Chronic knee pain is one of the most debilitating injuries that an active person can experience. Of all the joint injuries, Jumper’s Knee injury affects the patellar tendon the most. This injury can be life changing, not only because of the physical mobility it impedes, but also the long-term psychological strain caused by an injury that results in constant pain during daily activities. Even small, seemingly innocuous things, like climbing stairs, can be excruciatingly painful. These injuries often fail to respond to traditional therapeutic pathways to return full range of mobility. There is a desperate clinical need for new regenerative therapies within this injury pathway. While traditional therapies often only address pain symptomatically, this new Stem Cell approach promotes cellular healing. It is a paradigm shift to utilize UC-MSCs to address the underlying cause of injury. Rather than address the superficial inflammation, this biological intervention will target the underlying structural deterioration. This shift is long overdue for patients in need of complex care.
Understanding the pathology of Jumper’s Knee necessitates an examination of the tendon at the micro-anatomical level. This connective tissue structure attaches the kneecap to the shinbone, and is subjected to colossal mechanical loading, especially during explosive activities. If the repetitive loading on the tendon exceeds the reparative ability of the tenocytes, small tears within the collagen occur. This mechanical overload instigates a chain reaction of degenerative changes. In contrast to acute inflammation, this disorder is characterized by a failed healing response, a high degree of collagen disorganization, an accumulation of a mucoid ground substance, and a greater degree of microvascular hyperplasia and ingrowth. Type I collagen is replaced by type III replacement collagen, and fibroblasts perish because of microvascular ischemia. Repetitive microtraumas within the tendon cause necrotic regions to form along the tendon’s structure, making it more prone to complete rupturing. Eventually, complete failure of the tendon’s mechanical properties occurs, causing the clinical signs of Jumper’s Knee to manifest, requiring UC-MSCs Stem Cell treatment.
Figure 1: Understanding Jumper’s Knee pathology
Traditionally, orthopedic specialists have relied on conservative management strategies. In the early phases of a Jumper’s Knee injury, orthopedic specialists recommend prolonged rest, non-steroidal anti-inflammatory drugs (NSAIDs), and eccentric loading exercises as a form of therapy. Localized pain management often consists of intra-tendon corticosteroid injections. All of these strategies have significant drawbacks. NSAIDs and corticosteroid injections are more focused on pain management, and have the potential of prolonging the natural healing and remodeling of the injured tendon. Corticosteroid injections have the potential of inducing atrophy of the tendon, and increase the likelihood of a spontaneous rupture of the tendon with continued use. Surgical debridement is also an option for therapy, but is not without long rehabilitation phases and the potential of not resolving the symptoms of the injury. This then subjects the patient to a cycle of partial recovery and re-injury. Because of the severe limitations of the strategies used historically, the development of advanced Stem Cell therapies utilizing UC-MSCs becomes necessary to promote healing.
In overcoming the biological barriers to healing, regenerative medicine will be the most promising. Mesenchymal therapy of any type, when delivered directly to the damaged tendon structure, will provide the most significant benefits in relieving Jumper’s Knee. In the case of Jumper’s Knee, mesenchymal cells are not simply replacing cells in the injured tissue, but, through complex cellular signaling, are actually going to help restore and improve the structure of the tissue. When these cells are present in the hypoxic environment of tendon healing, they are able to produce a variety of growth factors like FGF, VEGF, and TGF that have a significant impact on the tissue’s ability to heal itself. TGF-β prompts resident tenocytes to produce strong type I collagen, which sufficient tensile strength needs. Meanwhile, the Stem Cell population’s immunomodulatory attributes convert the local macrophages from the harmful M1 phenotype to the beneficial M2 phenotype, which eventually halts the degradation of the matrix. The Stem Cells also provide a strong anti-apoptotic protection to the surviving tenocytes against the cell death caused by the mechanical stress. The UC-MSCs promote neo-angiogenesis while avoiding the potentially harmful neurovascular ingrowth to restore the healthy repair microenvironment for the patellar tendon, and also remodel the compromised tissue to its normal and more robust state.
Figure 2: Stem Cell therapy for Jumper’s Knee
The other countries in the Southeast Asian region are in the early stages of modernizing their medicine by integrating the regenerative technologies. Thailand is in a strong position to be a world leader in the regenerative cell-based medicine because its modern clinical research facilities are coupled with modern clinical research infrastructure. Thailand is a high injury country due to the highly popular explosive sports like Muay Thai, making available treatment for Jumper’s Knee highly sought in the population. With the aim of positioning Thailand as a choice destination for medical tourism for regenerative medicine, the Thai government is facilitating resorts in biomedical innovation. Many of the local research universities in Thailand are at the forefront of clinical research, with some of the first published data and clinical applications demonstrating the improved safety and efficacy of Stem Cell interventions in orthopedic sports medicine. It is guaranteed that Thai facilities will soon have internationally acceptable UC-MSCs and Stem Cell curative interventions.