Regenexx stem cells for knee?

author : AMSSM

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Is stem cell treatment a viable solution for degenerating knees?

Question from member mxr726: Regenexx stem cells for knee?

"Do you have any advice about stem cell treatment for knee issues? I'm reading some conflicting data on using your body's own cells from marrow, or from fat tissue around the stomach, both being claimed as better than the other. Getting tired of chondromalacia, and poor results with physical therapy over the last five or more years. First I had to quit running, jumping, any deep knee bending or weight training, and now it's ruining cycling. Swimming is all that remains now. (Cycling is definitely my breaking point, I can't give up the bike.)"

Answer from Anne Marie Zeller, DO, MSc and Caitlyn Mooney, MD
Members AMSSM

Thank you for your question. It certainly is frustrating not to be able to participate in the activities that you enjoy and with the overwhelming information that is both fact and fiction on the internet, we get a lot of questions like yours in our clinics.

Many specialized cells such as those found in cartilage, muscle, tendon, ligaments and other musculoskeletal structures have a limited ability to repair themselves. While rest, medications, and even surgeries can sometimes result in healing and pain relief sometimes patients are left with chronic pain and deficiencies of their injured structures. For this reason there has been a great deal of research in new treatments that may help tissues heal themselves, decrease chronic pain, and restore the function of the injured structures. Regenerative injection therapies or (RITS) are one example of new therapies that may offer relief to those with chronic musculoskeletal pain. Stems cells injections are just one type of regenerative injection therapy (RIT) currently offered for chronic pain due to musculoskeletal injuries. Other examples of RIT include platelet rich plasma injections, prolotherapy, and perineural injections. Stem cells are cells that have the ability to both duplicate themselves as well as become other types of cells needed in the body. Thus stem cells act as reservoirs that allow the body to develop specialized cells including those which are unable to replace themselves when damaged. Due to these special qualities of stem cells, they may be an exciting and new therapy for many types of illnesses and injuries.

There are many different types of stem cells that come from different sources. Mesenchymal stem cells (MSCs) are the type of stem cell most associated with therapies for the musculoskeletal system. These are a type of stem cell that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells). Different brands/companies that advertise stem cell injections are using your own cells from your bone marrow or fat tissues where they are prepared/purified in different ways then injected into areas of musculoskeletal pain. Stems cells cannot legally be grown in the U.S. and injected into joints, muscles, and ligaments at this point. The field of regenerative medicine is quite new and thus there is much ongoing research. The use of MSCs are also being researched in humans to potentially be used in heart attacks, Crohns disease, cartilage and meniscus repair, cancer, and spinal cord injury. Initial animal models are promising to show soft tissue, cartilage and meniscus repair in chronic musculoskeletal pain. Currently the clinical use of stem cells has outpaced the research of its utility. As of today there is not enough data to state whether one source is preferable to another for any given condition. 

Due to this ongoing research, MSCs injections (including Regenerative Medicine injections) are not covered by traditional insurances. Prices for MSCs injections can range from minimum ~$500-$10,000. Follow-up and rehabilitation programs after injection are also extremely variable between practioners. It is important to ask your physician the time of rest, rehab protocol required, and cost prior to receiving an injection. It is also important that you go into the injection with realistic expectations. As with any procedure there is a risk of side effects including infection or bleeding. There is also a risk that you will have no benefit or short lived benefit from your treatment. While many conditions may have pain relief with an injection, stem cell injections are not going to reverse conditions such as severe knee arthritis. 

Most sports medicine and orthopedic practitioners recommend maxing out your other treatment options before RITs especially given the cost. My recommendations would be to speak with your sports medicine or orthopaedic physician about how to maximizing evidence-based and/or insurance covered treatments including:

1. Oral medications


2. Topical anti-inflammatories, such as diclofenac and emu oil


3. Supplements, examples are glucosamine, chondroitin and tumeric


4. Cortisone or hyaluronic acid injections


5. Sports-specific orthopedic trained physical therapist.


6. Maintaining an appropriate weight

In addition to all these recommendations it may benefit you to seek out a professional bike fitting specialist. No matter what you choose for your treatment options, bike fit and shoe fit (prices range from $0-200) may keep you in the saddle for years to come. Cycling is an amazing sport for weight loss, cardiovascular health, and mental health and I hope this was helpful for keeping you active in your sport for the future. If you have already tried these options a trial of an RIT such as a stem cell injection may be of benefit to you and I recommend that you discuss these options with your own physician. Good luck!

Author: Anne Marie Zeller, DO, MSc
Case Medical Center Rainbow Babies and Children’s Cleveland, OH

Co-Author Caitlyn Mooney, MD
Case Medical Center Rainbow Babies and Children’s Cleveland, OH

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date: June 30, 2016