Non Surgical Solution For Knee Repair: Know All About Stem Cell Regenerative Therapy From Dr Pradeep Mahajan

To know everything about the regenerative therapy for knees, let's begin with a case study of Mrs Suvarnamala Uttarwar.

CASE STUDY ON KNEE JOINT OSTEOARTHRITIS

Patient name: Mrs Suvarnamala Uttarwar 

Age/Sex: 66 years/ Female

History

• Sixty-six years old, Mrs Suvarnamala from Nanded had complained of knee pain for more than ten years. In the last three years or so, her pain increased in intensity. She found it difficult to walk and consulted an Ayurvedic doctor for treatment. She was prescribed medicines which helped her walk comfortably for short distances. However, when she discontinued the treatment, she had pain again. Suvarnamala also had difficulty in standing up from sitting position as well as stair climbing. She could not stand for more than 15-20 minutes. 
• Suvarnamala heard about cell-based therapy from a relative and decided to consult Dr Pradeep Mahajan, Regenerative Medicine Researcher, Mumbai. She underwent two sessions of cell-based treatment over two months. She was also advised physiotherapy to strengthen her muscles that would aid her to stand for more extended periods and walk comfortably. 
• Within a week following treatment, Suvarnamala found that her pain reduced considerably. She was able to walk around the house and carry on her routine activities much more comfortably. She continued physiotherapy after discharge from our centre and noticed further improvement over the following two months. 
• Presently, the patient says she can walk more comfortably and can stand for a more extended period. Overall she also says that she has improved strength and can perform activities of daily living adequately. 

“Cell-based therapy can work wonders in orthopaedic conditions such as arthritis. Cells have an intrinsic anti-inflammatory property which aids in reducing swelling around the affected joint, thereby alleviating pain. Also, mesenchymal cells are known to have multi-differentiation potential, thus are capable of regenerating damaged tissues in the joint. As the therapy is autologous, it is safe and effective with long term results”, says Dr Mahajan.

What is regenerative therapy?

• Regenerative therapy is a branch of translational medicine that deals with utilising the natural healing mechanisms of the body in the treatment of various diseases. This is the interdisciplinary field that applies principles of engineering and life sciences to promote healing, and can potentially restore diseased and injured tissues as well as whole organs.
• The purpose is to enhance the intrinsic regenerative capacity of the human body by altering its environment using cells, growth factors, and other molecular components of the body.

What is the impact of regenerative therapy on the knee?

• Our knees are one of the essential weight-bearing joints and are considered among the most durable structures of the body. As with other joints, the knees are also made up of bones, cartilage, muscles, ligaments, and synovial fluid. As the knees have to bear the weight of the body while walking, standing etc., it is subject to wear and tear and injuries. Sports injuries of the knee are widespread, as is arthritis. Injuries and degenerative changes damage the cartilage of the knees predominantly and subsequently the bone. Among the various conditions that affect the knee, chondromalacia patellae (irritation of the cartilage), osteoarthritis (OA), meniscal tears, cruciate ligament tears, subluxations injuries are common.
• Palliative Pain and mobility management remain the first line of conventional treatment for any condition affecting the knees. Over time, if the disease progresses, surgery to repair defects and ultimately joint replacement are advised. The chief disadvantages of surgical intervention are that the procedures are invasive, may use prostheses and other materials (which may cause infection), and has limited longevity.
• Thus, surgery might not be an attractive therapeutic option for young patients, especially.
• In older individuals, there is a risk of co-existing systemic conditions, thereby surgical and post-operative management has to be planned with care.
• Here, regenerative medicine can be a boon. The procedures are non/minimally-Invasive and predominantly utilise components from the patients’ own body. Therefore, there is no risk of side effects and definitive results can be achieved. Being minimally invasive, recovery is faster, and patients can resume their routine activities (after consulting with the doctor) faster.

How does regenerative therapy help in knee cartilage damage?

• OA is a common degenerative disorder affecting the cartilage, underlying bone and is characterised by chronic structural and functional degeneration of the knee joint.
• Similarly, sports injuries also cause tears in the ligaments and tendons that ultimately lead to difficulty in mobility; therefore, daily living activities. Medications only control the signs and symptoms of the condition, while surgery can only repair the damage that has already occurred and cannot regenerate lost tissue.
• Mesenchymal cells in our body are capable of self-renewal and differentiation.
• Research has shown that mesenchymal cells in the body can differentiate into cartilage, bone, muscle tissue etc. This property can be beneficial in regenerating the tissues lost/damaged in the knees. These cells are also known as ‘guardians of inflammation’; thus, any form of inflammation and resultant tissue damage is tackled naturally.

Types of regenerative therapy for knee cartilage

• Cell-based therapy in cartilage regeneration has gained immense popularity owing to the ease of acquisition of cells, and the definitive results achieved. Autologous mesenchymal cells can be harvested from the bone marrow, adipose tissue, among other sources. There is ongoing research on autologous chondrocyte implantation (ACI) and matrix-associated autologous chondrocyte implantation (MACI). These procedures aim to be more specific in the regeneration of target tissues and include implantation of the concerned cells along with the surrounding environment. The advantage of this target- The Specific approach is that the natural environment of the cells is stimulated in vitro, thereby facilitating sufficient tissue growth when transplanted in the joint. Collagen matrices are commonly used, which is the natural component of the extracellular matrix of the body.
• Tissue engineering research has also used 3D polymer scaffolds to promote the expansion of chondrocytes. Compared to the traditional techniques (chondroplasty/microfracture), these treatments have demonstrated improved outcomes.
• Platelet Rich Plasma (PRP) has been utilised in conjunction with cell-based Therapy and is a rich source of growth factors that provides nutrients to the cells, thereby enhancing outcomes.
• Alternative treatment modalities that are recommended in conjunction with regenerative medicine to enhance outcomes are electro/magnetic stimulation based modalities, physiotherapy, ultrasound- and oxygen-based therapies.
• Moderate physical exercise is a pre-requisite after regenerative therapies.
• Exercising improves blood flow to various parts of the body, which brings about improved regeneration of tissues. Moreover, other healing molecules required during the recovery phase are transported to target sites via blood, and tissue fluid and exercise enhances these processes. Electro/magnetic stimulation based modalities induce physiological actions at a cellular level such as cell oxygenation, enhanced cellular proliferation and differentiation, the release of anti-inflammatory factors, improvement in tissue elasticity, increase in capillary permeability, blood flow improvement etc. Some examples of such allied therapies are low-level laser therapy, therapeutic ultrasound, transcutaneous electrical nerve stimulation, and Interferential Current.
• Another allied regenerative approach is the use of the principle of shockwave therapy. This adjunctive modality stimulates the healing response of the body, by inducing microtrauma at the local area where applied, thereby relieving pain and inflammation.

Potential results of treatment

• Conventional therapeutic methods of diseases/conditions of the knee are focused on short term symptomatic relief and do not promote regeneration or restore the normal homeostasis of the joint.
• Regenerative medicine is helping a paradigm shift in the approach to the management of such conditions by supporting the inherent healing potential of the body.
• We have our own ‘drug store’ in our collection in the form of cells and growth factors. Treatment of conditions affecting the knee joint by utilising principles of regenerative medicine, tissue engineering, cell-based therapy etc. is fundamental for effective symptom relief, including pain management, improvement of functional limitations and quality of life.

(With inputs from Dr Pradeep Mahajan, Regenerative Medicine Researcher)

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