Dr Andrew Dutton

Can knee cartilages be regenerated with stem cell therapy?
The knee is one of the body’s largest and most complex joints and is unsurprisingly vulnerable to strains, sprains, swollen or torn ligaments and even gout. Osteoarthritis mainly affects people over the age of 60 and is a major cause of disability. It is a degenerative disease caused by wearing away of the cartilage in joints that have been continually stressed during a person’s lifetime, including the knees, hips, fingers and lower spine region. The World Health Organization estimates that around 9.6% of men and 18% of women aged over 60 years have symptomatic osteoarthritis.

Osteoarthritis (OA) means inflammation of the joints although it is better known as a degenerative disease due to the inflammation of the joints with thinning of the articular cartilage. The cartilage in our joints allows for the smooth movement of joints. When it becomes damaged due to injury, infection or gradual effects of ageing, joints movement is hindered. As a result, the tissues within the joint become irritated causing pain and swelling within the joint. Typically, there are no symptoms in the morning but as the day progresses discomfort will increase. In the evening, there will be a dull ache in the area of the affected joint.

Most commonly it is treated by a type of knee surgery called arthroscopy. It involves vacuuming out bits of debris and scar tissue, however, does little to help osteoarthritis. Many surgeons are now very cautious when it comes to procedures like arthroscopy. The procedure is performed for a range of knee problems but should be used as a last resort for certain patients, such as those who have a torn meniscus – the shock-absorbing cartilage between the knee bones. For mild osteoarthritis, lifestyle changes, such as losing weight, and physiotherapy can help. But stem cell implantation may be another option to grow back the cartilage.

With this method, stem cells are removed from the patient’s bone marrow under local anaesthetic. It is hoped that the stem cells will create cartilage cells that are as good as natural cartilage. Stem-cell treatment is still at the trial stage and risks should be minimal. The stem cells won’t be rejected, as they are the patient’s own. Current treatments for osteoarthritis can only relieve painful symptoms, and there are no effective therapies that delay or reverse cartilage degeneration. Joint replacements are successful in older people, but options are not effective in younger people or athletes with sports injuries. This is where stem cell therapy can be used to help these patients ease their painful joints.

There are many ways to prevent osteoarthritis and relieve and manage its symptoms. Maintaining a healthy lifestyle with low-impact exercise such as walking, stretching and swimming, getting plenty of rest and enough sleep, and maintaining a healthy diet and weight are simple ways you can reduce and manage osteoarthritis symptoms so that you can live a healthy and fulfilling life.

Catherine Paddock, PhD, Ability to repair cartilage with stem cell steps
Singapore General Hospital (SGH) Department of Rheumatology and Immunology, Osteoarthritis: Pain and Inflammation of the Joints
SingHealth, Osteoarthritis
NHS, Stem cell and bone marrow transplants
International Society for Stem Cell Research (ISSCR), Patient Handbook on Stem Cell Therapies
Thea Jourdan, From Botox to ‘grow your own’ cartilage – how to ease your bad knees