How SCAARS works.

The reasoning behind SCAARS.

SCAARS stands for Stem Cell Augmented Articular Restoration Surgery. The name says what it is: articular restoration surgery, augmented with stem cells. It rests on four ideas:

1. In the joints SCAARS treats, the problem usually starts with the mechanics. Three mechanisms are behind many of the problems SCAARS is designed for. A ligament injury that does not heal well leaves the joint unstable; the joint then moves in ways it was not built for, and over time that instability damages the cartilage. Some people's long bones are slightly bowed or angled, from a young age or after an old injury; for years this causes no trouble, but with age the side of the joint that carries the extra load starts to wear first, and as that cartilage thins the angle increases: more load on a smaller area of contact. And a fracture that was not treated well heals out of position, with the same effect: the load falls where it should not, even though the X-ray shows the bone as healed. In each case the cartilage tends to wear first where the load is wrong, and in the early stages the rest of the joint may still be in good condition. The joints of a limb also work together, so a problem in one can change how the others are loaded. These principles are well established in orthopedics; Dr. Vega-Croker has worked with 3D reconstruction and 3D-printed models for training, and in selected cases uses 3D planning to study alignment and plan the correction.
2. Joint cartilage has little ability to heal itself. Joint cartilage has no blood supply and very few cells, and those cells cannot move into a defect to fill it, so damaged cartilage heals poorly. Some ligaments also heal slowly or incompletely. Bone, by contrast, has a good blood supply and usually heals well once it is fixed in the right position. A repair needs functional cells; SCAARS places donor cells where healing is poorest, to support the functional cells that remain near the lesion.
3. Cells need a corrected joint and a precise place. Cells injected into a joint that keeps overloading the same spot cannot correct that overload. Placed under direct vision in a lesion the surgery has prepared, and held there with a matrix, gel or membrane, they are meant to stay where they are needed, to support the healing of your own tissue. Whether, and how much, they add to the repair is still being studied.
4. Therefore one operation, for selected patients. Correct the mechanics, then add the cells, in the same procedure, for joints worth keeping. When the damage involves the whole joint, a replacement or a fusion is usually the better option.

This is the rationale of the method. It explains why SCAARS is surgery and not an injection, and why patient selection comes first. What the evidence supports, and what it does not yet, is set out further down this page.

Why millimeters matter.

The ankle shows the scale of the problem clearly. Its joint surfaces fit closely, so when the fibula, the thin bone on the outer side of the leg whose lower end forms the outer ankle, heals even slightly short or turned, the surfaces can stop meeting as they should: the same body weight can end up on a smaller area of cartilage, which can then wear faster. A standard X-ray shows that the bone has healed, but it can easily miss that it healed slightly short or rotated. The damage that follows is slow, and that is the window in which correcting the mechanics makes sense. If pain persists months after a fracture has healed, it is worth looking for its cause, mechanical or otherwise.

Step 1 · Assessment and planning

Everything starts with your diagnosis: what is damaged, what is still healthy, how the joint moves and carries load, and what you want to get back to. Dr. Vega-Croker can review your case first in a video consultation, and then in person, with examination and the imaging your case requires. When a fracture may have healed slightly short or rotated, the injured side is compared with the healthy side, on CT when needed, because a standard X-ray can miss it. In selected cases he plans the correction in 3D, measuring the difference between your two sides in millimeters and degrees before surgery.

This step also decides whether SCAARS is the right path. If the damage involves the whole joint, a replacement or a fusion is usually the better option, and you will hear that clearly.

Step 2 · Surgery corrects the mechanical problem

The operation depends on your case, within the five situations SCAARS is designed for:

• Ligament repair or reconstruction to restore stability to an unstable joint.
• Corrective osteotomy to realign a bone and move the load toward the healthier part of the joint.
• Reconstruction of injuries that healed in the wrong position, to restore alignment. Depending on the case, the bone, the joint surface or a ligament that did not heal is corrected, because each can damage the joint.
• Treatment of a cartilage defect: the damaged area is prepared and the healthy cartilage around it is protected.
• Surgical repair of selected muscle injuries.

Regions include: Knee · Ankle and foot · Shoulder · Hand · Elbow · Hip. Arthroscopic or open techniques are used depending on the problem.

Step 3 · Stem-cell augmentation, placed under direct vision

Once the mechanical problem is corrected, the cells are placed where the surgery has prepared the tissue. How this is done depends on the lesion:

• Part of the cells goes directly onto the injured tissue; depending on the case, part may also be left in the joint space.
• In cartilage defects, your own cartilage tissue, collected during the operation, is combined with the cells and a matrix that keeps them in place inside the defect.
• In other lesions, a gel or a collagen membrane is used, depending on the defect, to hold the cells where they are needed.

The purpose is to support the healing of your own tissue exactly where it is poorest. The cells do not replace the correction; they are added to it.

The cells: where they come from, their documentation and regulatory status

• Origin. Donor cells cultured from umbilical cord; these are the stem cells the name SCAARS refers to. They come from independent laboratories in Panama; imported products are also an option. There is no harvesting of cells from your own bone marrow or fat.
• Who provides them. You contract and pay for the cell product directly with an independent laboratory. Dr. Vega-Croker does not manufacture or sell it: he coordinates its use and performs the treatment. His professional fees are paid to him through the hospital's and the laboratory's charges. Your itemized estimate, before you travel, shows what you pay to the hospital and to the laboratory.
• Documentation. Each lot comes with the laboratory's documentation, which you can review on request: lot of origin, biological-safety test results, and cell count and quality.
• Regulatory status. Panama regulates the clinical use of human cells. Under its current rules, the only recognized clinical use of stem cells is blood-forming (hematopoietic) stem-cell transplantation, and other uses are considered investigational. The cell products used in SCAARS do not have a specific regulatory approval in Panama. In the United States, no umbilical-cord cell product is approved by the Food and Drug Administration for any joint, cartilage, ligament or muscle problem. In the absence of an approval, quality rests on the laboratory's own testing; its lot documentation gives you information and traceability, not an approval or a guarantee. Dr. Vega-Croker explains what this means for you before you decide.
• Risks of the cells. Donor cells carry risks of their own, in addition to those of the operation: pain and swelling from a reaction at the site, infection or contamination of the product, a reaction of your immune system to the donor cells, cells that move elsewhere or grow into unwanted tissue, including tumors, the possibility that they do not work at all, and long-term effects that are not yet fully known. Testing of each lot reduces some of these risks; it does not remove them.

What we know, and what we don't.

Most of the surgical part of SCAARS rests on established procedures: ligament repair and reconstruction, osteotomy and the correction of a malunion each have their own evidence and indications. The way cartilage defects are filled in SCAARS, with your own cartilage, donor cells and a matrix, is newer and less studied, and so is adding cells to a muscle repair. Evidence for stem-cell augmentation in orthopedics is still limited, and it differs from one cell type and one condition to another. There is no proof that the cells make cartilage grow back, or that they lower the chance of needing a replacement later.

Dr. Vega-Croker does not publish outcome statistics for SCAARS. What you can expect is a clear explanation of the purpose of each part of your operation, the evidence behind it, its uncertainties and risks, and the alternatives.

Recovery is part of the treatment.

Your recovery depends on the procedure, your health and your individual healing response; the cells are not expected to shorten it. A ligament repair, an osteotomy and a cartilage procedure each have their own period of protection, rehabilitation and milestones. Preserving your joint does not automatically mean a shorter recovery than a replacement, and some procedures need a long and disciplined rehabilitation.

Dr. Vega-Croker follows you in Panama during the days after surgery and then by teleconsultation once you are home. Before you book, discuss the expected length of your stay, when you are likely to be fit to fly, and what rehabilitation you will need in your home country.