So, I'll be presenting our study that was published in the Arthroscopy Journal a few weeks ago. I'd like to acknowledge all my co-authors, and we have no relevant disclosures. Mesenchymal stem cells have the ability to differentiate to become specialized musculoskeletal cells and may act as regenerative substrates through immune response modulation and release of trophic cytokines. Modified stem cell injections have garnered interest and optimism from basic science studies in their ability or potential to reverse damage and alleviate symptoms from degenerative orthopedic conditions and delay and prevent the need for surgical intervention. However, numerous limitations remain in the clinical application of these therapies, a primary one being the lack of high-quality evidence supporting their effectiveness. Much of this is the result of inherent difficulties associated with studying stem cells. These difficulties include variability in stem cell source, extraction method, culture expansion versus sample and concentration methods, quantification of cells, method of administration, and the list goes on and on. There's a paucity of high-level evidence suggesting that MSCs play a role in treating osteoarthritis. A recent meta-analysis of some randomized control trials, mostly out of Europe, found mild improvements in pain after mesenchymal stem cell injections compared to controls for the treatment of NeoA. Important to note that these were culture-expanded stem cell therapies containing concentration of cells in the magnitude of millions in contrast to BMAC, which has concentration in the magnitude of thousands. Another recent RCT, which Dr. Chawla touched on, with a patient's bilateral NeoA receiving BMAC in one knee and saline in the other, found significant improvements in pain and function, but no difference was found between the groups. Another recent systematic review on the use of stem cells to treat tendon disorders found that the current level evidence for stem cell use in tendon disorders is extremely poor and the results from the identified trials are at high risk of bias. The Academy has recently released a position statement that emerging biologic therapies may lack demonstrated safety and effectiveness profiles of many traditional orthopedic treatments. However, our patients do not see these recommendations or the results of these trials. Rather, they experience often exaggerated direct-to-consumer marketing, including from stem cell clinics, which are becoming increasingly commonplace in the United States. With the ambiguity surrounding the federal regulation of minimally manipulated stem cell therapies, patients may be at risk of making misinformed healthcare decisions. This recent study out of the Cleveland Clinic reached out to stem cell clinics throughout the United States via simulated emails and telephone calls, and they found that they reported very high levels of patient satisfaction for the treatments that they offer, and the cost of these therapies were surprising, in the magnitude of thousands of dollars. In this setting, we sought to explore the public opinion, understanding, and preferences regarding the use of stem cell therapies for the treatment of joint and tendon disorders. We created a 30 questions custom survey, and this was a survey that was aimed to assess the public's understandings and beliefs of stem cells. We also assessed demographic variables across the sample, including assessment of the subjective patient health assessments, as well as health literacy. Our survey sample, which is one of the most interesting things about the study, we used the Amazon Mechanical Turk, which is an online platform where you can crowdsource different tasks, such as surveys. This has been a validated platform with high levels of internal consistency, reliability, and metric equivalence across samples that has been found to be generalizable to the U.S. population. Our inclusion criteria was adults over the age of 18 residing in the U.S. with a valid social security number, and our exclusion criteria was duplicate responses from a given IP address or incomplete survey responses. In total, we had 931 total respondents, predominantly age 25 to 60, and most of them were at least college educated. The majority were reasonably active, with 77 percent reporting exercising regularly, and over half reported frequent joint pain. 72 percent of these respondents believed that, or were familiar with stem cell therapies and orthopedics, and 84.5 percent believed that there's convincing evidence supporting their use. 65 percent believe that they are FDA regulated. And this is one of the take-home slides from this paper. The majority of patients, over 80 percent, believe that stem cells can alleviate joint pain from arthritis and alleviate pain from damaged or torn ligaments. And over half, 54.7 percent, believe that stem cells can cure arthritis. Stem cells were selected as the, were most commonly selected as the best perceived treatment for chronic degenerative joint and tendon disorders, and this was over 25 percent of the respondents. And this was over more common conservative or surgical options. We performed a multivariable logistic regression assessing for factors associated with this belief that stem cells are the best available treatment for chronic degenerative orthopedic conditions. And the factors that were associated with this belief were younger age, Medicare, Medicaid insurance status, annual income less than $30,000, and reported familiarity with stem cells. Research on the safety and effectiveness and doctor recommendation were some of the top reasons to receive stem cells. And 63 percent stated that they would consider stem cell therapies to treat joint and tendon disorders if their doctor recommended it, even if they were presented with evidence or lack of evidence supporting their effectiveness. High costs and potential side effects were the two largest deterrents to these therapies. As for the amount that they'd be willing to pay out of pocket, the majority said they would be willing to spend around $100,000 to $1,000 for these therapies. In conclusion, stem cells may be a treatment patients prefer when hoping to avoid surgery. Limited public understanding and misconceptions may contribute to unrealistic expectations and misinformed medical decisions regarding stem cell therapies and orthopedics. And patient education, expectation setting, and evidence transparency are paramount when counseling these patients that come to your office seeking these treatments. And thank you, everyone. That was great.

study

Arthroscopy Journal

stem cell therapies

joint and tendon disorders

public understanding