Updated: Oct 2, 2021
Cartilage defects can be a devastating injury for an individual as cartilage does not heal spontaneously. Pain, swelling, mechanical symptoms, loss of function, and inability to participate in activity are common. Autologous Chondrocyte Implantation (ACI) or the MACI procedure for cartilage defects involves one surgery to harvest or remove a portion of healthy cartilage from a joint in your body, usually your knee, and then after culturing them in a lab and seeding them on a membrane, they are implanted back in a second surgery into the articular defect of your injured joint. The MACI procedure is not without failure, cost, or risks, one of which has been repeatedly reported in the literature, that of donor site morbidity present at one year. In other words, the healthy site where cartilage was removed for the MACI procedure now becomes a painful damaged arthritic site. The decision to harvest cartilage to perform a repair procedure such as ACI should be taken with extreme caution is the conclusion from Donor site morbidity after articular cartilage repair procedures: a review Acta Orthop Belg. 2010 Oct;76(5):669-74. Stem cell injections are a viable, non-surgical alternative to treat cartilage defects or cartilage injuries and should be tried prior to any operative intervention such as ACI or the MACI procedure.
Remember surgery can never be undone.
Intra-articularly injected mesenchymal stem cells have been found to promote cartilage regeneration. Satué, M., Schüler, C., Ginner, N. et al. Intra-articularly injected mesenchymal stem cells promote cartilage regeneration, but do not permanently engraft in distant organs. Sci Rep 9, 10153 (2019) Dr. Silberman at New Jersey Sports Medicine recently treated a cartilage defect in a young individual's knee with bone marrow stem cell aspirate, who had been seen at The Hospital for Special Surgery in anticipation of having the MACI procedure performed, having already had the biopsy taken. In the interim prior to re-implantation, the patient was seen by Dr. Silberman and chose to have a bone marrow aspirate stem cell injection by Dr. Silberman performed on 2/21/20. MRI of his right knee on 11/17/2018 compared to an MR 3/11/2016: "No substantial change in a small shallow partial-thickness cartilage defect along the lateral patella facet. There are new horizontal oriented articular cartilage fissures extending from the medial patella facet to the median ridge." On 2/21/20, Dr. Silberman performed a bone marrow aspirate stem cell injection into his right knee. Several month later after having pain for more than 4 years, the patient's pain was gone and a repeat MRI was performed: MRI right knee 9/2020 performed at The Hospital for Special Surgery HSS: "Comparison is made to the prior outside study from 11/17/2018. The cartilage over the patella is minimally heterogenous without prominent fibrillation. There is no chondral defect." Upon follow-up with his surgeon at HSS, who himself read the films personally, his surgeon reported to the patient he was NO LONGER A CANDIDATE FOR MACI as there WAS NO LONGER A CARTILAGE DEFECT SEEN. To learn more about Bone Marrow Aspirate Stem Cell Injections please call to schedule an appointment with Dr. Silberman at New Jersey Sports Medicine and Performance Center by calling (908) 647 - 6464. This is just one case study of many success stories with stem cell injections. More rigorous scientific studies are needed. References: Satué, M., Schüler, C., Ginner, N. et al. Intra-articularly injected mesenchymal stem cells promote cartilage regeneration, but do not permanently engraft in distant organs. Sci Rep 9, 10153 (2019). https://doi.org/10.1038/s41598-019-46554-5 Andrade R, Vasta S, Pereira R, et al. Knee donor-site morbidity after mosaicplasty - a systematic review. J Exp Orthop. 2016;3(1):31. doi:10.1186/s40634-016-0066-0 Matricali GA, Dereymaeker GP, Luyten FP. Donor site morbidity after articular cartilage repair procedures: a review. Acta Orthop Belg. 2010 Oct;76(5):669-74. PMID: 21138224.