The Blind Leading the Blind: Stem Cells placed in a Knee without Guidance
We’re advocates for specialty care when stem cells are used for orthopedic injuries. We practice an evolving specialty we call “Interventional Orthopedics” which involves the use of precise imaging guidance for the placement of advanced biologic therapies using new and novel tools. The goal of all of this is to reduce the need for arthroscopic or open surgeries which in turn reduces recovery time and speeds healing. As this new specialty grows, we’ve become concerned about patients being treated for musculoskeletal injuries by non-specialists or using any number of dangerous stem cell processing methods. A patient we just saw in clinic this week only highlights this growing problem. The patient had a patello-femoral problem with arthritis and went to see a physician on the West coast who stated he was a specialist in stem cells. The patient should have been tipped off by the fact that the physician proported by be able to treat everything from Alzheimers to macular degeneration to Multiple Sclerosis with stem cells. The physician then proceeded to place the stem cells using a blind injection behind the patella (meaning he used no guidance, so the cells could have gone anywhere). This is ill-advised, as we always tell patients that stem cells need to be placed with high accuracy, sometimes using a variety of imaging techniques such as fluoroscopy and ultrasound combined. In addition, the stem cells were also harvested blind, so it’s unsure if any stem cells were obtained in the first place. The patient’s stem cell therapy regrettably resulted in a severe chronic swelling in the patellar tendon (new on his most recent MRI) rather than any improvement or lack of effect. He came to us because after doing his homework on-line, he understood that our specialty was the use of stem cells for knee and other orthopedic problems. While any kind of needle based or surgical treatment can make a patient’s condition worse, we feel strongly this therapy could have been performed better with imaging guidance so the physician knew where the cells were going, and avoid stem cell side effects from randomly placed cells of unknown type. In addition, the specialty of the treating doctor wasn’t interventional pain, sport’s medicine, interventional radiology or one of the other specialties one would expect to know how to place medications or cells into a specific area using imaging guidance, it was pathology. Finally, nobody knows how the cells were processed and whether the cell prep might the type likely to be effective in orthopedic injuries, since the physician was treating multiple other types of neurologic conditions presumably with the same cell preparation. The upshot? We’re seeing an explosion in the use of stem cells for orthopedic conditions, which we welcome. However, there’s great confusion over the types of stem cells that work best for orthopedics and we regrettably see non-specialized family doctors, emergency medicine doctors, cosmetic specialists, and pathologists performing complex stem cell placement procedures without guidance or sophisticated knowledge of knee anatomy. You wouldn’t go to your dentist to get a mole removed, so don’t go to your cosmetic doctor to get your knee injected! If you want to know more about picking a doctor to perform your orthopedic stem cell procedure, see our top 10 questions to ask about orthopedic stem cells guide.