Category: Clinical Sciences/Health Conditions
Case Diagnosis: Mr.X,medical officer, Aftabnagar, Chittagong; 36 years, came on 1 January,2019 with the complaints of knee pain with feeling of instability after 3 months of road traffic accident. He also has feeling of giving way on uneven surface. His VAS score was 7. On examination, knee joint was mild swallowen, mild tender (grade-II), Range of Motion was 0-100, anterior drawer test was positive (0.5cm), Quadriceps muscle was mild wasted (mid thigh circumfernce-42cm), Knee Injury and Osteoarthritis Outcome Score (KOOS) was 30. MRI shows altered high signal intensity of anterior cruciate ligament (ACL) indicate partial tear of ACL.
Patient had undergone Bone Marrow Aspirate Concentrate (BMAC) Mesenchymal Stem Cells (MSCs) treatment followed by 3 months rehabilitation program. With all aseptic precautions, Ultrasound (US) guided aspiration of BMAC from right posterior-superior iliac spine (PSIS). Then BMAC–MSCs was processed and applied into ACL by using C-arm. Needle engagement is confirmed by tracking of dye (Iohexol) in both antero-medial & postero-lateral bundle. Then 3cc stem cell injection is given into it. After3 months, he enjoyed painfree (VAS-0) squatting & absence of giving way, negative anterior drawer test, mid thigh circumference 50 cm, KOOS score was 100 and returning normal MRI image of ACL.
Poor healing capcaity of the ACL has been speculated to be a consequence of its intraarticular location and thin synovium membrane. Centeno et al reported on 10 patients on ACL partial tear treated with intraligamentous injection of autologous BMC and PRP using fluoroscopic guidance. Seven of 10 patiens shows improvement in terms of MRI images and anterior drawer test.
Tissue regeneration of ACL by BMAC-MSCs is excellent. Early Intervention in ACL partial tear is necessary to prevent loosening or becoming full tear treated by surgery. A large scale research is need to establish the effectiveness of stem cell induced ligament regeneration.
mohammad moniruzzaman– Associate Professsor, Dhaka Medical College