Autologous Stem Cell Injection (ASCI) Therapy
The fourth treatment, autologous stem cell injection (ASCI) therapy, utilizes the patient's own bone marrow or fat, both rich sources of stem cells -- which is collected, filtered, centrifuged and injected into the injured areas. This method, still in its infancy, promises to be particularly advantageous in treating advanced arthritis, severely degenerated tendons, ligaments, cartilage, spinal discs and chronic fractures. Preliminary work shows level 2 and 3 evidence that it is as safe as other injection-based treatments, poses no risk of tumor genesis and in numerous retrospective and prospective case series shows excellent clinical outcomes and objective healing of multiple musculoskeletal tissues.
During this procedure a small volume of the patient's bone marrow is extracted from their iliac crest near the base of the spine, then placed in a centrifuge and spun at a high rate of speed to separate the mesenchymal stem cells from other blood cells. The concentrated bone marrow is then injected into the targeted joint or tendon followed by some of the patient's PRP to activate the stem cells to turn into the tissue needed for repair. Some clinics are using concentrated fat as a scaffold or architectural construct for the stem cells to hang onto until the tissue can be incorporated into the tissue that is missing from the diseased area. In this case a few milliliters of the patient's fat is obtained by liposuction from the patient's abdomen or thigh. After the fat has been prepared for injection it is injected into the target joint or tissue at the same time as the stem cells and PRP. The additional risks and complications of obtaining fat and bone marrow from a patient is the additional procedures needed to obtain these tissues can cause additional pain, bleeding and infection. In the hands of an expert with the use of image guidance like high-resolution ultrasound this risk is very small.
The major decision point for the doctor and patient is to decide between reconstructive surgery versus ASCI, which is still considered an experimental treatment and is the most expensive of these four therapies. But, for most patients being treated, ASCI is worth every penny.