AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-MSC’s Update_ What the Evidence Says, What to Use and When-Gabriella Ode, M.D.

MSC’s Update_ What the Evidence Says, What to Use and When-Gabriella Ode, M.D.

Pdf Summary

This presentation by Dr. Gabriella Ode provides an evidence-based overview of mesenchymal stromal cells (MSCs) and related cell therapies in orthopedic applications, clarifying terminology and evaluating current clinical data.<br /><br />The term “mesenchymal stem cells” is considered vague and often misleading; “mesenchymal stromal cells” is preferred by the International Society for Cellular Therapy (ISCT). Cell therapy broadly includes minimally manipulated autologous cell products (e.g., bone marrow aspirate concentrate [BMAC], microfragmented adipose tissue [MAT], amnion-derived tissues) and culture-expanded cells (e.g., expanded adipose-derived stromal cells [ADSCs], bone marrow stromal cells). Minimally manipulated products are cleared under FDA 510(k) exemptions but have variable cellular composition and biological function. Culture-expanded cells require more stringent FDA approval due to changes induced by ex vivo expansion.<br /><br />Clinical evidence for BMAC shows promising early outcomes for soft tissue injuries (tendinopathies, rotator cuff repair) and articular cartilage defects when combined with scaffolds, though high-quality RCT data are limited. For knee osteoarthritis (OA), BMAC improves pain and function in mild to moderate cases, but RCTs show mixed results, with one RCT finding no difference versus saline.<br /><br />Adipose tissue therapies, including both culture-expanded ADSCs and microfragmented adipose tissue, show encouraging results for rotator cuff pathology and knee OA, with some small trials and case series demonstrating pain reduction and functional improvements. However, these are preliminary and limited by small sample sizes.<br /><br />Amnion-derived tissues have limited but growing data, including one large recent RCT showing significant short-term pain relief in knee OA compared to saline and hyaluronic acid.<br /><br />Overall, strongest evidence supports BMAC for cartilage defects, adipose-expanded cells and microfragmented adipose tissue for OA. Tendinopathy and amnion-derived applications lack robust evidence. The field requires more high-quality, prospective studies with standardized outcomes to ethically advance cell therapies in orthopedics.<br /><br />In summary, while MSC-based therapies hold promise across orthopedic indications, current evidence is preliminary and heterogeneous, underscoring the need for further rigorous clinical trials before widespread routine clinical adoption.

Keywords

mesenchymal stromal cells

cell therapy

bone marrow aspirate concentrate

adipose-derived stromal cells

microfragmented adipose tissue

amnion-derived tissues

orthopedic applications

knee osteoarthritis

rotator cuff repair

clinical trials