At this time I do not personally find sufficient evidence in the literature that stem cell use in musculoskeletal medicine and chronic pain is cost-effective, and thus I have not begun their use. Those for whom finances are not an issue, please do not let me discourage you from the use of stem cells, because stem cells are powerful, and have little downside other than expense. However, if you become frustrated with results, the most important thing to keep in mind is that a complete diagnosis of pain sources and treating them thoroughly, including both connective tissue (ligament/tendon/cartilage [joint]) and nerve sources, is crucial and is rarely done. By way of illustration think of being attacked by 4 people at once. If you address just one of them with a powerful method but miss the others, you MAY scare the other 3 off for a while, but they will be back, and you have not truly solved the problem. These brief comments are written for the majority of people for whom comprehensive treatment, not power, is the key, and for whom the cost of stem cell use is prohibitive. At the point, I am not convinced that stem cells are needed often enough to merit use in my clinic. In the meantim,e I do have several colleagues currently using them and am certainly happy to refer patients to them if I believe that would be the most effective treatment.
In April of 2018, I presented the table you see here in a talk at the American Association of Orthopedic Medicine. In summary, on the left are the primary areas that have been researched using stem cell injection. Across the top are the names of authors who wrote summary articles called meta-analyses that reviewed the overall evidence. Level A indicates strong evidence for benefit; level B, a moderate level of evidence; and level C suggests it may be helpful but is uncertain. At this point then, the evidence for use in knee osteoarthritis and after ACL reconstruction is moderate. For those conditions, stem cell use is certainly reasonable, if it is affordable. However, even in those areas in which research is accumulating for stem cell use, my impression is that other methods (with comprehensive treatment using dextrose prolotherapy +/- platelet rich plasma) can achieve similar benefit. For examples of this, see the research tab for clinical trials of dextrose prolotherapy for knee osteoarthritis and ACL laxity.
In April of 2018, I presented the table you see here in a talk at the American Association of Orthopedic Medicine. In summary, on the left are the primary areas that have been researched using stem cell injection. Across the top are the names of authors who wrote summary articles called meta-analyses that reviewed the overall evidence. Level A indicates strong evidence for benefit; level B, a moderate level of evidence; and level C suggests it may be helpful but is uncertain. At this point then, the evidence for use in knee osteoarthritis and after ACL reconstruction is moderate. For those conditions, stem cell use is certainly reasonable, if it is affordable. However, even in those areas in which research is accumulating for stem cell use, my impression is that other methods (with comprehensive treatment using dextrose prolotherapy +/- platelet rich plasma) can achieve similar benefit. For examples of this, see the research tab for clinical trials of dextrose prolotherapy for knee osteoarthritis and ACL laxity.