Last Friday was episode 4 of my stem cell injections. It was full of blood, sweat, and needles. Who doesn’t like those?
This time around, I got a large concentration of bone marrow and fat stem cells (FYI-you get free liposuction with these procedures…..). My right knee was pumped full of these two different concoctions. This gave me an angry swollen knee full of potential which I am currently enjoying.
I feel much more educated about these injections than I did last year at this time. What brought me back for more injections was studying micro fracture surgery for the last several months. What really struck me as odd was how micro fracture (a bone marrow stimulation technique) is considered mainstream and is covered by insurance while autologous (i.e. from yourself) bone marrow injections are NOT considered mainstream and are not covered by insurance. While it is obvious that micro fracture surgery and inter-articular bone marrow injections are different procedures, the goal of both of procedures is to deliver bone marrow (with its growth factors and stem cells) to chondral lesions.
Both methods have a glaring similarity. Bone marrow is brought to the site of injury with the hope and expectation that new cartilage will form. Currently, studies on micro fracture clearly demonstrate good short term benefit to patients. Studies on the use of bone marrow stem cell injections is mixed and highly variable. Here is a nice summary of some key studies of various stem cell injections by Blue Cross Blue Shield and why this company still lists such injections under experimental.
https://www.bluecrossma.com/common/en_US/medical_policies/254%20Orthopedic%20Applications%20of%20Stem%20Cell%20Therapy%20prn.pdf
In direct contrast, studies on micro fracture surgery are well done and well standardized. The results of micro fracture are repeatable. Most importantly, what patients do after micro fracture surgery is greatly emphasized in the literature. The post therapy protocol after micro fracture is critically important. After reading about micro fracture surgery outcomes for several months a few themes kept coming up. Many researchers noted again and again how the post surgical rehab is one of the biggest indicators of how successful a patient will do with micro fracture surgery. It was noted that many doctors, patients, and therapists get caught up in quick rehab protocols that doom a patient’s new cartilage because the blood clot and forming cartilage is exposed to too much load too soon. The bigger, faster, stronger/ no pain, no gain fallacy strikes again.
Last I checked, no studies on stem cell injections talk about what they tell their patients (or study participants) to do post injection. During my last 3 injections, I was simply told to rest for a few days, listen to my body, and to get back into activities slowly. (FYI, this last time, I was given more instructions on what to do after the injection…a mobility/ exercise page). I think it is safe to say that any micro fracture surgeon would think such advice would certainly set any micro fracture patient up for failure. Again, I realize that micro fracture does not equal stem cell injections, but I think clinics that treat patients with injections of bone marrow, PRP, and fat should consider the well established rehabilitation protocols of micro fracture surgery. At a minimum, micro fracture patients are told to be on crutches for 6 weeks, but many of the researches advise more time (8-12 weeks!).
The primary reason for so much non/ partial weight bearing time is to allow new cartilage to form and to protect it. Whether a person gets micro fracture surgery or bone marrow injections, any cartilage that forms starts out as a blood clot. Should people be running around on a blood clot? I don’t think so, nor would many rehabilitation professionals. Therefore, I plan on using crutches for up to 12 weeks. It makes a lot of sense to follow the same protocol as micro fracture surgery.
With some luck, I will hopefully reap all the benefits of a micro fracture surgery (minus the nice cartilage bed the drilling provides) without any of the downsides.
After thinking about how I treated my newly forming cartilage during the past 3 injections, it makes sense that I got minimal results in regard to gains in function. If I had gotten micro fracture surgery and started walking a week after the procedure, I would have gotten very poor results.
For those interested here is a great page on micro fracture rehab:
http://lowerextremityreview.com/article/rehabilitation-following-microfracture-surgery
Let’s see how this goes.
