(openPR) Cell therapy in bone healing and sports injuries: Norwegian experts advocate cautious use and intensified research
Cell therapy, a beacon of hope for healing lesions in bones, cartilage, tendons, muscles or ligaments, is already used in treating sport injuries. Yet comprehensive understanding of the underlying mechanisms and robust evidence for its efficacy are still lacking. Experts at the EFORT Congress in Copenhagen called for its continued use but with particular caution. They also want to intensify research on its functioning and clinical outcomes.
Copenhagen, 1 June 2011 - Scientists at the 12th Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) in Copenhagen today advocated the continued but cautious use of cell therapy. Cell therapy is an innovative, non-surgical approach to treatment of bone, cartilage, tendon, muscles or ligament tissue damage through injections of mesenchymal stem cells or platelet enriched plasma. It is a beacon of hope already used in sports medicine, even though sufficient understanding as to the underlying mechanisms is still lacking, as is robust evidence of cell therapy's efficacy. More basic research and methodologically reliable clinical trials were also encouraged.
Cell therapy: applying the body's own healing resources
Cell therapy aims at exploiting the body's own healing mechanisms to repair damaged tissue which otherwise would heal more slowly, or not at all. Its key ingredients under research are mesenchymal stem cells (MSCs) and platelet enriched plasma (PRP). MSCs are multipotent cells synthesised by the bone marrow of mammals. They can transform themselves - or "differentiate" - into a variety of cell types such as osteoblasts (bone building cells), chondrocytes (cartilage cells) or myocytes (muscle cells). The cells are injected directly into the site of the injury in the assumption that they will transform into the cell type needed for healing.
Platelet rich plasma (PRP) is made from the patient's own blood. It involves withdrawing blood and spinning it for approximately 10 minutes in a centrifuge. This yields a PRP solution with a high concentration of platelet cells that is subsequently injected back into injured tissue and activated there. PRP contains a cocktail of cytokines and growth factors that play an important role in the healing of injured tissue.
In-vitro results raise hope that MSCs might help healing intricate fractures
"Certain types of MSCs have already proven their capacity to differentiate into bone cells in the test-tube, but it is less clear that they will fulfill our hopes in helping us heal complicated fractures where the areas of fracture don't meet or have come to meet late. To obtain optimal fracture healing in clinical practice, we need more research on the type and doses of cells needed, and on how to trigger the kind of differentiation we want these cells to undergo," Prof. Gunnar Kvalheim (Oslo University Hospital, Norway) explained today at the EFORT Congress.
PRP should continue to be applied in injured athletes, but with caution
Acute and chronic musculoskeletal injuries in sports - such as muscle strain and contusions, painful tendon disorders or cartilage and ligament lesions - are difficult to treat. But they are exactly the kind of traumas for which cell therapy is thought to help. PRP is already used in their treatment, therefore, "although so far we don't have robust clinical studies to support its use," Prof. Lars Engebretsen told the Congress today. Prof. Engebretsen is a specialist at the department of orthopaedic surgery at the Oslo University Hospital and the Oslo Sports Trauma Research Center, as well as head physician at the Norwegian Olympic Center. He nevertheless advocates a further careful application of PRP in sports traumatology: "The need for more work on the basic science is beyond question. Greater rigor should also be applied in developing robust clinical trials to demonstrate PRP efficacy or non-efficacy. However, any procedure or method that may assist in the reduction of such morbidity would be most welcome. Since our theoretical model of how PRP could work is plausible and supported by in vitro and some clinical trials, and since evidence of its being harmless is sufficient, we recommend continued trials, at least in athletic sporting injuries, but with attentive caution."
About EFORT
The European Federation of National Associations of Orthopaedics and Traumatology, EFORT, is the umbrella organisation linking Europe's national orthopaedic associations. It aims at promoting the exchange of scientific knowledge and experience in the field of prevention and both the conservative and surgical treatment of diseases and injuries concerning the musculoskeletal system. It places particular emphasis on education and research.
EFORT was initially established by the national associations for orthopaedics and traumatology from twenty European countries. The Federation was founded in Marentino, Italy, in 1991, thus celebrating its 20th anniversary. Today it has 42 national member societies from 40 member countries, as well as six associate scientific members. EFORT is a non-profit organisation and all funds are used exclusively in the pursuit of the Federation's aims.
