I read with great interest the review written by Duncan Ackerman, MD, that detailed his problem in North Dakota with stem cell injection clinics (“North Dakota Community Challenges Selling of Nonautologous Stem Cell Injections,” AAOS Now, November 2018).

It should be noted that we cannot perform stem cell injections in the United States unless under a Food and Drug Administration protocol. The implication is that if you have a stem cell injection, you have isolated the “stem cell,” which is illegal.

What Dr. Ackerman is really referring to, which is a documented problem across the United States, is not stem cell injections but cell injections (with unsubstantiated claims). Cell injections from fat, bone marrow, blood, or even placenta all have viable cells, of which very few are stem cells. I refer you to a review article that my colleagues and I published in Arthroscopy, which demonstrates that adipose tissue contains as much as 20 percent stem cells. Placenta tissue, bone marrow, and blood all have a very small number of stem cells.

The importance of safety in Dr. Ackerman’s article is emphasized, which is terrific. Clinical efficacy, of course, is suggested, yet simply not proven to date.

C. Thomas Vangsness Jr, MD
Keck School of Medicine of the University of Southern California
Los Angeles

Reference

1. Vangsness CT Jr, Sternberg H, Harris L: Umbilical cord tissue offers the greatest number of harvestable mesenchymal stem cells for research and clinical application: a literature review of different harvest sites. Arthroscopy 2015;31:1836-43.