{"id":37313,"date":"2021-01-25T12:14:20","date_gmt":"2021-01-25T19:14:20","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=37313"},"modified":"2023-01-23T09:56:25","modified_gmt":"2023-01-23T16:56:25","slug":"can-stem-cell-transplants-help-to-repair-damaged-knee-tissue","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/can-stem-cell-transplants-help-to-repair-damaged-knee-tissue\/","title":{"rendered":"Can stem cell transplants help to repair damaged knee tissue?"},"content":{"rendered":"
<\/div>
\"Jonathan
Jonathan Gray in action on the rugby field. Photo courtesy of Jonathan Gray.<\/figcaption><\/figure>\n

In June 2018, Jonathan Gray left the field after a USA Rugby Club Championship match at Infinity Park in Glendale, Colorado with an unwelcome companion: severe pain in his left knee.<\/p>\n

The discomfort was as emotional as it was physical. Gray loved rugby. Now 41, he had been a top-level player since his high school days in Seattle. He was a two-time All-American at the University of Arizona<\/a> and regularly competed after graduation overseas and on United States club teams.<\/p>\n

Gray was no stranger to injuries he sustained playing the high-contact sport. The list includes a dislocated collarbone, broken ribs and fingers, lacerations, and a badly torn hamstring. But the knee injury had slowed his game since 2014. The 2018 pain ultimately forced him off the field for a year and a half \u2013 and threatened his ability to play rugby again.<\/p>\n

\"Jonathan
Jonathan Gray plays in the rain, supported by the left knee that Dr. Jason Dragoo repaired with surgery stem cells transplanted from Gray\u2019s stomach. Photo courtesy of Jonathan Gray.<\/figcaption><\/figure>\n

\u201cThe injury had been a sticking point,\u201d Gray said. \u201cWhen I came out low, made a hard cut or squatted, the pain was unbearable. It held me back for a long time.\u201d<\/p>\n

Steadily worsening knee pain<\/strong><\/h2>\n

The problem was badly damaged cartilage in the knee that forced pressure on his femur (thighbone). The result: a hairline fracture and a bone bruise. Gray tried a battery of treatments to ease the pain: cortisone shots, plasma-rich platelet injections, lubricating gel, \u201cmassive\u201d physical therapy, massage, and transcutaneous electrical nerve stimulation \u2013 all to no avail.<\/p>\n

\u201cNothing seemed to work,\u201d Gray said.<\/p>\n

As the pain worsened, he had to ease his way down the stairs sideways. If he took a wrong step or tripped, the leg gave out.<\/p>\n

\u201cIt was like a knife went through it,\u201d Gray recalled.<\/p>\n

\"Jonathan
Jonathan Gray, far left, emerges from scrum on the rugby field. Photo courtesy of Jonathan Gray.<\/figcaption><\/figure>\n

A rejuvenated knee with help from a stem cell transplant<\/strong><\/h2>\n

Two-and-a-half years after his dispiriting trudge off the Infinity Park field, Gray is back to playing with USA Rugby, relying on a left knee that he says feels like new. He owes the reversal to reconstructive surgery last summer at UCHealth Steadman Hawkins Clinic \u2013 Denver<\/a>. His recovery may also have gotten an assist from cells in his own body that show tantalizing promise for boosting the body\u2019s healing power.<\/p>\n

In the operating room, Gray\u2019s surgeon, Dr. Jason Dragoo<\/a>, Professor and Vice Chair of Academic Affairs for the Department of Orthopedics at the University of Colorado School of Medicine, worked to redistribute force in Gray\u2019s knee joint away from the weakened cartilage. He then turned to regenerative medicine, one of his specialty areas.<\/p>\n

Dragoo used liposuction to harvest fat tissue from Gray\u2019s abdomen. Still in the OR, he separated from the fat tissue mesenchymal stem cells (MSCs), the kind that give rise to connective tissue, bone and fat, and injected the cells into the knee joint.<\/p>\n

Putting a therapy to the test<\/strong><\/h2>\n

It was no wild experiment. Dragoo explained that MSCs can help to decrease pain by naturally activating opioid receptors<\/a> and also reduce inflammation<\/a> by modifying the body\u2019s immune response to the injury. In Gray\u2019s case, the strategy appears to be an unqualified success.<\/p>\n

\u201cHis knee exam is now normal,\u201d Dragoo said.<\/p>\n

He\u2019s now putting MSCs to a further test. In a trial<\/a> underway at the Steadman Hawkins Clinic \u2013 Denver, Dragoo is conducting surgery on two groups of patients with knee osteoarthritis. On both groups, he makes surgical repairs, such as removing loose cartilage and fixing meniscal tears. He then harvests MSCs from a layer of tissue under the kneecap called the fat pad. One group gets an injection of the cells, while the other gets a placebo injection of saline. It\u2019s a randomized double-blind study, meaning neither the patient nor Dragoo know who received which treatment.<\/p>\n

Two years of observation, including independent review of functional MRIs, will follow to answer the question of whether or not these MSCs derived from fat tissue can unleash the body\u2019s power to regenerate new cartilage.<\/p>\n

Healing power of stem cells<\/strong><\/h2>\n

The notion of the body self-healing is hardly revolutionary, Dragoo noted. Think cuts, scrapes and broken bones that repair over time. Damaged cartilage is another story. If it could heal itself after injury, athletes wouldn\u2019t agonize over losing their careers to anterior cruciate ligament tears.<\/p>\n

\u201cWhy can the body heal one area and not the other?\u201d Dragoo said. \u201cThat is what is behind the science we are pursuing. We are learning and understanding how we can use the body\u2019s own resources to heal parts of that body where it doesn\u2019t otherwise do so.\u201d<\/p>\n

A rigorous clinical trial like the one he is conducting is the only way to definitively answer the question. Dragoo is openly worried about clinics that make unsubstantiated claims about the ability of stem cell treatments to heal musculoskeletal injuries<\/a>.<\/p>\n

\":
Dr. Jason Dragoo, surgeon at the UCHealth Steadman Hawkins Clinic \u2013 Denver, leads a clinical trial that tests the ability of transplanted stem cells to repair damaged knee tissue. Photo by UCHealth.<\/figcaption><\/figure>\n

\u201cWe\u2019re trying to prove if these cells can actually lead to restoration of cartilage tissue,\u201d Dragoo said. \u201cAs of now, we just don\u2019t know.\u201d<\/p>\n

A much-studied question<\/strong><\/h2>\n

Dragoo said the clinical foundations for the trial stretch back to his residency in orthopedics at UCLA Medical Center, where he was part of a team that discovered MSCs within adipose (fat) tissue. He and his colleagues began studying how they might be useful in treating musculoskeletal disease. That work led to examinations of the fat pad \u2013 a heretofore poorly understand part of the anatomy \u2013 that yielded an important finding. The pad, it turned out, contains \u201chuge numbers\u201d of MSCs, Dragoo said.<\/p>\n

With this new knowledge in mind, Dragoo said he and others looked at cartilage damage in the knee from a surgical perspective. They noticed that the fat pad grew around injured areas.<\/p>\n

\u201cWe saw the body\u2019s response, which was to grow local tissue over the injury,\u201d Dragoo said.<\/p>\n

That observation suggested the healing power of MSCs in the fat pad. But the fat pad contains a variety of cells. How to harness the regenerative cells for surgery?<\/p>\n

\u201cWe realized that MSCs are not necessarily accessible to the joint without freeing them up,\u201d Dragoo said. While at Stanford University Medical Center, he and a colleague described a method for harvesting and processing stem cells from the fat pad<\/a> so they could be used in regenerative procedures.<\/p>\n

A subsequent trial demonstrated that the processed cells could be used to heal cartilage damage in animals, setting the stage for the current clinical trial of human osteoarthritis patients.<\/p>\n

Rebuilt knee holds up<\/strong><\/h2>\n

Jonathan Gray was not part of the trial, but his experience with cell therapy offers at least anecdotal evidence of the promise of cell therapy. The surgery has also restored his ability to play the game he loves.<\/p>\n

\u201cIt feels again like I can play week in and week out,\u201d Gray said. \u201cThat\u2019s invigorating.\u201d<\/p>\n

Rugby is more than just a game for him, he added. He was born in the United States, but his family is from New Zealand, where rugby is huge. Gray spent a few formative years there before returning to the States, settling in Seattle, taking up the sport seriously and forming enduring bonds around it.<\/p>\n

Building back physically and socially<\/strong><\/h2>\n

\u201cA lot of my social network and my friends, I met through rugby,\u201d Gray said. He recalled his coach at the University of Arizona addressing him and about 60 other rookies. His coached asked them to look around.<\/p>\n

\u201cHe said, \u2018You may not know any of these people, but one day you\u2019ll be at one another\u2019s weddings and funerals and you will be there when one another\u2019s babies are born.\u2019 That\u2019s the rugby culture. It\u2019s a very tight community.\u201d<\/p>\n

Thanks to the surgery and cell therapy, Gray has been able to renew that connection.<\/p>\n

\u201cTo be able to go back and reunite with friends and those still playing and have tournaments to go to or travel on weekends and practice is a great outlet for me,\u201d he said.<\/p>\n

Gray said after steady work rehabbing and strengthening his knee, he\u2019s now able to work out with local rugby teams. He\u2019s practiced tackling without pain and steps from his truck without fear of wincing.<\/p>\n

\u201cI no longer have to be extra careful,\u201d he said.<\/p>\n

He credits Dragoo and his team for being upfront with him about his care options, the most extreme of which was a partial knee replacement and six months of recovery. Gray said he was interested in the cell therapy option, but Dragoo did not push it.<\/p>\n

\u201cHe told me the jury is still out on it, there are no guarantees, and that I should do my own research,\u201d Gray said.<\/p>\n

With a knee that now feels like it\u2019s 30 years old again, he feels he made the right surgical decision.<\/p>\n

\u201cI was put back together by science,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"

In June 2018, Jonathan Gray left the field after a USA Rugby Club Championship match at Infinity Park in Glendale, Colorado with an unwelcome companion: severe pain in his left knee. The discomfort was as emotional as it was physical. Gray loved rugby. Now 41, he had been a top-level player since his high school […]<\/p>\n","protected":false},"author":2143,"featured_media":37318,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[167,3063,3372,183,9167,3681],"class_list":["post-37313","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-clinical-trials","tag-orthopedic-joint-replacement-preservation","tag-orthopedic-trauma-and-fracture-surgery","tag-orthopedics","tag-specialized-services","tag-uchealth-steadman-hawkins-clinic-denver"],"acf":[],"yoast_head":"\nCan stem cell transplants repair damaged knee tissue? 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