This week I examined a new patient in clinic who exemplifies the wild west of stem cell injections that has developed. This was a competitive distance runner who had an outside (peroneal) tendon inflammation with small degenerative tears. He had a stem cell injection and what happened before and after exemplifies the issues of the blind leading the blind that we see in developing world of orthopedic stem cell use.
Prior to seeing us, the patient had outside ankle pain with running and the MRI was convincing for swelling in the peroneal tendon and degenerative tears. He went to one podiatrist who decided to perform a diagnostic block. This is when the physician numbs up a specific structure and asks the patient to try the offending activity to ensure that the injection helped the pain. There were two problems with this first encounter. One was that nobody ever asked why just the left peroneal tendon was painful. This could be due to a problem with biomechanics causing the left outside ankle to be overloaded. In this patient’s case, with a history of back surgery, there was likely weakness in the peroneal muscles from a low level low back nerve issue which lead to the chronic tendon issues. Second, the anesthetic used for the numbing was Marcaine, a toxic drug. It’s so nasty that the American Academy of Orthopedic Surgeons has taken the unusual step of placing a warning that it’s members not inject this anesthetic into joints. So for a competitive runner, injecting a toxic anesthetic into an important stabilizing tendon of the foot and ankle could be a problem.
After getting the diagnosis that his peroneal tendon was painful, another podiatrist offered him a magic stem cell injection, however this injection had few stem cells. This next issue is a big problem in the wild west of stem cell treatments springing up on every street corner-physicians who don’t have enough basic knowledge about stem cells to question sales reps. In this case, the podiatrist was likely told that the amniotic fluid or micronized amniotic membrane had stem cells. It did have stem cells before it was frozen and shipped, but by the time it arrives to the physician’s door to be injected, it has few stem cells. It has mostly growth factors, something that can had be had in abundance with a simple platelet rich plasma injection taken from the same patient’s vein for less cost.
The next thing that happened to this poor gentleman is what caused him to come to our office. He was placed into rigid immobilization for 6 weeks. While this would be needed if there was a surgical repair of the tendon, since this much immobilization causes severe muscle loss and decreased range of motion, it usually isn’t used nor needed with injection based treatments. What happened? He developed severe range of motion loss. He then spent weeks in therapy trying to recover from this joint stiffness. It was at that point that he pulled too hard and often on his big toe to force the ankle into dorsiflexion and this lead to a painful big toe joint. This joint was then finally injected with steroid and anesthetic, not helpful when the MRI showed he had arthritis in that joint.
The upshot? It’s the wild west out there in stem cells. We now have surgical practitioners adding stem cells onto their practices who have never had basic training in how interventional injection based orthopedics is supposed to work. They also don’t have enough training to question the sales reps hawking magic stem cells. Finally, because of a lack of training in basic cellular medicine, they’re still using injectables that cause more harm to stem cells and joints than good.