“The first thing I think we need to do is be clear what we’re talking about when we’re saying stem cells, because people can get a little crazy when they hear the phrase ‘stem cell.'”
That’s how Dr. Riley Williams, orthopedic surgeon at the Hospital for Special Surgery (HSS) in New York and Medical Director for both the Brooklyn Nets (NBA) and New York Red Bulls (MLS), begins our phone conversation about the treatment that he has provided to professional athletes from a variety of sports over the last several years.
He’s right of course. The conversation surrounding the use of stem cells in medical procedures and research can often become contentious and devolve into a screaming match. However, Dr. Williams wants to be clear of the difference between the stem cells he uses and the ones that we typically associate with the phrase.
“A fertilized embryo is the ultimate stem cell. It is the cell from which all other tissues — muscle tissue, nerve tissue, bone — come from. What happens as we mature and get older and grow is certain cell lines develop that will control and make certain kinds of tissue,” said Dr. Williams. “Now, what we’re finding is that because methods are available to identify, via gene mapping and DNA analysis, cells that exist in our bodies now actually remain somewhat de-differentiated. In other words, they have potential to do more [outside of] the tissue in which they live.”
These are the cells that Dr. Williams has been using in his practice at HSS to treat athletes that present to him with joint inflammation or soft-tissue injuries, like hamstring strains, that can often sideline players for weeks. In particular, Dr. Williams has found that the human body has very high levels of stem cells stored in fat. These cells have various potential uses, and from Dr. Williams’ studies, he’s found that they can help resolve inflammation or irritation that an athlete experiences from their strenuous activities.
“Those cells are called pericytes. They live on the capillaries or blood vessels in the fat,” said Dr. Williams. “So, if you can access those cells, you can use those cells to do a few things. One is… to signal a joint or a tissue to heal more quickly. The second is to help the joint not be inflamed or irritated. And the final thing is cause the creation of new tissue.”
Now, take a moment to think of the typical NBA season. The regular-season schedule spans seven months, from mid-October to mid-April, with the potential for another month and a half of play if a player’s team advances to the NBA Finals in June. In that time, joint inflammation and soft-tissue injuries become fairly commonplace. In the past, those injuries would have been treated with rest and an anti-inflammatory medication like cortisone. But, since discovering the potential of these stem cells, Dr. Williams said that he has largely phased out his use of cortisone in treating those types of injuries.
“They (athletes) all understand the benefits of cortisone and, by and large, these biologics, both the stem cell and the platelet-rich plasma (PRP), have really significantly decreased my personal use of cortisone in these inflammatory circumstances, mainly because you get all of the benefit and none of the negatives,” said Dr. Williams. “It’s just your own cells, your own tissue that I’m minimally processing and putting into an area of need or injury.”
“Cortisone, basically what it does is just shut down all cellular activity temporarily which is why the inflammation goes down,” said Dr. Williams. “Think of it like throwing a little bit of water on a campfire. It may dampen it or put the flames down short-term, but ultimately, the embers are still there, they’re still going, and it rekindles. Cortisone, except for really isolated circumstances is really a stop-gap and can, negatively impact your ability to feel things, which could lead to more injuries.”
According to Dr. Williams’ observations and the data that he’s collected in treating players at HSS, the adipose treatment that he uses typically decreases the return-to-play timetable by about 30-40% in athletes that present with tendinitis or muscle strains.
How does it work? Well, according to Dr. Williams, it’s a fairly simple procedure that can be done in an office session.
“You lay a patient down, and the first needle goes in and you inject local anesthetic to numb up the belly area. Wait 15 minutes. Then you go back with the aspiration needle and basically suck out, typically, 70-90 CCs of fat,” said Dr. Williams. “Then, the fat is processed, usually by some sort of centrifugation or agitation. For example, one system is you shake the fat up in a sterile container with little marbles or ball-bearings. It breaks the fat up and you run it through a filter. The whole process takes about half an hour to 45 minutes between aspirating, processing and injecting.”
As with any medical treatment, there are certain situations that are more appropriate than others. By no means does Dr. Williams suggest this is some kind of cure-all. But, as the technology continues to advance, he hopes to continue to learn what works best and, eventually, make the treatment available to everyday athletes, not just professional athletes.
“Academically, it’s a windfall for me, because I have these guys come in that know about it, and I have the ability to not only do it, but to track it because of where I work and the kind of institution where I am,” said Dr. Williams. “I look at this as an opportunity to try to help define for the specialty what works best for the high-demand group (athletes). And then that can filter down to the rest of us every day athletes as well.”