At night I use my headlights to see the road.
At the Centeno-Schultz Clinic when injecting knees we use MSK ultrasound or x-ray or both.
Because it ensures that the medication, whether it be prolotherapy, PRP or autologous adult stem cells, gets to the intended target i.e knee joint, ligament or torn meniscus.
Is there a chance of failure if guidance is not used?
Yes. Jackson demonstrated that accurate needle placement into the knee joint space by an orthopedic surgeon varied from 71-93% depending upon the approach utilized. That means 7-29% of patients had injections into the anterior fat pad or subsynovial tissues where the likelihood of success is limited.
Does MSK ultrasound guidance make a difference?
In a recent study, Sibbitt demonstrated that the use of ultrasound guidance to inject arthritic knees resulted in a 48% reduction in pain from the procedure, 42% more reduction in knee pain, twice as many patients responded and the treatments lasted longer.
Bottom Line: Demand guidance be used on your next knee injection.
X-rays are able to directly visualize osseous features of osteoarthritis, including osteophytes (bone spurs), sclerosis, and subchondral cysts. They are used in clinical practice to confirm the diagnosis of osteoarthritis.
Osteoarthritis (OA) severity is commonly graded from x-rays using in the Kellgren and Lawrence scale as previously discussed.
MRIs of the knee provide much more detailed information including the quality of cartilage, meniscus integrity, presence or absence of meniscus tears, fluid collections and integrity of ligaments and tendons.
Do Kallegren-Lawrence scales correlate with findings on MRI?
Yes as evidenced by Agnesi’s article which demonstrated an inverse relationship between KL score and joint space width as measured on MRI. That is to say that as the osteoarthritis increases as reflected in a higher KL score the more advanced the degeneration in the joint.
Stem cell therapy is an non- surgical alternative for many knee conditions. Knee debridement suregery has been shown to be be no better than a placebo surgery. The larger the portion of the mensicus that is removed the greater the stress that is placed on the joint. The clinical success of patients who have undergone Regenexx-C, -AD and Regenexx SCP have been previously described. The use of expanded stem cells, Regenexx-C, has been demonstrated to be safe and not associated with the development of tumors. The Centeno-Schultz Clinic just published another study which tracked 339 patients for up to 4 years and involved 200 research MRI’s on 50 patients.
Bone morphogenetic proteins (BMP) are a group of growth factors that induce bone formation. Surgeons use BMP in spinal fusions reducing the need to use a patient’s own bone and the complications and pain associated with bone harvesting.
The use of BMP
in spine fusions increased from 0.69% in 2002 to 24.89% in 2006.
Is it safe?