The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells—Their Current Uses and Potential Applications

Abstract

Only select tissues and organs are able to spontaneously regenerate after disease or trauma, and this regenerative capacity diminishes over time. Human stem cell research explores therapeutic regenerative approaches to treat various conditions. Mesenchymal stem cells (MSCs) are derived from adult stem cells; they are multipotent and exert anti-inflammatory and immunomodulatory effects. They can differentiate into multiple cell types of the mesenchyme, for example, endothelial cells, osteoblasts, chondrocytes, fibroblasts, tenocytes, vascular smooth muscle cells, and sarcomere muscular cells. MSCs are easily obtained and can be cultivated and expanded in vitro; thus, they represent a promising and encouraging treatment approach in orthopedic surgery. Here, we review the application of MSCs to various orthopedic conditions, namely, orthopedic trauma; muscle injury; articular cartilage defects and osteoarthritis; meniscal injuries; bone disease; nerve, tendon, and ligament injuries; spinal cord injuries; intervertebral disc problems; pediatrics; and rotator cuff repair. The use of MSCs in orthopedics may transition the practice in the field from predominately surgical replacement and reconstruction to bioregeneration and prevention. However, additional research is necessary to explore the safety and effectiveness of MSC treatment in orthopedics, as well as applications in other medical specialties.

Characterization and Comparison of Human and Ovine Mesenchymal Stromal Cells from Three Corresponding Sources

“…These unique immunomodulatory properties establish MSCs as a cell type of primary interest for clinical advancement in many fields of research [32]. More specifically, MSCs show great potential as future therapeutic option in the pathophysiology of orthopedic injury and disease, and MSCs have been identified for their promising potential in regenerative medicine [33].…”

Sources and Clinical Applications of Mesenchymal Stem Cells: State-of-the-art review

“…8 In addition, under specific culture conditions, MSCs can differentiate into non-mesodermal lineages such as hepatocytes, neurons, pancreatic cells, cardiac muscle cells or astrocytes. 9…”

“…Obtaining BM-MSCs, for example, can result in pain, bleeding or infection, thus making harvesting MSCs from this source more problematic than harvesting cells from peripheral blood or surgical remnants such as AT or birth-derived tissues. 9 Table 1 describes current sources of MSCs along with their characteristics, advantages, disadvantages and clinical applications. 7, b o n e m a r r o w Initially discovered in 1976 by Friedenstein, BM-MSCs were first described as undifferentiated MSCs in 1987.…”

“…However, their procurement requires a highly invasive and painful procedure involving heavy use of anaesthesia; moreover, the cell yield, longevity and potential for differentiation diminishes with donor age. 9 Compared with MSCs derived from other sources, BM-MSCs possess a longer duplication period, reach senescence earlier and constitute only 0.01-0.001% of nucleated marrow cells. 9,10 Nevertheless, one advantage of BM-MSCs over other cell types is their relatively short culture time.…”

Urinary Bladder Matrix Does Not Improve Tenogenesis in an In Vitro Equine Model

“…Conservative therapies for tendon injuries include cold therapy, anti‐inflammatory medications, rest with controlled exercise, and physical therapy, including eccentric exercise . While regenerative medicine therapies such as mesenchymal stem cells (MSC) and platelet‐rich plasma show promise in treating tendon injuries, evidence of their efficacy is limited. A critical need remains for the development of therapies capable of promoting physiologic tendon healing and reducing the risk of reinjury.…”