Stem Cell Cartilage Regeneration: What Everyone With Joint Pain Should Know

stem cell cartilage regrowth

I love talking to patients in the clinic, as it gives me a never ending stream of ideas for stem cell related blog posts. Social media also provides a way to understand what patients are thinking and we recently received this question about stem cell cartilage regeneration, which I’ll attempt to answer below:

“I recently had an appointment with a Dr X last week, regarding my knee and cartilage degeneration in the lateral meniscus. I asked about stem cell regeneration and was met by if it could be done he would be doing it. He said it is very difficult to sustain the cells in that area. That it still was not accepted as working. He advised that in medical journals and conferences it is no further on and i basically got from him that is a waste of money. Is there concrete evidence it works? Are there MRI’S out there showing severe loss of meniscus and one showing post treatment with a huge increase that i can see???”

Can Stem Cells Regenerate Cartilage?

Mesenchymal stem cells (MSCs) can naturally transform into many tissues including bone, cartilage, and fibrous tissue. There are hundreds of studies of animal models where these cells have been shown to help repair cartilage.  In fact, as of this morning there are 1,782 such studies listed in the U.S. National Library of Medicine. So from a conceptual standpoint, we have good prima facie evidence that this can work.

When looking at different stem cell sources, the two most commonly used today are bone marrow and fat. Of the two, there’s much better evidence that bone marrow MSCs can help regenerate cartilage than fat MSCs. So if you had to choose a stem cell source for the purpose of regenerating cartilage, bone marrow would be your best choice. This is why Regenexx uses bone marrow derived stem cells for all of our stem cell procedures.

The Myth of Cartilage Loss as a Primary Source of Pain

Cartilage is the shock absorber that lines the end of your bones. One of the hallmarks of arthritis that’s easy to see on x-rays and MRIs is the loss of cartilage. Given the orthopedic community’s obsession with cartilage loss, you would think we had solid evidence showing that loss of cartilage in a knee is directly associated with increased pain and disability. In reality, there is little evidence that’s actually true.

The largest government funded research studies to date do not relate more cartilage loss to pain. In other words, there are lots of people walking around out there with “bone on bone” knees who don’t have much pain and seem to get along just fine. There are also people with normal cartilage on their MRIs who are in tremendous pain.

Knee pain is a very complex thing that goes beyond the structure seen on an MRI. For example, the orthopedic surgical community has drilled into the heads of patients now for a generation that a torn meniscus on the MRI of a middle-aged person is a big deal. However, based on multiple research studies this seems to be more of a marketing message created to sell unnecessary surgeries than anything that’s based in scientific reality. In essence, a meniscus tear seen on an MRI of a middle aged person who has knee pain is about as important and clinically meaningful as the wrinkles on their forehead.

So if cartilage loss and meniscus tears usually don’t have much to do with why a knee hurts, what does cause this issue? Frankly, we’re just beginning to unravel this medical mystery. Luckily, we do know a few things:

  1. There is a toxic “witches brew” of chemicals that live inside the joint that cause swelling and continue to break down the structure.
  2. There are nerves inside and around the joint that along with the nerves in the spinal cord become “sensitized” to pain signals. These same irritated nerves can cause bad chemicals to be dumped into the joint.
  3. The bone in the joint can accumulate many tiny microscopic fractures and this leads to bone swelling, which can also lead to pain.

What’s really interesting is that of the MRI findings listed above (cartilage loss, meniscus tears and bone swelling), only bone swelling, or what’s called a bone marrow lesion (BML) is linked to knee pain!

So if Cartilage Loss Has Been Over Hyped, What Should I Care About the Most?

You should care about how your knee functions. Is it stable? This means that all of the ligaments that hold it together are doing their job. Does it swell? If it does, this is a sign of the toxic witches brew mentioned above. Does it have BMLs on MRI? This means the bone is failing and may help explain your pain more than cartilage loss or a meniscus tear. The nerves are also an important factor and consideration.

As far as cartilage is concerned, it’s certainly a good thing to have more. But getting really freaked out about not having an ideal amount of cartilage, or having surgery solely due to a tear in the meniscus that’s visible on an MRI is not a good idea.

Stem Cell Cartilage Regeneration on MRI

stem cell cartilage regeneration visible on MRI
Cartilage Regeneration on MRI

Based on more than a decade of experience in using stem cells to treat knee arthritis, the patients who normally get the best before and after MRI results with regard to cartilage healing are those with smaller holes. For examples of MRIs that show improvement in cartilage following stem cell treatment, see these posts:

  1. Trochlear groove cartilage defect treated with stem cells
  2. A cartilage lesion under the knee cap treated with cultured cells
  3. Improvement in medical compartment cartilage thickness in a patient with only partial thickness loss treated with same day stem cells.

Stem Cells Don’t Regenerate Large Stretches of New Cartilage in Patients with Severe Arthritis, So What Do They Do?

You’ll notice that in all of the cases above, the patient had only a small problem in the cartilage. For example, none of these patients were “bone on bone”. That’s because, in general, we don’t see MRI evidence of cartilage regeneration in patients with severe arthritis.

Having said that, stem cells can do some pretty cool things, all of which are pretty revolutionary. Here’s a list:

  1. Controlling inflammation by deactivating bad “Pac Man” cells called “macrophages”
  2. Releasing helpful growth factors that can assist in repair
  3. Helping dying or damaged cells by recharging their mitochondrial batteries
  4. Helping other cells produce proteins that can help initiate repair

The upshot? If you have small cartilage problems, a good quality stem cell procedure using precise placement of stem cells into the problem area, performed by an experienced provider, may help repair your cartilage or least make it look better on MRI. If you have a huge amount of cartilage loss, then a stem cell procedure isn’t going to “retread” your knee with loads of new cartilage. Although, in those instances cartilage is somewhat overrated. Stem cell procedures can often provide years of pain relief and improved function in those “bone on bone” patients through a a bevy of mechanisms. So stop freaking out about your lost cartilage and focus on maintaining the healthiest joint possible!

 

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*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.
Read 42 Comments
  1. Thank you for addressing this issue. I have been researching diff between Regenexx and replacement of hip and possibly knee.

    1. Susan,
      We are always so uplifted when people take the time to research something as important as the choices you are faced with. Our website is a wealth of information: http://www.regenexx.com There is a knee and a hip section under “Regenexx Procedures” and you might be interested in the “Research” Section. This page brings you to many blogs written on studies re knee replacement, but they generally apply to hip as well: http://www.regenexx.com/?s=knee+replacement

  2. I have an x-Ray that supposedly shows bone on bone, my knee has hurt so bad in the last six months I do not know what to do all though this rooster comb injection has helped me. I do not want to go through total knee replacement iam over weight and have type 2 diabetes. Iam in the process of losing weight I felt so bad this year I did not want to move. Iam improving slowly I seem to be tired all the time sleep a lot since the pain is better. Maybe I am just worn out from it all. My knee pain came on fasr last March 2015 by summer I was trying to swim and could not pull myself out of the pool. Sincerely Sandra Green

    1. Sandra,
      It’s great that the Rooster Comb injections have helped. They do provide lubrication for a time, but unfortunately have no regenerative potential. An important thing to be aware of is that several of the Type 2 Diabetes medications can cause disabling joint pain, which resulted in a new FDA warning recently. Working to lose weight is a great idea as that generally helps in blood sugar control. Adding in supplements can also be helpful. Glucosamine, Chondroitin, Resveratrol and Curcumin are some of the ingredients in our Advanced Stem Cell Support Formula. Ultimately, an exam by someone who can truly figure out both what’s going on with your knees, what caused it and what can be done to get things going in the right direction while you still can, is crucial. http://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/

  3. I had this Regennix procedure done 4.5 months ago. My knee with moderate arthritis is about 95% healed. I have practically no pain. My other knee has severe arthritis in the medial capsule only. It happened literally overnight. I had 18 year old cartilage 2 years ago. Now it’s bone on bone. I am confident it was from the 4 cortisone shots that I had. Anyways that knee is finally showing about 30% improvement. I hiked the other day for 45 minutes without pain. It’s a miracle. However I still have to wear a knee brace in that knee. I hope to continue to see improvement for the next 3 years. Regennex is amazing.

    1. Dianne,
      Thank you for the update. Glad to hear you’re doing so well! Thanks also for sharing your story. Your insight into the cortisone shots are right on point, and hopefully, sharing your experience will help other people to not start down that road!

  4. I am 76, female, diagnosed with bone-on-bone in both knees two years ago. The cultured stem cell procedure has been a huge help. In addition, I have learned that I need to wear arch-supporting orthotics at all times and that diet plays an important part: several foods seem to be quite inflammatory. I am now content to walk normally without pain and swim for exercise. (I am paying for years of running and trekking!) As the women in my grandparents’ generation lived to their high nineties, I could envision wearing out 2 or 3 sets of knee replacements if I lived that long. We will see how far the Regenexx procedures take me.

    1. Judith,
      Thanks for the update! That is wonderful news, and wonderful to hear that you have been doing all you can with diet and thinking biomechanically with orthotics. Taking care of what we have, is clearly the way to go!

  5. Hello Regenexx Gang,

    Your blog info is great. This past Wednesday, December 16, I had my first face to face with a surgeon for my bone on bone knee troubles. here in Periguex, France.. He told me there is zero benefit of stem cell treatment for my stage four knee..Case closed end of story. However, I’ve also got significant Lyme Disease symptoms so until they get that figured out because my blood analysis showed negative, no Lyme antibodies….no surgery is possible..

    Here is the really interesting part. That very same evening, I ran into a 78 year old Brit from Dubai, who retired here, who was ten days post surgery for a hip replacement.. He got it done in Limoges , France and was recovering super well. I asked him all the details, and they gave him the option of either stem cells, or a mechanical hack and sew job. He went for the surgery because he didn’t have a clue how stem cells work. But he did read after the surgery about metal contamination from wearing parts.
    I got the name of his surgeon ant the clinic and plan on checking it out. After Christmas..

    As an aside, he said he has no insurance so paid out of pocket. Total cost for all in costs to date on that surgery, hospital, testing etc, 7,500 Euros, or about 8,300 U.S. Dollars.
    Jim

    1. Jim,
      My only concern here would be accepting the opinion of a surgeon about whether there is any benefit of stem cell treatment for your stage 4 knee. Basically akin to asking me to write this reply in French! Both are totally different languages, its just that one involves removing a knee or not. While I have much more confidence in our stem cell treatment as it bears little resemblance to stem cell treatment available generally, everyone owes it to themselves to try everything available before the amputation of a joint and the insertion of a prosthesis. It’s an irrevocable decision whose most common complication is chronic pain, not to mention metal toxicity, device failure, cardiac and pulmonary risk etc. I’m very heartened that the choice of a TKR or stem cell treatment was given to the gentleman from Dubai. Interestingly, the average cost of a knee replacement in the US is $57,000, and with recent changes in our healthcare system, with insurance the average out of pocket costs are very similar to the cost of stem cell treatment. The problem is, people proceed with knee replacement (and other orthopedic surgeries) with the impression that there is some sort of gauarentee when nothing could be further from the truth.

  6. Hello Jim Again from France,

    This is a ps to my earlier post. For everybody out there, drill into the Regenexx information pile about using EFA (fish oil Pills) , how and why they work. This is the best explanation I’ve ever read.

    Simply thorough info.

    Here’s my story on EFA.

    December 4th started taking 4 gel caps 3 times per day. My bumknee was always very hot. In fact a chiropractor measured the temperature in September and found it was 6 degrees hotter that the good knee.
    After that I started using my digital chef thermometer to measure it daily. Always 5 to six degrees difference. Two days after beginning the fish oil, the heat stopped . I record my results daily. It runs about a half a degree warmer and some of the pain is gone. Plus my overall body flexibility has markedly improved. I’m 63 years old.
    Jim

    1. Steve,
      We licensed our Cultured disc procedure to a company whose ticker is BRTX. They are pursuing a IND filing with the FDA and should be in Phase 1-2 Clinical Trials by the end of this next year.

  7. Good info about how stem cells may help bone on bone knee issues. Does the same apply to bone on bone hip joints. I had a “partial” ( Birmingham ) hip replacement 4 years ago. It went really well, I recovered great and have good mobility in my right hip. At the time it was noted by my orthopedic surgeon that I had less than 50% cartlage in my left hip and at my current activity and health level that I’d probably need that hip replaced in 4-5 years. It’s been 4 years and I am seeing significant deterioration in strength, stability and chronic achyness in the left hip. Definitely want to check out stem cells before another surgery. So back to my question. Is all the info u provided on bone on bone knee issues relevant to hip joints?

  8. I have been told that I have none on bone in both thumbs. The left thumb has had cotizone injection twice and the right just once. I wear a brace on both thumbs and the brace helps when -my pain is severe. Is their help for me?

  9. I have contacted Regenezx twice and filled out a form to see If I am a candidate for stem cell therapy, no one has contacted me.
    Can some one please call me.
    Nitin

    1. Nitin,
      Our sincere apologies. I have forwarded your email address to the appropriate dept, and they will contact you.

  10. This all sounds like a load of B.S.to me—there is no cure for arthritis. I have it like millions of others & we will all die with it, I’m sure.

    So, what can we do? Exercise to your ability & pray more.

    If you have a concrete answer……..I’m all ears.

    Jim Murphy kelly532@att.net

    1. Jim,
      We’re not talking about curing arthritis. What we do is intervene in joints that have been damaged by injury or the degenerative changes of arthritis and seek to the repair the damage. There is a lot of published peer reviewed research that this works well:
      http://www.regenexx.com/stem-cell-research/
      There is actually quite a lot you can do on your own contained in these free downloadable books. Proactive is an incredibly quick read, Orthopedics 2.0 more extensive: http://www.regenexx.com/library-complimentary-regenexx-resources/

      You can also avoid steroid injections, steroid epidurals etc. as they damage the stem cells you have, avoid NSAIDS and take the right kind of supplements to provide your joints with support. A lot of these suggestions are in : http://www.regenexx.com/knee-replacement-questions/

  11. Hello Regenexx Team,
    Your web site here is great and your great answers here,
    I’m from kuwait, and my mom She is 72, diagnosed with bone-on-bone in both knees 5 years ago. I hope to contact with you for sending her midcal report if there is help of recovery of cultured stem cell procedure, we can then set Aappointment to get a visa to travel,

    Million thanks

  12. Hello there! I’m a 47 year old man who has been active in sports throughout my life. At the age of 27 I was diagnosed with slipped capital femoral epiphysis. I was told at the time that if I continued running long distance, I would need a hip replacement in 5 years. And if I continued playing basketball, I would need a replacement in 3 years. I pretty much stopped playing both but picked up basketball as a once a week activity for most of the last 20 years. I got into biking and hiking and except for a lot of tightness in my hips/back, I have been able to do most everything pain free. That is until about 6 months ago. My hips have started to impinge and my latest xray shows very little cartilage in my left hip. I visited with an orthopedic specialist last week and he suggested cortisone shots to hold off the replacement surgery. I came upon your research and am curious if I might be a candidate for stem cell regeneration of cartilage. I’m not totally bone on bone yet. Let me know your thoughts. I’m trying to be hopeful as this hip has thrown my life of active and competitive living off. Thanks for your time.

    1. Charles,
      The issue with Cortisone shots is while they offer temporary pain relief, studies show they escalate the problem long term as they break down cartilage, are lethal to the local stem cell population and damage tendons. Joint replacement is an irreversible step, so avoiding it until all more conservative measures have been tried is important. Beginning that route at 47 would likely entail more than 1 revision surgery which are bigger surgeries than the original hip replacement. We’d be glad to see if we can help avoid that direction. Please submit the Candidate form to upload your MRI, medical history, and speak to one of our Physicians to see if you’d be a good Candidate for a Regenexx Hip procedure. Please see: http://www.regenexx.com/the-regenexx-procedures/hip-surgery/ and http://www.regenexx.com/steroid-injection-risks/ and http://www.regenexx.com/more-active-after-hip-replacement-wrong-impressions-hip-replacement/ and http://www.regenexx.com/hip-replacement-risks/

  13. When you say stem cells can repair/regenerate cartilage in small defects, what size is small? Specifically for articular cartilage. I’ve got a 1.2 centimeter full thickness defect in my post lateral femur. I’m 22. Active and athletic. My other option is an oats procedure. I’m not only looking for symptom relief I need to repair this injury to get back to playing sports. Do you have research in humans for this specific injury.

    1. Daniel,
      We have observed lesions around 1cm close with our licensed culture expanded procedure. No specific research has been done on this subset of patients.

  14. I have close to bone on bone cartledge in both knees. I had stem cell injections in both knees which seemed to help at first two injections. After that the pain has come back. The stemcells were taken from blood in arm. Can stem cells from bone marrow be more effective.

  15. Hi, I’m a very active 45 year old and would very much like to continue this lifestyle. However 2 years ago I had 80% of my meniscus removed in my left knee and now, just recently, whenever I train legs I’m in pain for a couple of weeks or so! Would stem cell injections help me?

    1. James,
      The meniscus is the shock absorber of the knee, supports and protects the cartilage and helps to guide the knee bones. Removing all or parts of it, leave the cartilage and bone to take the brunt, which is why studies have linked meniscus surgery to arthritis. https://www.regenexx.com/knee-meniscus-surgery-increases-odds-knee-replacement/ A stem cell procedure is actually quite important in these cases. If you’d like to see if your particular case would be a good candidate please submit the Candidate form. Please see: https://www.regenexx.com/stem-cell-treatment-for-knees/

  16. Hello Regenexx Team members,
    I read with growing interest what many patients had to say about your treatment for bone on bone, cartilage worn out knees. I’m hoping that my particular set of woes can be alleviated by the stem cell treatment you propose. It’s strange that in 2012 I was chasing about in the world and in 2013 after a severe emotional shock, I began to develop knee problems. Don’t believe in surgical procedures. Can you help, please?

    1. Marie-Anne,
      We’d be glad to! A good percentage of our Knee patients are “bone on bone”. You’ll find alot of information on how we treat knees in the Knee section of our website. Please see: https://www.regenexx.com/the-regenexx-procedures/knee-surgery-alternative/ Both of these patients were “bone on bone” knee patients. Please see: https://www.regenexx.com/4-year-knee-stem-cell-procedure-update-amazing-patients/ and https://www.regenexx.com/getting-a-golfer-back-on-the-links-with-knee-stem-cells/. To see if you’d be a good candidate for a Regenexx procedure, please submit the Candidate form and our team will contact you.

  17. The link for the trochlear groove repair says the patient was treated with same day cells, but if you follow the link the patient was treated with cultured cells.

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