Normal MRI: No therapy Indicated

 NG is a 34 y/o patient who presented with a 5 year history of left knee pain which was constant in duration, 3/10 in severity, progressive in nature localized principally at the knee cap and deep within the joint.  Her large German Shepard ran into her  left knee 5 year earlier which resulted in onset of severe pain.  Treatment included physical therapy, E-stimulation, steroid injections and one surgery( lateral release).  Surgery unfortunately increased her pain and frustration.  Postoperative MRI of the left knee was normal .   NG was informed that no more therapy was indicated.     

Physical examination was significant for tenderness along the patellar tendon, slight limp, muscle tightness in her lumbar spine and tenderness and pain with palpation of her sacro-illace jont.  Most significant however was the instability of her knee which her husband noted from across the room. The anterior cruciate ligamant(ACL),was very loose suggestive of a tear.  Review of the MRI demonstrated a chronic tear in the ACL.     

The anterior cruciate ligament is one of four major ligaments in the knee.  It originates from the back portion of the thigh bone( femur) and attaches to the front portion of the shin bone ( tibia). It prevents forward movement of the tibia in relation to the femur.  It provides critical stability to the  knee.  Tears of injury to the ACL result in instability of the joint with resultant pain.     

   

 

  

ACL: Thick Black Band

           

 

There is no substitute for a complete physical examination.  MRI’s alone can not make a diagnosis.  Putting the physical findings together with MRI results is the standard of care at The Centeno-Schultz Clinic.       

Utilizing a patient’s own stem cells, repair of a partial tear of the ACL is possible.  The Regenexx procedure affords patients the opportunity to use their own mesenchymal stem cells to treat common orthopedic conditions.

Is there a Cancer Risk with Stem Cell Therapy?

Mesenchymal stem cells can differentiate into many types of tissue including muscle, bone, cartilage and tendon.

Because mesnechymal stem cells are multipotent, there has been concern that implanted stem cells could form cancer cells.

Studies have demonstrated chromosomal abnormalities in mesenchymal stem cells that have been cultured for extended periods of time.  Other studies have demonstrated that mesnenchymal stem cells expanded  for less than 60 days poses no detectable risk of cell changes or cancer formation.

The critical question is whether mesenchymal stem cells are safe ?

Centeno et. a.l. have shown that they are safe.

Centeno, in a prospective study examined 227 patients and found no evidence of cancer formation at re-implantation site.  This finding is consistent with others who failed to find any evidence of cancer formation in mesenchymal stem cells culture expanded for limited periods.

Landmark study.  Stem cell therapy has a green light!

SAFE TO PROCEED

 

The Regenexx procedure utilizes minimally expanded autologous meenschymal stem cells to treat common orthopedic conditions.  This affords patients a non-surgical option with no extensive rehabilitation or the risks associated with anesthesia and surgery.

Abnormal Head Position with Neck and Shoulder Pain

Dystonia:  Abnormal muscle tone characterized by prolonged muscle contractions.

RV is 53 y/o patient with a 1.5 year history of left neck and shoulder pain which is constant in duration, 5/10 in severity, nonprogressive in nature localized exclusively on the left. Pain is throbbing in character, aggravated by extension and rotation to the right.  Patient has no significant past medical or surgical history and denies any trauma.  Patient had involuntary muscle contractions which pulled her head to the left making walking straight, operating a car and sleeping difficult.

 Treatment to date included chiropractic care, neurologic, orthopedic and physical medicine consultations.  The orthopedic surgeon diagnosed a tear in shoulder and recommended surgery.  The neurologist injected Botox repeatedly on both sides of her neck which resulted in head and neck weakness precipitating nausea.   Facet injections provided no significant relief.  MRI of the brain, cervical and thoracic spine were all normal except  mild degenerative changes at C5/6.

Physical examination was significant:   left rotation of head, downward  gaze , left shoulder and neck was tender to the touch with multiple muscle nodules.  Most striking was her right sternocleidomastoid muscle (SCM) which was contracted, thick and very painful.

Cervical Dystonia is a movement disorder in which sustained muscle contractions cause abnormal postures.

Insertion of several small needles (IMS) into the right SCM provided the patient with complete resolution of her left sided neck and shoulder pain along with a significant reduction in her involuntary head rotation. 

  Understanding the complexity of the musculoskeltal system is essential.  It was contraction of her RIGHT SCM which led to the left head rotation and stretch of left shoulder and neck muscles.  Injection of the left side, the side where the pain was would only have increased her head rotation and pain. 

The Centeno-Schultz Clinic is committed to the highest level of  diagnostic and regenerative medicine.

Achilles Tendon Pain Unresponsive to Therapy

EC is a 80 y/o patient referred for platlelet rich plasma (PRP) injections of his inflamed left Achilles tendon.  Patient was active with no significant past medical history.  He denied any traumatic injury but had a 6 month history of severe left Achilles pain which was constant in duration, 6/10 in severity and progressive.  Treatment to date included physical therapy, trial of non-steroidal anti-inflammatory mediations and massage.   PRP therapy was considedered due to patient’s failure to improve.

PRP therapy is the injection of a patients own platelets into the damaged/irritated tissue.  RPR therapy is aimed at accelerating the healing process. 

Physical examination was significant for the following:  reduced  flexion/extension of lumbar spine secondary to pain,   decreased sensation along the left big toe and outside aspect of foot, decreased strength of left big toe and significant muscle banding in both the back and leg.

 After the initial evaluation, an x-ray of the lumbar spine was obtained which was significant for instability of the several vertebral bodies(anterolisthesis) along with marked reduction in the disc height at L5/S1.

EC’s Achilles tendon problem was not responding to conventional therapy since no have bothered to look beyond the tendon itself.  He had irritation of the left L5 and S1 nerve root which required treatment in addition addressing the Achilles tendon inflammation.

Looking at the bigger picture is essential for maximal clinical outcomes.  This is the essential paradigm required as we move from joint replacement to joint restoration. Ortho 2.0 presents  four principal elements previously discussed.

This is the standard at Regenerative Sciences and  The Centeno-Schultz Clinic.

Ed underwent PRP therapy in addition to injection of platelet derived growth factors at the L5/S1 and S1 levels.  He had  reduction of his debilitating Achilles pain  and headed off to florida for the back nine. I will report back upon his return.

New Perspective: Ortho 2.0

Everyone told Christopher Columbus that the world was flat.   

 Friends told the Wright brothers that birds were the only creatures capable of flight.  

    

A paradigm shift was required.  This also applies to medicine. The time has come to focus not on joint replacement but on joint restoration and repair.     Dr. Centeno has termed this Ortho 2.o.   Ortho 2.0 has a bigger focus beyond just fixing one part of the musculoskeletal system (bone, joints, muscles, tendon, and ligaments).   When the focus shifts to repair, the amount one needs to know about the joint increases exponentially.  There are four principal elements which are addressed when evaluating a gvien joint: (S.A.N.A.)   

ORTHO 2.0 : S.A.N.A.

  S: stabilization   

A: articulation   

 N: neurologic   

 A: alignment   

 Injection of magic stem cells alone is not sufficient for joint restoration.  Multiple studies have shown that just injecting stem cells into a joint blindly is not that effective.  For the best clinical outcomes, each of the factors listed above must be evaluated and treated. At Regenerative Sciences and The Centeno-Schultz Clinic this is the standard.  Case examples utilizing the S.A.N.A. paradigm will be in future blogs.   

It is truly a new day:)    

Resolution of Thumb Pain with Stem Cell Therapy

LK is 60 y/o patient who presented with a 1 year history of bilateral thumb pain, constant in duration, 4/1o in severity, progressive in nature localized at the base of the thumb.  Pain was sharp and stabbing in character and preventing him from buttoning his shirt.  Prior therapies had included a trial of NSAID and chiropractic care.  MRI of the thumbs was significant for moderate to advanced arthritic changes at the base on the thumb(CMC joint).  LK was told that surgery was his only option:  fusion of one joint and tendon wrap at the other.  Both surgeries are significant with extensive rehabilitation and poor outcomes.

Patient elected to proceed with the Regenexx procedure which allowed him to use his own mesenchymal stem cells.  At six months post injection of his own stem cells,  LK reports a 90% reduction in pain and  increase in range of motion.  Friends and work associates have stopped asking him about his swollen thumbs.  Buttoning a shirt is no longer an issue.

 Through the use of his own stem cells, LK has had significant reduction in his thumb pain, increase his range of motion and avoided a significant surgery. The time has come to embrace joint restoration instead of all therapies directed at joint replacement.

Non-Surgical Options to Shoulder Osteoarthritis

JM is 47 y/o athletic patient who had a 1.5 year history of severe shoulder pain and restriction in movement.  He was unable to shave or lift objects from the kitchen cabinet with the affected arm.  MRI was significant for advanced osteoarthritis, degeneration of the labrum and tears in the rotator cuff.  Total joint replacement was the only option presented.  This is a major surgery with extensive rehabilitation and relatively poor outcomes.

Patient elected to undergo a non- surgical stem cell therapy:  the Regenexx procedure. The patient’s own stem cells (autologous) were injected into joint, labrum and rotator cuff tears.  Mesenchymal stem cells have significant repair and regeneration properties. JS made significant improvement after multiple sessions.    13 months after starting the Regenexx procedure, an MRI was obtained for comparison. The most striking changes are below.  The top picture show multiple tears in the supraspinatus tendon identified by the red arrows. The extensive light-colored areas in the tendon represent swelling and tears.  The bottom picture is significant.  It shows significant reduction in rotator cuff tendon swelling  as evidenced by the much improved dark-colored signal in the tendon which is identified by the yellow arrows.  The corresponds with JS’s clinical improvement.  JS was able to avoid a major surgery through the use of his own stem cells.

Surgical Complications: A Tale that is Seldom Told

Surgeries have risks.  Some are minor while others are major.  While we acknowledge that there are risks most believe it is not going to happen to them.

JM is a 55 y/o patient with long-standing left knee pain who underwent knee arthroscopy and micro-fracture 14 months ago.  She had no significant past medical and surgical history, did not take any medications and did not smoke or drink.  Despite her knee pain she exercised 2-3 time a week.

Micro-fracture: Surgically created holes into bone

The  knee surgery went well without any complications.   Seven days after the procedure JM had abrupt onset of shortness of breath with crushing chest pain.  She spent the next 10 days in the hospital where it was determined that multiple  clots had gone to her lungs (pulmonary embolism). The clots most likely originated from a leg vein but may have also have been from  fat dislodged from the bone during the micro fracture.   Long-term coumadin therapy was started which thins JM’s blood to prevent future pulmonary embolism.

Coumadin therapy places patients at an increased risk for bleeding.  Many medications increase coumadin levels which include NSAIDs, antidepressants(particularly the SSRI’s) and medications that induce the liver enzymes.  This further increases the risk of bleeding.  Coumadin therapy is a known factor associated with death and brain injury after falling.

Non-surgical options of many knee, hip and shoulder conditions include the use of stem cell therapy.

The Regenexx procedure allows patients the opportunity to use their own mesenchymal stem cells for common orthopedic conditions thereby eliminating the risks inherent with surgery and anesthesia.

Is Knee Arthroscopy Effective ?

Knee arthroscopy is a common orthopedic procedure.  It is estimated that 1 million arthroscopic knee surgeries are performed annually in this country.

Knee arthroscopy involves making a small incision into the knee-joint through which a small camera and surgical tools are inserted.

Various parts of the knee are visualized which include the meniscus, the cartilage and supporting ligaments.  When damage is noted the area can be debrided:  rough surfaces are made smooth.

This is a significant advancement from the open surgeries performed in the 1980’s.

Is knee arthroscopy effective?

A recent article in the New England Journal of Medicine demonstrated that knee arthroscopy for osteoarthritis  provided no additional benefit to optimized physical and medical therapy.

A non surgical alternative to treat common orthopedic conditions is the use of your own mesenchymal  stem cells. The  Regenexx procedure allows patients to use their own mesenchymal stem cells to treat many knee, hip and shoulder conditions.

Avascular Necrosis of Femoral Head

Avascular necrosis (also know as osteonecrosis)  is a disease in which bone death occurs.

While the exact cause is unknown there are known risk factors which include alcoholism, excessive steroid use, trauma and vascular compression.

Avascular  necrosis (AVN) primary affects shoulders, knees and hips with death of the bone.  In addition there is often degeneration of the joint articular surfaces which result in pain and restriction in range of motion.

The Regenexx procedure, which allows patients to use their stem cells has been used in the treatment of AVN of the hip. Instead of surgery patients had their own expanded mesenchymal stem cells into the area of necrosis in the bone via x-ray guidance.  The Regenexx procedure with much less downtime than even a surgical CORE decompression and certainly less invasive than a hip replacement surgery.

Preliminary review of the data was significant.  Of the 27 patients treated to date, 4 were lost to follow-up (couldn’t get outcome information), and 3 went on to hip replacements so their data was removed as any results might be due to the hip replacement.  All patients were between 3 months and more than a year out from their stem cell injection.  Of the 20 remaining patients, approximate mean reported improvement was 50%.  This data requires more work.   We will be examining outcomes with regard to the disease severity( ARCO grade I, II, III, IV).  More to follow.