Pain; It is the most common complaint that mankind has referred to for centuries, from healers, shaman priests to practitioners of modern medicine… In fact, the reason for the existence of pain is nothing more than an early warning. It can occur with the contact of a needle to our skin to protect it from it.
Sometimes it is too late, for example, when a decaying tooth causes pain, we may be too late. In the musculoskeletal system, pain may indicate a more severe situation, especially in the joints, rather than an early warning.
When the cause of joint pain is questioned, we think that cartilage and other intra-articular structures (meniscus and ligaments) are damaged by various diseases or trauma. Our body has the ability to repair damaged structures, but this is very limited for articular cartilage. The improvement in tissues such as joint cartilage and muscle is almost nonexistent compared to the regenerative ability of our skin.
Considering that pain is not a cause but a result, we can say that cartilage damage occurs with surface changes and decreased slipperiness as a result of poor healing. Joint attachment, restriction of movement and swelling are perceived as ordinary findings. However, the cause of joint damage is immediately eliminated.
should be removed, its recovery should be accelerated and its recurrence should be prevented.
If the joint damage is caused by a rheumatism, the primary approach is of course to try to stop or reduce the cartilage damage of the disease. If it occurred as a result of trauma and is above the body’s capacity to heal itself, it should be repaired immediately. Meniscus repair, removal of tears, correction of cartilage surfaces are possible with arthroscopy, which is the gold standard today. However, the issue of replacing cartilage is still fraught with technical difficulties.
The joint damaged by arthroscopy is largely ready to repair itself. Advanced arthroscopic surgery not only detects and repairs problems with high resolution cameras, but also enables cellular treatments.
For science that succeeded in replicating a sheep with “cloning = gene copying” that has emerged from fantasy novels in the last two decades, it has not yet been possible for every tissue to copy organs and tissues. Cartilage can be used in cellular treatments by being reproduced to a certain extent. In cellular treatments, tissue is obtained in two ways. The first method is to take a sample of the tissue and provide a suitable environment for proliferation. In this method, tissues that do not have the ability to reproduce, such as muscle and brain cells, cannot be produced. At the same time, it is not yet possible to produce some secreting specialized tissues and organs in this way. The second method is to produce cartilage by “differentiation from stem cells”, even in muscle tissues in highly specialized laboratories started to happen. Promising treatment is the way of using stem cells in treatment by differentiating them into tissues. Human-cloning production of human tissue is ethically prohibited worldwide. The world of science continues to work on the cloning of organs by establishing their ethical foundations.
Who can receive cellular therapy in joint diseases?
First of all, the person to be transferred should have full body functions that can heal himself. Cellular therapy applications for the elderly are limited compared to young people. In the area to be treated with cellular therapy, the disease must be terminated and sufficient nutrition must be available for the cells to heal to survive. Finally, the alignment and surface relationship of the joint should not be disturbed, cartilage losses should not be common.
The second issue is that the tissue to be transferred carries living cells capable of proliferation. The tissue must be undamaged and unaffected by the disease. In this respect, I think the difficulty of finding tissue that preserves vitality with the advancement of age will increase the importance of tissue banks. When tissues to be differentiated in stem cell banks are extremely expensive, it can be an economical solution.
The age limit can be considered as the average age of 50 while qualifying recovery capacity. If the loss of cartilage covers the entire surface, cellular therapy cannot be performed because its success decreases considerably. Surgery is much more than the treatment of surface cells in people with active rheumatic disease and deformed joints.
treatments are applied. These treatments can range from therapies that change the center of gravity to prosthetic surgeries.
If the patients undergoing cellular therapy meet the appropriate conditions during arthroscopy, the tissue sample is immediately taken and sent to the laboratory with a special carrier. The cells, whose suitability is tested in the laboratory, are put into production, made into tissue in a special carrier and made ready for transfer within 15 days. The treatment continues with the placement of the produced cartilage in the area where the cartilage is lost by re-operating the patients. This method, which is gradually spreading around the world, can be applied in selected centers in our country.
Cellular therapies, which are currently applicable, are to eliminate the consequences of diseases or traumas with complete cartilage loss on the joint surface. Instead of such treatments in superficial losses, arthroscopic applications are performed to increase the improvement of the existing tissue.
Arthroscopic examination is essential to determine the degree of cartilage loss and to determine the type of treatment. Since today’s advanced radiological imaging methods are not yet sufficient to determine the type of treatment, it is very difficult to understand without arthroscopy, even in patients selected for such a treatment option. This situation is a major disadvantage if patients refuse surgery as a treatment option.