BY MADDIE PICCIONE

Stem Cell Therapy: An Alternative to ACL Surgery

Background on the ACL

ACL (anterior cruciate ligament) attaches the tibia and femur

Crucial ligament that keeps the knee stableKeeps the knee from sliding backward and

forward (femur and tibia rubbing against each other)

ACL Injuries

ACL tears occur when the femur and tibia turn in opposite directions

Hyperextension of the kneeVery common in sports like basketball,

soccer, football and skiing

Severity of ACL Injuries

Grade 1 Sprain: ACL undergoes a partial tear and becomes loose, resulting in some knee instability.

Grade 2 Sprain: ACL is completely torn into two pieces, but still stay together (non-retracted)

Grade 3 Sprain: ACL is completely torn into two separate pieces and they pull apart (retracted)

Severity of ACL Injuries (contd)

Typical ACL Reconstruction Surgery

A graft is needed to act as the temporary ACL and provide a scaffold for the new ACL to grow on Autografts (taken from your own tendons)

Patellar tendon Hamstring tendon

Allografts (donated from someone else’s tendons) Synthetic grafts (like silk) – less common

Typical ACL Reconstruction Surgery (contd)

Incision made for an arthroscope (small camera)

Incision where sterile fluid is pumped into knee joint

Third incision for surgical instruments

Typical ACL Reconstruction Surgery (contd)

Torn ACL is removed and area cleaned by motorized shaver

Tunnels are drilled in tibia and femur for new graft Surgeons use the footprints of the torn ACL

roots for guidanceGraft is pulled through tunnels and secured

with bioabsorbable screws

Issues with ACL Reconstruction Surgery

Drawbacks of using autografts: Donor site pain and damage

Drawbacks of using allografts: Infections Allergic Reactions Disease Transmission

In some surgeries, there has been poor placement of the graft Results in less resistance to front-back motion

Stem Cell Therapy: Regenexx Process

Dr. Centeno pioneered the Regenexx stem cell treatment

Regenexx began this treatment in 2012Stem Cell Therapy can treat partial tears and

complete non-retracted tearsSynovial sheath around ACL must be intact

This guides the injected stem cells to grow in the right area

Stem Cell Therapy: Regenexx Process

Bone marrow aspirate is extracted from patient’s hip

Stem cells are concentrated by centrifuging bone marrow several times

Fluoroscopy and musculoskeletal ultrasound are used for visualization in order to accurately inject stem cells

Stem Cell Therapy: How it works

Synovial sheath: one of the two membranes of the tendon sheath that covers the ACL

Synovial sheath of the ACL must be intactIn the case of an ACL tear, the sheath holds the

torn fibers in the correct positionSynovial sheath also facilitates the release of

growth factors and cytokinesThis protective sheath acts as a guide that helps

the injected stem cells work at the correct locationStem cells must be injected accurately in order to

detect the sheath

Stem Cell Therapy: How it works (contd)

The bone marrow contains mesenchymal stem cells (MSCs)

MSCs are very good at differentiating into other cell types

Cytokines help cells communicateThe cytokines guide the MSCs to the zone of

tissue injuryThe sheath guides the MSCs while they

proliferate and regenerate

Success of Stem Cell Therapy

Case studies show that 7/10 patients saw evidence of healing in their post-injection MRIs

Stem Cell Therapy has been able to heal torn ACLs with up to 1 cm of separation

Less painful than traditional ACL reconstruction surgery

6-12 weeks of recovery as opposed to 6-9 months of recovery from surgery

Success of Stem Cell Therapy (contd)

Developing Stem Cell Therapy

Stem Cell Therapy is a new and growing treatment for injured ACLs

Bibliography

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2453248/ http://www.sciencedirect.com/science/article/pii/S1369702104002329 http://stemcells.nih.gov/info/basics/pages/basics1.aspx http://www.sciencedaily.com/terms/adult_stem_cell.htm http://www.researchgate.net/profile/Ardeshir_Bayat/publication/38087944_Adult_stem_cells_i

n_tissue_engineering/links/0c96052aa1e40355ac000000.pdf http://www.nature.com/nature/journal/v414/n6859/abs/414118a0.html http://jasn.asnjournals.org/content/15/5/1113.full http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303781/ https://en.wikipedia.org/wiki/Mesenchymal_stem_cell http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.324.9496&rep=rep1&type=pdf http://e-collection.library.ethz.ch/eserv/eth:8022/eth-8022-02.pdf http://www.onthesnow.com/news/a/593682/stem-cell-acl--cutting-edge-knee-repair-sans-surger

y http://www.drmagaziner.com/stem-cells-for-acl/ http://www.outsideonline.com/1921886/no-more-knife-stem-cell-shortcut-injury-recovery http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3255293/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3522096/

http://www.sporttechie.com/2014/03/06/new-treatment-for-acl-injuries-using-patients-own-stem-cells-may-be-game-changer/

http://www.oulu.fi/spareparts/ebook_topics_in_t_e_vol2/abstracts/korossis_0102.pdf https://expertbeacon.com/surgery-not-your-only-option-treating-acl-injury#.VbmgPflVhBc