Stem Cell Treatment
Stem Cells are basic cells from which other cells with specialised functions like cartilage can be generated. No other cell in the body has the ability to generate new cell types and hence there is a lot of interest in these types of cells in regenerative therapies.
Adult stem cells are present in Bone Marrow and Fat and they have Chondrogenic potential providing an alternative to expanded Chondrocytes as used in ACI. The advantage is that this can be done as a One Step technique and with the help of tissue engineering we can try to improve the regenerative potential. It may be better to use the Stromal Cells instead of Stem Cells.
Bone marrow Derived Stromal Cells
Stomal cells from bone marrow aspirate can be concentrated or expanded and their chondrogenic potential is well known.
- Poor yield of cells and if expanded they change in their phenotype and the problem of injected BMSCs in the knee is that only a small volume of cells get to the repair site.
- BMSCs can form Fibroblasts or Chondrocytes.The presence of certain growth factors helps direct BMSCs to form Chondrocytes. The use of tissue engineering and scaffold can help overcome the relative poor yield of BMSCs from bone marrow.
Adipose derived Stromal Cells (ASC) or Stromal Vascular Fraction
Lots of Stromal cells can be harvested from adipose tissue and these can be mechanically processed activating the MSCs that are released. SVF has a stronger immune-regulatory effect than BMSC. They have been used in a variety of settings in combination with Hyaluronic Acid or PRP and have shown improvement in pain in the knee and a potential regenerative effect.
Nice Guidelines on PRP
To note are that there are different types of PRPs with different preparation and administration methods. The procedure is safe and it can be used in conjunction with biological reconstructive treatment.