Dr. James Andrews, the man who revolutionized orthopedic surgery, is pioneering U.S. research into the use of stem cells to treat not traditional sports ailments as well as, potentiallly, brain injuries. The promise is vast, but so are the questions still to be answered

GULF BREEZE, Fla. — To find the future of sports medicine, head to the Andrews Institute and inside the Athletic Performance & Research Pavilion, past the bespectacled, lab-coat wearing wooden pelican in the lobby. Take the elevator up one floor, turn right and traverse the long hallway. Don’t miss the sign—“Regenerative Medicine Center”—written in small letters on the door. That’s it. No blinking neon bat signal announcing: Behold, three rooms that could change sports!

Of the hundreds of doctors, therapists and clinicians who work for the renowned orthopedic surgeon Dr. James Andrews, only five know the code that opens the door. One is Adam Anz, a doctor whose angled face and long, brown hair suggest a swapped-at-birth Wilson brother who chose medicine over movies. He strides down the hallway, each step closer to the entrance and thus the future, glances left and right, then punches in the code.

Anz, 36, dons blue scrubs and tucks his wavy locks into a teal surgical cap before entering the most sterile of laboratories. He proceeds to the far back corner, where near the red can labeled “biohazard” there rests an oversized steel tub stamped ominously with “Liquid Nitrogen Vapor Freeze Freezer.” Anz opens the lid and wisps of white haze curl toward the ceiling. “Liquid nitrogen isn’t the safest thing in the world,” he says, as he reaches inside, grabbing containers filled with 40 small vials apiece. Each vial holds about four milliliters of stem cells and all their magical potential.

A quick science lesson: At a basic level, stem cells respond to stress and heal injuries. They’re the key to the human body’s internal repair system. They replenish adult tissues. How they work is so complex that doctors aren’t even exactly sure, but what’s important is that stem cells can monitor, respond, divide, heal and release other molecules to tell other cells how to help aid in in healing. Because they’re so adaptable—a five-tool cell—scientists think they’re capable of everything from regenerating cartilage, helping to fix torn ligaments and damaged rotator cuffs, to repairing traumatic brain injuries.

Adam Anz, M.D., retrieving cells from the liquid nitrogen vapor phase freezer in the Andrews Institute Regenerative Medicine Center. Tim Ludvigsen (Tim Ludvigsen Photography)

This hope carries widespread implications into the sports world. Fewer surgeries. Faster recovery times. Football and basketball players who return to action after torn ACLs in three to four months. Teams that harvest and bank stem cells from their players to treat injuries as they occur throughout seasons. Cartilage repaired before ligaments are fully torn. Partial tears that can be fixed without surgery.

That’s only one prong, for current athletes. Then there are possible stem cell therapies for former players: treatments that ease knee, hip, shoulder and joint damage; accelerate muscle repair; or counter early-onset dementia, brain damage, or strokes.

This lab exists for those reasons, so Anz can unlock the cells’ power to heal and apply those powers to injured athletes. As the liquid nitrogen swirls and evaporates around him, Anz stops, as if pondering the magnitude of what he says next, which is, “These technologies have the potential to impact everything we do.”

What’s possible? “No telling,” says Andrews, the most respected doctor in sports medicine, the preferred surgeon to star athletes. In fact, stem cell research reminds him of the last great invention in his field. The one he bet on more than 40 years ago.

Andrews, 74, reclines on the black leather couch in his VIP waiting room, underneath the framed and signed jersey from soccer goalkeeper Hope Solo that’s hanging on the wall. Clad in gray slacks, brown loafers and black socks, Andrews is on the telephone, only he doesn’t hold his cell to his ear but rather five inches from his face.

He’s advising a young basketball player on how to treat the swelling in his knee. Andrews suggests stem cell treatments to wrestle the inflammation under control before surgery. He would inject the cells into the knee itself, where they would flock to the injury and speed healing. Lately, Andrews finds himself making similar recommendations every week, if not every day.

He listens to the call on speaker and shouts back his recommendations, before kicking up those loafers. “Do you know what it reminds me of?” he asks.

Nearly half a century ago Andrews worked at a hospital in Columbus, Ga. He was certain that a relatively new invention, the arthroscope, would allow for minimally invasive orthopedic surgeries. His partner told Andrews he was wrong, describing the arthroscope as the “devil’s instrument.” Andrews had to leave for another hospital in order to perform arthroscopic surgery. Years later, his old partner sent over a patient and wanted Andrews to scope his knee. “I was right,” Andrews says. “He came around. That was the biggest revelation in sports medicine in the last 40 years.”

Dr. James Andrews. Nick Wass/AP

Andrews has spent those years fixing the knees, shoulders and elbows of famous athletes, everyone from Michael Jordan to Bo Jackson to the Manning brothers. In his world, everything connects. Patients to doctors. Ligaments to bones. Even great advancements in sports medicine.

He first met Anz in 2000, after Anz tore his left ACL on the basketball court. Anz’s father noted that his son was in medical school before Andrews performed the surgery. “Maybe one day he’ll work for you,” he told Andrews. Anz just laughed. He wanted to become a heart surgeon, or a neurosurgeon. Orthopedic surgery had never crossed his mind.

Had the stem cell therapies Anz studies existed then he might not have arthritis now. That doesn’t drive him as much as what’s possible. Since the advent of sports medicine, he says, orthopedic surgeons have served as carpenters, carving into knees, sewing ligaments back together, fixing bodies after they have broken. If stem cell therapy works the way he thinks it can, they will become more like gardeners—guiding healing, steering growth.

Andrews first considered the possibility of such treatments around 2000. But the available research and technology didn’t start to match his vision until about five years ago. Even now, he says stem cell researchers know about 10 percent of what they will know, in futures both near and distant.

Stem Cell Treatment: Out from the Shadows, Onto the Cutting Edge

Experts in stem cell research believe at least 50 countries are currently studying and developing treatment options, many at advanced levels far beyond what’s happening in the United States. Already, at the Andrews Institute alone, they’ve treated at least 200 athletes with their own stem cells. (In other countries, companies grow stem cells for treatments. Their process is more controversial and not yet allowed in the U.S.)

All of these implications come with a giant asterisk. Andrews must tell his patients stem cell treatments are approved only for clinical use in the U.S. The evidence backing their usefulness is largely anecdotal. They aren’t covered by insurance and haven’t been proven safe or effective, at least not by the FDA’s standards—yet. “The problem is the clinical use of new techniques, particularly with professional athletes, gets out in front of the actual research,” Andrews says. “Oh, they’re all asking about it. Pitchers come in here hoping to heal minor injuries without surgery. But we haven’t proven that. We can’t make false claims. But we’ve seen enough evidence anecdotally to feel like it’s justified to move forward.”

Don’t confuse that warning, though, with disbelief. Andrews opened the regenerative medicine center because he trusts in stem cells. But it’s not enough to simply think that. He has to know. He has to provide proof.

For the “most important revelation” since the arthroscope, Andrews took the opposite approach of his old partner. He staked the future of his institute on stem cell treatments. They link three men from Alabama. One is Anz. One is Andrews. The other is a Hall of Fame NFL quarterback.

As Bart Starr approached his 81st birthday, his health continued to deteriorate. On Sept. 2, 2014, the Packers legend had a stroke. On Sept. 7, he had another stroke, three seizures and a heart attack. Doctors, his wife, Cherry, says, “never expected him to live through the night.” He was bedridden for months, unable to speak.

The email that changed everything arrived that December. Jerry Kramer, Starr’s former Packers teammate, sent it to the general address on Starr’s website and addressed it to his son: “Hey Bart Jr. this is hard to believe but it is a chance . . . I know they are doing some incredible work. —Jerry”

Starr’s executive assistant, Leigh Ann Nelson, clicked on the link to a story from the San Diego Union-Tribune, which detailed (and questioned) the stem cell treatments that hockey great Gordie Howe had undergone in Mexico. Howe had traveled to Tijuana and been injected with two types of stem cells; one to repair the brain damage from a stroke and the other to improve the blood circulation in his brain. He walked to the bathroom that same week after not walking for months. He started eating more, talking more. He still suffered from dementia and died in 2016, but his family credited the treatments with extending his life and drastically improving the quality of his final years.

As Nelson read the story, tears streamed down her cheeks. The family was out of other options. One recent visitor had watched Bart and wondered aloud if his worsening condition was as “good as it’s going to get.” No, Nelson answered, emphatically. They were not giving up, even if the article seemed to her at first like “mad science.” Cherry pushed for research into stem cell treatment, which lasted for five months and included interviews with multiple clinics.

After his strokes and seizures, Bart Starr was wheelchair-bound and his family felt it was running out of options; a year later, after stem cell treatments, he celebrated with Brett Favre at Lambeau. Mike Roemer/AP

Andrews helped the Starrs research the clinic in Mexico and recommended that Bart try the treatment, where he would be injected with cultivated stem cells that aren’t available in the U.S. “There wasn’t any other hope for him,” Andrews says. Starr took a private flight to Mexico in June of 2015, underwent his first injection and three days later, back at the airport, announced “I don’t need a wheelchair” when boarding the plane home. He climbed the steps, with assistance. “Miraculous,” Cherry says.

Starr did three treatments between that June and last September. His family cared little about the skepticism cast his way from those who question what is called “medical tourism,” or seeking surgeries in other countries that aren’t available in the U.S. Beyond that, Starr was entering a clinical trial, set up by the Mexican government, that was based on anecdotal evidence and that charged patients to participate, all potential red flags.

Two weeks after his first treatment, Starr put his wheelchair back in the garage. Cherry hired a personal trainer and Starr started working out again. Much of his vocabulary returned with the help of a communications specialist Cherry hired. He broke his hip, and it healed in five weeks. The family hadn’t planned to use stem cell therapy for the fracture, but that’s how stem cells work. They go where they’re needed. They hone in on what hurts. No one can be sure the stem cells healed the hip but the Starrs believe they at least sped up the process. “Even the skeptics were like, Wow,” Nelson says.

Starr began to multitask in ways that seemed impossible before Mexico. He caught tennis balls while pedaling on exercise bikes and also threw them at moving targets with the accuracy of his playing days. He vacationed at the family’s beach house for the first time in years. “I’ve heard doctors say all this could have happened without stem cells,” Cherry says. “I don’t believe that. His brain damage was so severe.”

In November of 2015 the Packers retired the No. 4 jersey of Brett Favre, another Andrews client, in a Thanksgiving Day ceremony at Lambeau Field. Favre asked Starr to join him, and Starr felt well enough to travel. On game day he woke up to cold temps and steady rain, but when he arrived at the stadium the clouds parted. He hugged Favre. The crowd went crazy. “I’m absolutely sure he would not have been there if not for stem cells,” Cherry says.

While finishing his residency at Wake Forest in 2009, Anz stumbled upon a presentation from Dr. Khay Yong Saw, a guest lecturer from Malaysia who specialized in fixing torn cartilage using stem cell treatments. Since 2006, Saw had given patients hormones to boost the number of stem cells in their bloodstream, drawn their blood and then spun that blood in a centrifuge machine to separate out the good stuff—the actual cells. He then stored the cells at higher concentrations and injected them back into his patients at various points in their recovery.

Intrigued, Anz flew to Malaysia for three weeks that fall. Saw showed Anz how he wrapped repaired ligaments or patched rotator cuffs with a layer of stem cells, which honed to injuries like bees to honey. Anz asked his brother, a cancer doctor, if it was dangerous to purposely increase stem cells like that. No, his brother said. That’s what they do for cancer patients.

Saw applied his process to various injuries, across myriad sports. Two weeks before the 2012 Olympics, Malaysian badminton star Lee Chong Wei considered withdrawing due to patellar tendinitis. Saw injected the sore knee with stem cells and Wei won the silver medal.

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Similar interest boomed all over the world. Tennis star Rafael Nadal sought stem cell therapy. So did former Chiefs running back Jamaal Charles, Braves pitcher Bartolo Colon, Spurs forward Pau Gasol and Redskins tight end Jordan Reed. Retired quarterback Peyton Manning reportedly received stem cell injections in Europe for his injured neck in 2011.

Interest, as Andrews feared, sometimes outpaced the research. Most athletes he operates on ask if they should augment their surgeries with stem cell treatments. Often he answers yes. But even Andrews admits there’s so much they don’t know yet. Are the labs that grow stem cells outside the United States in higher volume better? Andrews and his colleagues are trying to find that out. They don’t know whether it’s best to remove stem cells from fat, bone marrow or the bloodstream; or even from placentas. They don’t know whether frequent, scheduled injections work better than random ones, and if so, how often they should inject. They don’t know if the body will accept cultivated stem cells rather than ones drawn from human bodies. Or how well those cells will integrate. They don’t know the full range of side effects. “That’s what the lab is for,” Andrews says. “Right now, we’re just guessing.”

They think, for instance, that one key to stem cell therapy is adherence to physical therapy after surgery. That moving a knee back and forth, say, will stimulate the stem cells, forcing them to respond to stress. They’re not sure how to do that. Again, yet.

The process is slow because FDA approval takes time. Most studies require a minimum of five years. To gain approval they must prove that these treatments are safe on animals, then that they’re safe on humans, then that they’re effective, that they do what the doctors intend for them to do, and that any doctor can do them with the proper training. Meanwhile the religious right has described stem cell research on human embryos as “destruction of human life.” In 2001, then-president George W. Bush restricted federal funding on such research, further slowing progress.

Anz cites one story in The New York Times last summer where a man went to Mexico for stem cell treatments and afterward developed a tumor in his spine. “We have to be careful,” Anz says. “If you watch the news, you’ll see these clinics popping up everywhere. No one’s really sure what they’re doing, or how they’re doing it, or if it’s safe. It’s basically the Wild West.”

The notes of caution often feel buried under the optimism inherent in the first few steps toward transformative change. “We used to think our immune system just fights infection,” Anz says. “Nuh-uh. Your immune system is a monitoring, response, repair, adaptation system. We’re not cars. We’re trees. We adapt to our environment.”

“The question with stem cells,” he continues, “is how can we manipulate that?”

Say the MRI of an 18-year-old basketball forward shows a hole in the cartilage of a knee ligament. Eventually that hole will widen and that ligament will tear. But maybe stem cell therapy, injected at regular intervals, would close the hole, naturally, via the player’s own cells. It’s like watering a lawn, only the doctors are growing cartilage instead of grass. The player wouldn’t need surgery. He wouldn’t develop arthritis the way that Anz did.

The implications, the potential, cannot be overstated. “The possibilities are endless,” Anz says. ACLs that bond in half the time . . . rotator cuffs that heal stronger . . . more durable repairs . . . and, at the more ambitious end, ligament tears injected with stem cells that heal on their own. How much more valuable would stars be if their recovery from injury was cut in half? Would teams employ stem cell therapists? Would stars get injections for maintenance? Would that be considered performance enhancing rather than preventive?

Anecdotal evidence suggests all of that is possible. Again, just anecdotal at this point. Manning Sumner, a former Auburn linebacker turned trainer to NFL and NBA stars, says he turned 40 earlier this year, but stem cell injections “make me feel like I’m 25.”

“Your complexion changes,” he says. “You look in the mirror and you’re kind of glowing. You just feel better when you get them.”

At the Andrews Institute, seven studies are underway. One seeks to prove that Saw’s results in Malaysia can be replicated elsewhere. Another examines how many stem cells can be harvested at the moment of injury, when they’re mobilized toward damaged joints. There are dozens of clinics studying the same therapies for hundreds of potential applications.

One implication that interests Anz is the Gordie Howe Initiative, launched by Howe’s family and ProMedica, a health care network of non-profit hospitals. They initially plan to study 30 patients who have suffered brain damage from sports, military service or car accidents, to see if stem cells can repair their brains. “There’s some very cool anecdotal evidence around stem cells and traumatic brain injuries,” Anz says. “Stem cells know how to hone. They’re looking to attach. There’s a study in Italy that found they had integrated with brain cells. They have that ability to adapt.”

He’s rolling now, inside this nondescript room near the vat of liquid nitrogen. Everything seems possible in that moment, in this laboratory, as Anz drops the magic vials back into the freezer for safekeeping. He’s not certain that his work here will change sports medicine. But if it does, he’s certain it will change sports.

Question or comment? Email us at talkback@themmqb.com.