We live in strange medical times. I’ve heard from several concerned patients that plastic surgeons have begun injecting various joints with fat stem cells, also called adipose stem cells. Why would I be concerned? Injecting biologics into a joint is not just about injecting “magic” stem cells. First, as an example, blind injections into a knee joint miss the actual joint about a third of the time (depending on which study you read). So about 1/3 of the patients being injected likely never have the stem cells enter their knee joint. Second, adipose stem cells wouldn’t be the best choice for helping cartilage. There’s almost no research to show that adipose SVF (the cell type being injected) works well for orthopedic applications. Third, and really most importantly, is diagnosis. I would expect that a plastic surgeon would know as much about what’s wrong with a knee as I would know about what’s wrong with a cleft palate, which is almost nothing. Last, is targeting. Below is an MRI report we got back yesterday from a college football player we treated several months ago. His major issue was an ACL tear and the team surgeons wanted to yank out his ACL surgically and replace it, putting him out for at least a season and permanently altering the biomechanics of his knee. How did we help an ACL that’s not supposed to heal on it’s own (although he still needs work on his meniscus)? It wasn’t by injecting “magic” stem cells blindly into his joint. It was by using C-arm fluoroscopy to target stem cells into the ACL, a technique we pioneered. Based on my 8 years of experience with stem cells in knees, the likelihood of a blind stem cell injection helping his knee, rather than placed inside the ACL tendon sheath, is almost nil. The upshot? A plastic surgeon using adipose SVF to help replace lost adipose tissue for cosmetic purposes is a good fit. A plastic surgeon pretending he has knowledge of the exceedingly complex musculoskeletal system is not good. If you want to read more about how we conceptualize orthopedic problems, read our practice book, Orthopedics 2.0.
Not all patient’s with ACL tears should expect to see interval healing on follow-up MRIs.
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…