Stem Cell Applications in Diabetic Charcot Foot and Ankle Reconstructive Surgery

Bone regeneration and repair via mesenchymal stem cells (MSC) are intriguing and challenging thoughts today. Many have claimed that MSCs are powerful tools for bone regeneration due to their ability to differentiate into osteoblasts. Seeking all three essential bone growth properties for successful bone remodeling and repair-osteoinductive, osteoconductive, and osteogenic-has been a complex task; however, they are essential in difficult surgical situations with poor host bone tissue. Diabetic Charcot foot and ankle neuroarthropathy is challenging due to its inherent poor bone quality and patient's comorbidities. In this review of diabetic Charcot patients who underwent reconstructive surgery with and without MSC grafting, the radiographic healing time parameter was most striking between groups, 6.4 versus 9.2 weeks (P < 0.024). In both groups, there were non-unions, mal-unions, and/or delayed unions noted. Surgical application of MSC appears to be safe, and has the potential to be effective as an autograft substitute, but remains inconclusive. In these limb salvage situations, reconstructive surgeries create challenging environment for bone growth and healing. The ability to utilize the properties of MSCs to differentiate into the type of specialized cells is promising; however, it still does not support substituting autografts as the gold standard.