In 2005, at the age of 32, then Los Angeles Angel Bartolo Colón won the American League Cy Young Award for best pitcher, one of professional baseball's top honors. He stumbled through subsequent seasons, however, after a series of rips and strains in the tendons and ligaments of his throwing arm, shoulder and back. In 2009 he all but quit baseball. Desperate to reclaim his career, Colón flew home to the Dominican Republic in 2010 for an experimental procedure not vetted or approved by the U.S. Food and Drug Administration. Doctors centrifuged samples of Colón's bone marrow and fat, skimmed off a slurry containing a particular kind of stem cell—immature, self-renewing cells that can turn into a variety of tissues—and injected it into his injured shoulder and elbow. Within months of the procedure the then 37-year-old Colón was once again pitching near the top of his game for the New York Yankees—commanding a 93-mile-per-hour fastball.

Whether the injected stem cells rejuvenated his arm is an open question. The fda and the International Society for Stem Cell Research warn that no rigorous studies have demonstrated that such treatments safely and effectively repair damaged connective tissue in people. The results of related animal studies, though promising, have raised more questions than answers. “The term ‘stem cell’ makes it sound cutting edge and exciting,” says Paul Knoepfler, a cell biologist at the University of California, Davis, who also writes frequently on policy surrounding stem cells. “But the role of these cells in sports medicine is essentially all hype.”

No matter, apparently, to the aging, injured athletes who have followed Colón's lead. Lefty pitcher C. J. Nitkowski, who underwent the same procedure in 2011, told readers of his personal blog that he did not mind the lack of carefully controlled research. “My attitude is I don't have the time to wait for the five- or 10-year study to come out,” the then 38-year-old relief pitcher wrote, “so I'm taking a chance now.” Besides, Nitkowski figured, even if the treatment did not work, any health risks ought to be slight because the cells involved were his own.

That might not be such a safe bet. Numerous studies suggest that Colón, Nitkowski and others trying untested stem cell treatments may be risking more than they think. Even a syringe of one's own stem cells taken from one part of the body and squirted into another “may multiply, form tumors, or may leave the site you put them in and migrate somewhere else” the fda warns on its Web site. More clinical research is needed to define safety procedures, as well as how many cells of which types and what other tissue factors produce the desired results. In some animal studies, for example, the regenerated tissue is not as strong or flexible as the original. In other cases, an overgrowth of scar tissue makes the injected tendon or ligament adhere to the overlying skin. By preventing different tissues from gracefully sliding past one another, these adhesions sometimes pull an even bigger tear in an already serious wound.

In addition, Knoepfler worries that high-profile sports testimonials by Colón, Nitkowski and others will encourage joggers with blown-out knees and the parents of sore-armed Little Leaguers to demand the procedure before it has been thoroughly tested. “When celebrities take to a new treatment, many other people follow suit,” he says. Such premature enthusiasm—or an unforeseen tragedy that results from proceeding too fast too soon—could also prevent serious researchers from getting funding to do the kinds of careful experiments that might eventually lead to safe and reliable treatments.

Seeds of Repair

The need for better ways to reknit damaged tendons and ligaments is painfully apparent to the roughly two million Americans in a given year who seek medical help for tears in their shoulder's rotator cuff, for example, or the 100,000 patients in the same year who undergo surgery in the U.S. to repair a ripped or ruptured anterior cruciate ligament (ACL) of the knee. Tendons and ligaments are tough, fibrous bands, made mostly of collagen, that anchor networks of muscles to a bone or link bones and cartilage across crucial joints. They lend strength, flexibility and stability to your daily twists and turns, whether you are rocketing a baseball across home plate or hefting a suitcase into an overhead bin. Once frayed or snapped, they can take many months or longer to mend—even with surgery.

5 Comments

1. 1. priddseren 04:17 PM 1/16/13

   So what. If an athlete is going to cheat and enhance his body with a variety of drugs or other methods involving chemistry, he deserves to suffer any consequences that result from it. If he doesnt want his body screwed up by steroids or drugs, then dont do it. There is no reason to have any sort of sympathy for these people if they do this to themselves. It doesnt matter what the coach is saying or whomever, it is not hard to figure out that sports success comes from training and if you go beyond that, it is going to cause problems.

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2. 2. SteveZit 06:10 PM 1/22/13

   Yeah... that's a dangerous game. You know what's more dangerous? CHESS!!! You don't get axed after injecting yourself with stem cells, do you? Chess, however, is a whole different story - http://sports-facts.top5.com/chess-kills!-unbelievable-causes-of-death-while-playing-chess/

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3. 3. CVJones 11:40 AM 1/24/13

   This article is irresponsibilty one-sided, parading a deceptive caution without stating the strong case for continuing use of stem cell therapies in cases where other techniques fail - short of surgery. It might be helpful, for example, to note that Dr. Tuan, quoted in the article is co-editor with Dr. O'Brien of an important new journal. Dr. O'Brien states that,
   
   "Stem cells have enormous potential for alleviating suffering for many diseases which currently have no effective therapy. The field has progressed to the clinic and it is important that this pathway is underpinned by excellent science and rigorous standards of clinical research. The journal provides an important avenue of publication in translational aspects of stem cell therapy spanning preclinical studies, clinical research and commercialization."
   
   
   Prof. Timothy O'Brien,
   Editor-in-Chief
   Stem Cell Research & Therapy
   
   Ms. Franklin also might be more helpful if she took the time to inquire into the "potential problems" of the standard therapies, to wit:
   
   Surgical Complications
   
   Knee replacement surgery is a major surgery and therefore has potential complications. The most common serious complications from this surgery are infection, wound healing problems, deep-vein thrombosis (DVT) and pulmonary embolism. Serious infections of the newly replaced joint can require additional surgery and even removal of the replacement joint. Even once these infections heal, they may result in damage to the new joint that leads to ongoing problems with pain and loosening of the joint. A study by Frosch showed that 23.6% knee replacement surgeries had some complication and that a revision operation was required in 5.6% of the cases. The most common complication in this study was delayed wound healing.
   
   Long Term Satisfaction
   
   Success rates of knee replacement surgery are usually measured by how many patients have revisions of the initial surgery. But many patients who have had joint replacement end up with joints that still cause them pain and problems, but live with the symptoms instead of having a revision surgery performed.
   
   Studies that have looked at patients' expectations for knee replacement surgery have found that patients expect to be pain free and have great mobility of their knee joint after surgery. They expect to be able to return to all their old activities at the level of participation they had before they began having knee problems.
   
   The reality is different than patient expect. A study by Mannion showed that 85% of patients expected to be pain-free after surgery, but only 43% were. 52% of patients expected to by unlimited in their usual activities, but only 20% actually were. When this group of patients was asked if they could go back in time and make the decision over again to do the surgery would they do it? - 73.9% said yes definitely, 18.9% said yes probably, 6.3% said no probably not, and 0.9% said no definitely not.
   
   Another study by Nilsdotter found that 98% of patients expected much less or less pain postoperatively. At 1 year, 93% were experiencing much less or less pain, but by 5 years only 63% were experiencing much less or less pain than before surgery. In this same group, 96% expected their daily activity function to be better and 72% expected their sports and recreation function to be better. Daily activity levels were better for 90% at one year and 61% at 5 years, while sports and recreation function was better for only 25% at 1 year and 32% at 5 years.
   
   Age also plays a role in functional results. A study by Elson and Brenkel showed that patients younger than 60 years old at the time of surgery were more than twice as likely to report poor pain scores at 5 years after the surgery as patient who were over 60 years old. A study by Singh found that patients younger than 60 years old were more likely to have moderate to severe pain 2 years after surgery than patients who were 61 to 70 years old.
   
   A study by Price in patients under 60 years old found the 12 year survival rate was 82% when you considered revision surgery a failure. But when you looked at functional outcome or pain as the endpoint, the survival rate at 12 years was only 59%.
   
   Obesity and Knee Replacement
   
   Obesity is a rising problem in the United States and the world. Patients who are obese put more stress on their knees and are more likely to have knee problems. Obesity creates several problems for patients who have knee replacement surgery. A study by Samson showed that obese patients have a higher rate of knee replacement surgical complications than non-obese patients. They found a 3 to 9 times higher rate of infection in the obese patients. Additionally, they found that although obese patients might expect that their mobility would increase after surgery and that therefore they might lose weight, in fact, these patients did not tend to lose weight after surgery thereby continuing to put additional stress on their new joint.
   
   Obese patients wear out their replacement joints more quickly and are more likely to need revision surgery. A study by Amin showed that obese patients had a higher risk of complications than non-obese patients (32% of patients compared to 0%) and a higher failure rate at 3 years (27.7% of patients compared to 2.4%). Another study by Vazquez-Vela Johnson looked at patients 10 years after surgery. The overall survival rate was 96.8% at 14 years. However, the worst performing groups was a group of obese men less than 60 years old who had a 10-year survival rate of only 35.7%.
   

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4. 4. stringingalongfunds 01:45 PM 4/4/13

   Untested??? The article is completely wrong with its facts. First of all, there have been US clinics that have published their findings with stem cell treatments since 2008, especially the treatments mentioned in this article. It is a legit medical procedure that helps repair many injured athletes. The author's due diligence on finding all the facts before writing this article is the only untested thing here.

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5. 5. lungieboy 07:42 AM 4/13/13

   Due diligence....it should be a crime when someone in authority or looked at with any level of experience writes an "article" claiming knowledge or authority and yet IGNORES the act of due diligence....use it next time and wipe the egg off your face now, author of this misleading article. Go to pubmed.gov type in adipose derived adult stem cells and see the THOUSANDS of studies being performed as we speak....oh yeah, remember this doc, as you probably think that our country is the first and best with tech & medicine...we are 27th in the world...so maybe get your info from the ones that are actually DOING, instead of parroting the words that others say from the articles you lift your words from...this article is likened to a game of "telephone"....the real message has become distorted.

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