Stem Cells for ACL Tears
Can bone marrow aspirate stem cell injections heal an ACL ligament tear?
In a 2018 article by Centeno et al., Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non- controlled registry study, the authors have documented the use of bone marrow aspirate injections with stem cells for ACL tears with pre- and post- MRI images depicting healed appearances of previous documented torn ACL ligaments with symptomatic improvement of patient symptoms and exam after bone marrow stem cell injection.
Dr. Silberman of New Jersey Sports Medicine has found similar findings and it appears bone marrow aspirate injections which contain stem cells may heal certain types of incomplete ACL tears. Dr. Silberman too has seen post treatment MRIs of ACL tears treated with bone marrow aspirate stem cell injections depicting healed appearances of previous documented torn ACL ligaments, with the more important clinical measurement of improvement of patient symptoms, exam, and function with no surgery.
Below is an image of an MRI brought to Dr. Silberman of a patient with a symptomatic ACL partial tear, read by the radiologist as "diffuse mucoid degeneration of the ACL". As you can see the ACL is torn on the MRI with the insertion of the ACL on the tibia torn with fiber retraction, thickening, with a wavy non linear architecture. Patient was symptomatic with pain, instability, lack of motion, and laxity on exam.
Below is an MRI image of the same patient's knee seen above, 2 months post bone marrow aspirate stem cell injection by Dr. Silberman depicting an MRI of an intact ACL ligament reported by the radiologist as "The ACL and PCL are within normal limits. The ACL is linear, intact distally, without the previous wavy detached appearance. More importantly,post bone marrow aspirate stem cell injection the athlete has no knee pain, no instability complaint, with improved motion. While Dr. Silberman always teaches, "Treat the patient, not the film" it is exciting as a scientist when the practice of medicine produces solid appearing evidence that what we are doing is not just anecdotal.
Dr. Silberman's procedure with Marrow Cellution requires just one harvest site injection and aspiration of 10cc of bone marrow aspirate from the athlete's iliac crest versus other regenerative providers who may require 6 to 10 injections and aspiration sites in the iliac crest as performed in the article quoted above. And no large blood draw for platelet rich plasma (PRP) is required to be isolated when using the Marrow Cellution system. Dr. Silberman skilled in ultrasound guided injections is able to inject the ACL with bone marrow aspirate stem cells under ultrasound guidance which carries no radiation risk as fluoroscopy does that some other providers may use. The entire procedure from aspiration of bone marrow stem cells to injection into the knee and ACL ligament may take less than 30 minutes.
There is basic science evidence that supports bone marrow aspirate stem cell injection could accomplish ACL ligament healing. Animal models with stem cells found in bone marrow have demonstrated ligament and
ligament-bone interface healing. Mesenchymal stem cells have been found in injured ACLs, suggesting that stem cells are involved in ACL healing. Randomized clinical control studies of stem cell injections for
ACL ligament tears are needed.
Another common teaching by Dr. Silberman is "You can't undo surgery" and "elective surgery is elective". And this is especially true when cutting and removing your normal uninjured patella tendon or hamstring
tendon to reconstruct your ACL ligament. So while some athlete's may require ACL reconstruction, bone marrow aspirate stem cell injections appear to be a viable option for some ACL ligament tears.