sean-marshall-injuryOver the last decade, there has been a tremendous amount of controversy over the research and the use of stem cells in medicine. While there is still some debate about it, the world of modern medicine has begun to embrace the potential healing powers of stem cells—right or wrong. Stem cells are essentially non-specialized cells capable of giving rise to new cells to replace degenerated cells. By non-specialized we mean that stem cells can give rise to any number of specialized cell types such as brain, ligaments, bone, and many more types. This, in theory, means that injection or infusion of stem cells into a damaged ligament, tendon or bone can actually result in more effective and efficient healing.

Stem cell injections are different from PRP injections.  Please see some of my prior blogs for details of PRP.  However, simply said, PRP is a concentrated volume of platelets that normally circulate in our blood.  Platelets contain factors that initiate a healing response.  So when I inject PRP into a tendon, I am initiating a healing response.  Stem cells are different.  Stem cell injections try to infuse the area with baby cells that we try to get to grow up into the mature cells in the area, to recreate the desired tissue.

The debate over stem cells very well could be over as new procedures to harvest stem cells have come to fruition. Previously there were ethical questions regarding the harvesting of stem cells from embryos. Now, stem cells are acquired from an internal source (the patient) that has bountiful reserves of stem cells. The location: the marrow cavity of bones, skin (Aesthetic Pittsburgh), the fat below the skin, etc.  The most useful and easiest place to harvest stem cells is from the back of the hip (iliac bone). Stem cells are harvested by removing bone marrow blood with a specialized needle. This procedure is considered painless and non-threatening and can be done in just a few minutes. Once the blood is acquired it is taken to the lab to be separated to leave a concentrated amount of stem cells. In addition growth factors are gathered through this process in order to allow for stem cell activation.ilium-bone

Above: The Iliac bone is utilized to harvest stem cells from bone marrow blood.

Stem cell injections have taken on a particularly large roll in sports-related injuries. Professional athletes rely on their bodies for their livelihood. So when an injury does occur, the typical goal is to have the most efficient recovery, one that is both fast and thorough. In theory, the use of stem cells can help assure the efficiency of recovery and that is why so many athletes are opting for this relatively controversial treatment option. One such athlete who has recently opted for this procedure is Cincinnati Reds relief pitcher Sean Marshall. Marshall had been struggling with pain and inflammation for the better part of two years and has witnessed an epic drop in his performance. Non-surgical treatment such as shoulder strengthening exercises had shown little benefit, so Marshall opted for surgery to clean out his shoulder; this procedure is called an arthroscopic subacromial decompression and glenohumeral debridement. Marshall was also given stem cell infusions to aid in the healing process. Marshall is scheduled to miss the rest of the season so the hope is that he can return to form as soon as next year, and with the use of stem cell infusions he could be ahead of schedule.

The use of stem cells in medicine and especially sports medicine has taken a large spike over the last few years. The reason behind this spike is that new procedures have discredited arguments on the ethicality of stem cells. It is reasonable to expect that stem cell treatment will continue to become more predominant in medical facilities around the world.


Stem cell therapies are hardly new. In fact, they are perennially on the cusp of finding their way into mainstream orthopedic medicine. The problem has long been a lack of reproducible findings – and a prohibitive cost.

At least one half of that equation may finally be getting addressed. Doctors are seeing more consistent results with certain stem cell therapies for orthopedic issues such as knee pain and shoulder pain. The process has remained largely unchanged since the technology was invented/discovered:

Doctors use a needle to extract bone marrow from the crest of the hip bone. It’s then sent to a lab, where it is spun down to get at the layer of stem cells — cells that have the potential to become any type of cell.

The stem cells are then combined with the patient’s platelets, a type of blood cell involved in healing. Then, it’s given back to the patient. The idea is to have the stem cells turn into new tissue and improve pain and function. . . .

Typically, this is done for various inflammatory tendon problems, though it can be used  for hips, knees, shoulders, ankles, and spine. Patients usually notice improvement by three months, with full benefit in one year.

It is a promising approach, although the body of literature on stem cell therapies versus traditional knee surgeries remains in its infancy. The best bet if you’re experiencing chronic knee pain: Visit a San Diego Orthopedic Surgery Center and get a full workup.  You will be counseled on the risks and rewards of the various treatment options available to you, based on your unique situation.  We provide PRP (platelet rich plasma) injections among the other various conservative treatment measures. In addition, we are able to provide the complete array of surgical procedures. This broad and comprehensive approach to treating your pain and dysfunction puts us in a unique position of being able to provide you an honest appraisal of your options. Our goal is to make you better!

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow