Successful ACL Repair With Stem Cell Therapy

At the Centeno Schultz Clinic we have previously discussed treatment of anterior cruciate ligament (ACL) dysfunction.    Anterior cruciate tears have been successfully treated with stem cell therapy.

Below is another successful case of ACL repair utilizing stem cell therapy.  BT is an 18 y/o college football player who sustained an acute anterior ligament tear.  He declined surgical repair and underwent Regenexx SD with placement of his own stem cells into the ACL in November 2012.  Three months post injection a repeat MRI was performed at the same imaging center.  Below are the pre and post images of the ACL along with the MRI reports.

The ACL in the pre-procedure MRI is irregular and disorganized with a visible tear.  After Regenexx treatment the ACL fibers are uniform and well-organized.  The postprocedure MRI formal report notes ”previously described anterior cruciate ligament tear appears to have resolved”.

This corresponds to BT’s clinical presentation who describes no pain or swelling.  Regenexx SD enabled BT to avoid a major surgery and extensive rehabilitation.  A new option is now available for ACL dysfunction.

Successful Knee Stem Cell treatment for X-country Skier

Stem cell treatment is an alternative to traditional knee replacement surgery. The surgical complications associated with traditional knee surgery include:
A 25-31x increase in the risk of heart attack.
Blood clots in the legs or lungs or both
Infection
Wear particles.

HA is an active 62 y/o female who declined bilateral knee replacement as she was concerned about her ability to x-country ski.  She underwent Regenexx SD on   11.2012.  Additional therapies included IMS, ACL injection with Regenexx PL and injection of platelets into lumbar spine (Regenxx PL-Disc and Regenexx-DDD).

HA emailed me with updates which she has allowed me to share:

2.20.2013″ I’ve actually skied almost every weekend since early January, gradually increasing the length of time and level of difficulty.   My double knee stem cell procedure was on November 30, and it was my goal to be able to enjoy cross-country skiing again this winter.  I’ve had some minor swelling after a strenuous ski but no pain, and the swelling goes down by the next day”

3.24.2013  “Today’s ski was close to 3 hours of rigorous
skiing, up and down some big hills in NY’s
Adirondack mountains at the Garnet Hill cross-country ski area in North
River, NY.”

Stem cell therapy has enabled another patient to avoid surgery and return to their passion.

Successful ACL repair with Stem Cell Therapy

Tears of the Anterior Cruciate ligament (ACL) are game changers and often are repaired surgically. Surgical repair is associated with surgical risks and involves signficant rehabilitation and patience.  Stem cell therapy has been successfully used in the repair of ACL tears as previously blogged.

Another successful case is BT who is a 17 y/o collegiate football player who sustained a complete rupture of the ACL in November 2012. He declined surgical repair and underwent Regenexx SD in 11.2012. He is returning to clinic next week but he forwarded the new MRI report which is posted below. It reports repair of the ACL tear 3 months following stem cell therapy.  Stay tuned as I will post images next week.

Platelet Rich Plasma vs Hyaluronic Acid Comparison for Knee Osteoarthritis

At the Centeno-Schultz Clinic we acknowledge that knee pain can be debilitating and severely impact an active life style.

Stem cell treatment is an alternative to traditional knee surgery.

Hyaluronic acid (HA) is a thick liquid that helps lubricate the joints and is used routinely in the treatment of knee osteoarthritis.  Different brands of hyaluronan are available and include Euflexxa, Hyalgan and Orthovisc.

Platelet rich plasma is a concentration of a patient’s own platelets which can be used in treat degenerative knee disorders.  Many professional athletics have undergone PRP injections including, Hinds Ward and TigerWoods.

Is PRP better than HA for knee osteoarthritis?

 Cerza et al recently published such a study.   120 patients with knee osteoarthritis were divided into two equal groups and underwent weekly intra-artricular knee injections for 4 weeks.  One group received hyaluronic acid injections whereas the other group received platelet rich plasma.

Platelet rich plasma showed signficantly better clinical outcome compared to treatment with HA.  PRP was associated with a faster onset of relief that continued up to 24 weeks.  Unlike HA which had poor results with patients with advanced OA (LC 3) PRP showed no statistically signficant difference with varying severity of osteoarhtritis.

In 2013 when you doctor recommends a hyaluronic acid injection for your knee pain ask about the superior PRP alternative.

Posterior Cruciate Injection: Accurate Placement

At the Centeno-Schultz Clinic stability is critical as evidenced in our SANS approach: Stability, Articulation, Neurologic and Symmetry.  Joint stability is essential for optimal clinical outcomes.

Accurate needle placement is equally important and is accomplished through direct visualization either by MSK ultrasound or x-ray or both.

The posterior cruciate ligament is large ligament in the knee that provides restraining force to straight posterior translation of the tibia relative to femur.  It originates from  anterolateral aspect of the medial femoral condyle and attached onto the posterior tibia.
VM is a 32 y/o snowboarder seen in clinic today with knee instability and pain.  MRI was significant for partial tearing of the PCL and swelling at its tibial insertion.

Below is an x-ray image of the PCL injection.   A posterior approach was utilized.  The femoral nerve and vasculature was identified by MSK ultrasound.  Thereafter a 25 gauge need was advanced into the PCL at the tibial attachment.  A small amount of contrast was injected with filling of the PCL.

Patient hopes to return to riding soon and we are expecting snow this weekend.

Platelet Lumbar Epidural Gets Hiker Back onto Trails

At the Centeno-Schultz Clinic we acknowledge that low back and leg pain secondary to disc degeneration can be disability and severely restrict  one’s activity.

Regenexx PL has been used successfully in the treatment of back and leg pain.

PL denotes platelet lysate which is a process conducted at our state of the art lab.   The growth factors within the platelets are released from the cell membrane making them immediately available for healing.

Below is a recent clinical success utilizing platelet growth factors.

SF is 58 y/o hiker who presented to the Centeno-Schultz Clinic with 2.5 month history of right leg discomfort and weakness. Onset of symptoms was atraumatic and occurred while hiking. Weakness was constant and SF had difficulty with lifting his foot which made hiking difficult.

Initial treatment included oral steroids x 2 despite the side effects associated with steroids.

MRI of lumbar spine was signficant for broad-based right disc protrusion which displaced and flattened the right L5 nerve root.  This would explain his foot drop.

SF returned to clinic today after two x-ray guided Regenexx PL-M epidural injections.  He reports 90 % improvement in discomfort and 80% improvement in right leg weakness.  He avoided surgery and is now back on the trails hiking due to the benefits of platelet growth factors.

Shoulder injuries and Yoga: Things to know

During my New Year’s day practice I noted the absence of a favorite instructor.  She had suffered a shoulder injury last week. 

Injuries to the rotator cuff, labrum and shoulder ligaments can occur in yoga.  Upward-facing dog and downward dog are particularly stressful on the shoulder and can lead to inury.

I was surprised to learn that she had received a cortisone injection especially given the risks associated with steroids.

In 2013 the Centeno-Schultz Clinic provides some health guidelines for patients.

1) Know the source of your pain.  It is not enough to simply look at the MRI or x-ray.

2) Use diagnostic studies and physical examination to identity injuries.  Studies include but are not limited to x-ray, MSK ultrasound, MRI and CT.

3) All injections need to be performed with guidance.  At the Centeno-Schultz Clinic all injections are performed with either MSK ultrasound or x-ray.  This ensures accurate needle placement and best clinical outcomes. 

4) Avoid high dose steroids given their risks.

5) Consider regenerative therapies including platelets, prolotherapy and stem cells therapy.

6) Know that surgery may limit your future treatment options and advance the underlying condition.

7) Evaluate stability, articulation, neurologic and symmetry for maximum clinical outcome.

Lumbar Disc Surgery Update: Disappointing

At the Centeno-Schultz Clinic we acknowledge that ow back and leg pain secondary to lumbar disc disease can be disabling. Stem cell therapy is an alternative to traditional back surgery.

Regenexx PL-Disc utilizes platelet growth factors to enhance blood flow and reduce inflammation at affected disc level and adjacent nerve roots. 

PL stands for ‘Platelet Lysate”.  We take our novel Super Concentrated Platelet (SCP) mix and break open all of the platelets to get the growth factors out.  Why?  Just like an immediate release pill, it is sometimes better to have more growth factors available to help stimulate cells towards repair.  So while SCP is like a time released pill which releases growth factors slowly, PL is like an immediate release pill.  Our experience dating back to 2005 has demonstrated that PL works best around nerves.

Poor blood supply is at the heart of why many patients with chronically pinched low back nerves fail to heal.  Regenexx PL-Disc is an out-patient “walk-in/walk-out” injection procedure where patients can immediately return to activity as tolerated.  Blood is drawn from your arm, processed in our lab and the separated platelets are concentrated and injected into the lumbar spine. Unlike conventional PRP injections (platelet rich plasma) PL quickly accelerates stem cell growth. This is because all of the growth factors in the platelets become immediately available to the local stem cells.

Success to date:

http://www.regenexx.com/2011/02/regenexx-pl-disc-works-in-this-patient-when-steroid-epidurals-fail/

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Lumbar surgery has been utilized for the treatment of low back pain and sciatica.

Results?

http://www.regenexx.com/2012/12/epidural-steroid-injection-reviews-heres-a-patient-who-has-tried-both-steroids-and-using-his-own-growth-factors/

Jacobs et al conducted a systematic literature review on the effect of surgical techniques for sciatica due to disc herniation to update the Cochrane review of 2007. Sixteen studies were included: seven from the original review and nine additional studies.

No conclusions can be drawn with regard to the comparative efficacy of open, microscopic, and tubular discectomy surgical techniques to treat sciatica due to a herniated disc.   There was no clinically relevant superiority of either technique.

2013:  Patients beware.  Explore treatment recommendations and ensure that none limit future options.

Epidural Steroid Injections: Risks

At the Centeno-Schultz Clinic we acknowledge the pain, frustration and restriction in activity associated lumbar and cervical degenerative disc disease. Advanced treatment options include Regenexx PL where platelet growth factors are injected into the epidural space at the level of the degeneration or injury. The platelet growth factors increase the blood flow and increase inflammation.

High dose epidural steroids are utilized to treat lumbar and cervical disc disorders. Unfortunately the number of complications and risks associated with epidural steroids continues to increase.
Risks:
-significant bone loss

-suppression of hypothalamus-pituitary-adrenal (HPA) axis

-elevation of blood glucose in diabetic patients

-breakdown of  cartilage in animal studies

- ligament failure and breakdown.

In addition there is a signficant increase in the incidence of bone osteonecrosis in patients taking oral steroids.

In 2013 consider the risks associated with steroid injections and investigate the option of platelet derived growth factors.

Back and Leg Pain Regenerative Treatments: Platelets vs Steroids

At the Centeno-Schultz Clinic we acknowledge that lower back and leg pain can be debilitating.  Treatment options include epidural injections utilizing platelet growth factors (Regenexx PL-Disc) which are intended to increase blood blow and decrease inflammation.  Stem cell therapy is an alternative to low back surgery.

Our most recent data comparing the Regenexx PL-Disc procedure to traditional steroid epidural is shown below. The interesting points are that while 11 patients didn’t respond to steroid epidurals and switched over to the Regenexx-PL-Disc procedure, none switched the other way. In addition, note the dramatically higher increases in patient function with the Regenexx-PL-Disc.

Traditional steroid injections have signficant risks:

Increased risk of bone fracture

Changes in cortisol levels lasting weeks

Cause ligament breakdown and failure

Cartilage degeneration

Suppress stem cell function

Also alarming is the increase risk of osteonecrosis (bone death) associated with oral steroids.