Stem Cell Injections for Musculoskeletal Pathology: An Overview for the Sports Medicine Professional

Kolber, Morey J.; Purita, Joseph; Sterling, Bryan; Stermer, Jaclyn; Salamh, Paul A.; Masaracchio, Michael; Hanney, William J.

doi:10.1519/ssc.0000000000000500

Cited by 2 publications

(4 citation statements)

References 58 publications

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“…These interventions require minimal post-procedural downtime, which allow individuals to pursue a timely resumption of physical activity. [8][9][10] Furthermore, failure to respond to orthobiologics does not preclude future treatments.…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19] Furthermore, in addition to cellular content, adipose and BMA possess bioactive molecules such as cytokines, proangiogenic and antiapoptotic substances, as well as trophic factors. 10,18,20,21 Although BMA is rich in hematopoietic stem cells, a decline in MSC numbers occurs with aging. 22 Thus, procuring a fat graft via lipoaspirate may provide the required MSCs that are deficient in BMA when culture expansion is not an option.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

2022

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Purpose: This study was conducted to investigate the efficacy of a combined minimally processed bone marrow aspirate (BMA), adipose graft, and leukocyte-rich platelet-rich plasma (PRP) intra-articular injection series on pain, function, and global rating of change (GROC) among patients with glenohumeral osteoarthritis (GHOA) and record any complications or adverse events associated with the protocol. Methods: Ten adults (mean age 65 years) previously recalcitrant to conservative care with clinical and radiographic evidence of GHOA were included. At the initial visit, patients were assessed for eligibility of treatment. All patients were assessed pre- and post-treatment with numerical pain rating and patient-specific functional scales (PSFS). All study participants were treated with 4–6 ml of PRP, 6 ml adipose graft, and 12 ml of BMA, which were administered via a landmark-based anterior intra-articular injection. Patients were requested to return twice over 4-week intervals for booster PRP injections. At each follow-up, the GROC and prior outcome measures were completed. Results: Patients returned after an average of 27 days for first (F1) and 68 days for the second (F2) PRP injection. Friedman Chi Square analysis indicated significant improvements in best and worse pain and PSFS from baseline initial visit to F1 and F2 (P ≤ .002). Post-hoc Wilcoxon signed-rank testing with Bonferroni correction (α = 0.017) identified significant improvements from baseline to F1 and F2 for the PSFS (P ≤ 0.012). Improvements in best and worse pain were significant at F2 (P ≤ 0.016), not F1 (P ≥ 0.02), compared to baseline. Effect sizes were large, ranging from r = 0.57 to 0.84 for pain and function. Improvements in pain, GROC, and PSFS met minimum clinically important differences at F2 based on previously validated clinimetrics. The only adverse events reported are related to administration of injectate that was temporary and managed in all cases with over-the-counter analgesics. Conclusion: A minimally processed adipose graft with BMA and three PRP injections improved pain and function among individuals with GHOA who were recalcitrant to conservative care. Although significant functional improvement at both follow-up points occurred, clinically important and significant changes in pain did not occur until F2. A one-group design and multimodal approach limit generalization of results. Level of Evidence: IV

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

2022

View full text Add to dashboard Cite

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“…These interventions have an excellent safety profile and require minimal post-procedural downtime, allowing individuals to pursue a timely resumption of physical activity. [7][8][9] Furthermore, failure to respond to orthobiologics does not preclude future treatments. 10 Of the injectable orthobiologics, PRP is most performed, due to ease of procurement and reduced cost.…”

Section: Introductionmentioning

confidence: 99%

“…9,10,[13][14][15][16][17][18][19][20] Furthermore, in addition to cellular content, adipose and BMA possess bioactive molecules such as cytokines, pro-angiogenic and antiapoptotic substances, as well as trophic factors. 3,8,10,18,[21][22][23] Although BMA is rich in hematopoietic stem cells, a decline in mesenchymal stem cell (MSC) numbers occur with aging. 24 Thus, procuring a fat graft via lipoaspirate provides the needed MSCs that are deficient in BMA.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Severe Knee Osteoarthritis

et al. 2021

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Background: Owing to a paucity of research on minimally processed orthobiologics, we sought to investi-gate the efficacy of minimally processed bone marrow aspirate (BMA) and fat graft with a leukocyte-rich, platelet-rich plasma (PRP) intra-articular injection series on pain, function, and global rating of change (GROC) among patients with severe knee osteoarthritis (OA).Methods: Thirty-one adults (23 females and 8 males, mean age 67 years) with clinical and radiographic evidence of knee OA (Kellgren–Lawrence ≥ 3) were included. During the initial visit, patients were exam-ined and administered the patient-specific functional scale (PSFS) and a numerical pain rating scale ranging from 0 to 10. Patients then underwent procedures to obtain 4–6 mL of PRP, a minimally processed 6 mL fat graft, and 10 mL of BMA. Patients returned twice over 6-week intervals for booster PRP injections. At each follow-up (F1 and F2), the GROC questionnaire and prior outcome measures were completed. Results: Patients returned at an average of 41 days for the second PRP (F1) and 90 days from initial visit for the third PRP injection (F2). Friedman Chi Square analysis indicated statistically significant improvements in pain (best and worst) and PSFS from initial to F1 and F2 (P ≤ 0.001). Post hoc Wilcoxon signed-ranks analysis with Bonferroni correction identified improvement from initial to F1 and F2, as well as F1–F2 for pain, PSFS, and GROC (P ≤ 0.013). Effect sizes ranged from r = 0.32 to 0.51. Change, based on established minimum clinically important differences, indicated pain, GROC, and PSFS met thresholds at F2. Conclusion: A minimally processed fat graft with BMA and a series of three PRP injections improved pain and function among individuals with severe knee OA who were previously recalcitrant to conservative care. Although results indicated significant improvement, clinically important change did not occur until F2. A one-arm design is a limitation of this study.

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Stem Cell Injections for Musculoskeletal Pathology: An Overview for the Sports Medicine Professional

Cited by 2 publications

References 58 publications

Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet-Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Glenohumeral Osteoarthritis

The Effect of Combined Bone Marrow Aspirate, Lipoaspirate, and Platelet Rich Plasma Injections on Pain, Function, and Perceived Change Amongst Individuals with Severe Knee Osteoarthritis

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