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.

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.

Posterior Knee Pain: Popliteus Tendonitis

At the Centeno–Schultz Clinic we acknowledge that knee pain can be disabling. Knee pain can arise as result of loss of cartilage, ligament instability, meniscus degeneration or tears, bursa inflammation and tendon irritation. Stem cell therapy is a non surgical treatment option for many types of knee pain. At the Centeno –Schultz Clinic other treatment options include IMS, prolotherapy, Regenexx SCP and RegenexxPL.

All knee treatments utilize guidance in the form of MSK US and or x-ray to insure accurate needle placement.

Popliteus tendonitis can be a cause of posterior lateral knee pain.

The popliteus muscle originates from the lateral femoral condyle and the posterior horn of the lateral meniscus. The popliteus tendon runs deep to the LCL and passes through the hiatus to attach to the posterior surface of the tibia.

The popliteus muscle unlocks the knee in the standing or walking position whereby it rotates the tibia inward, pulls the lateral meniscus backwards and flexes the leg upon the thigh.

Popliteus tendonitis is common among runners and typically presents as pain in the posterior aspect of the knee.

Below are images of the popliteus tendon.

Meniscus Tears: Common Types

At the Centeno-Schultz Clinic we acknowledge that a meniscus tear can not only be painful but can also impact your game.  Non surgical treatment options are outlined in this video.

The clinical success of stem cell therapy in treating a torn meniscus has been discussed in prior blog.

Meniscus are semilunar shaped cartilage wedges that act as shock absorbers between the thigh (femur) and tibia (shin) bones.  Menisci are triangular shape in cross section. Each covers approximately two-thirds of the corresponding articular surface of the tibia.  There is a medial (inner) and (lateral) meniscus in each knee-joint.

Meniscus tears are noted by how they look and where the tear occurs.

Common tears include longitudinal, bucket handle, flap, transverse and torn horn which are illustrated below.

Posterior Calf Pain: Medial Gastrocnemius Injury

At the Centeno-Schultz Clinic we acknowledge that there are many sources of posterior calf pain.  Meniscus injuries, osteochondral defects and ACL tears have been previously discussed as a cause of knee and posterior calf pain.  Stem cell therapy is an alternative to traditional knee surgery.

The gastrocnemius muscle is a large muscle in the posterior calf and is commonly injured in sport activities such as hill running, jumping and tennis.  The condition is sometimes referred to as tennis leg and is more common in men than woman.  Mechanism of injury is typically  an acute, forceful push-off with the foot.  An audible pop is often heard and is accompanied by pain in the calf with radiations into the ankle and restriction in range of motion.

The gastrocnemius muscle has two heads which originate respectively from the medial and lateral condyle.  The  two heads join and then merge with the soleus muscle-tendon complex to form the Achilles tendon.

The principle actions of the gastrocnemius muscle are ankle plantar flexion and knee flexion.

At the Centeno-Schultz Clinic MSK ultrasound is available within the office for evaluation of injuries.  Below is an ultrasound image of the posterior knee.

Lateral Knee Pain: Iliotibial Band Syndrome

At the Centeno-Schultz Clinic we acknowledge that there are many causes of lateral knee pain.  An important case report was discussed in a previous blog.  Ortho 2.0 outlines the four key concepts: stabilization, articulation, neurological functions and alignment.

The iliotibial band (ITB) is a longitudinal fibrous reinforcement of one of the lateral leg muscles, the fascia lata.  It  originates from the anterior superior iliac spine region and extends down the lateral portion of the thigh to the knee.

Proximally it inserts into the lateral epicondyle of the femur and then passes to insert distally on the lateral aspect of tibia tubercle (gerdy’s tubercle).

When the knee is extended, the ITB is anterior to the lateral femoral condyle. When the knee is flexed the ITB is posterior to the lateral femoral condyle.

Actions of the iliotibial band include thigh flexion at the hip, abduction, medial rotation and  lateral stabilization the knee.

Iliotibial Band syndrome is an overuse phenomenon which is common in runners.  Typically pain occurs over lateral femoral epicondyle, which is caused by irritation and inflammation of the distal iliotibial band as it rubs against the lateral femoral condyle.

Differential diagnosis includes lateral meniscus tear,  popliteus,tendinitis, and patellofemoral pain syndrome.

The iliotibial band is a standard part of the diagnostic knee ultrasound conducted at the Centeno-Schultz Clinic.  In the ultrasound image below a normal  iliotibial band is identified by the white arrows.

Professional Athletes Taking Responsibility: Non surgical stem cell treatments

Average NFL career is 3.5 years.  An injury can end or significantly shorten a player’s career.  Surgery can also dramatically limit a player’s career.  Surgery all too often paints a patient into a corner form which they can not successfully rebound given the significant rehabilitation, down time, alternation of simple mechanics of the joint.

Jarvis Green, 2 time Super Bowl defense lineman knew first hand the limitations of surgery and its impact on his game.  After failed knee surgery and return of pain and restriction in range of motion he rejected surgery and opted for stem cell therapy utilizing the Regenexx C and SD procedure.

St Louis Cardinal’s Mark McCormick knows the limitations of surgery and acknowledges stem cells as an alternative to shoulder surgery.

Washington Redskins safety LaRon Landry suffered an Achilles tendon injury and has taken a similar path.   After undergoing team recommended PRP and shock wave therapy  Landry failed to fully recover.  The team  instructed him that” the best thing for me was to get open up and fully cut my Achilles and that’s a tough surgery as it takes a year and a half to heal”.  He rejected the extensive surgery and Redskins elected not to resign the defensive safety.  Ortho 2.0 discusses the importance of looking a stability, alignment and neurological function in treating an injury.

The list of professional athletes electing non-surgical stem cell treatments includes Tiger Woods,  Hines Ward,  Bartolo Colon and continues to grow.

Ortho Stem Cell Treatments: The Importance of Delivery

Stem cell therapy is a alternative to traditional orthopedic knee surgery.  Mesenchymal stem cells (MSC) can differentiate into cartilage, bone, tendon, ligament and disc.  Studies have demonstrated that the use of cultured expanded mesenchymal stem cells are both safe and effective in the treatment of knee osteoarthritis.

Does it matter how the stem cells are delivered to a targeted area?

In the case of soft tissue this is not a concern since the surrounding tissue will confine the spread of the stem cells to the targeted area.

In the case of a joint such as the knee the delivery of cells  is of critical significance. The key is that stem cell function through local attachment to the damaged site.  Animal studies have demonstrated that cells injected into a large joint often times have difficulty finding their way to the damaged area.

The key is delivering  stem cells directly into the damaged site.  Koga demonstrated this by comparing the results of blindly injecting stem cells into a joint vs dripping the cells directly into the damaged area.  The illustration below tells the story.  A defect in the cartilage was created and different methods of delivery were examined.  On the left there was minimal cartilage growth after the injection of saline.  In the middle there was minimal cartilage growth after blindly injecting stem cells into the joint. On the right where cells were injected directly into the area of damaged there was robust cartilage growth.  The new cartilage is purple in color.

Bottom Line:  The exact placement of stem cells within a joint is of critical importance.

At the Centeno-Schultz Clinic we utitlize x-ray and MSK ultrasound to guide bone marrow and platetlet derived stem cells into the  area of damaged tissue to maximize clinical outcomes.

Knee Replacement Complications

Stem cell therapy is an alternative to knee replacement.  Studies have documented the success and safety of using bone marrow derived cells in the treatment of knee osteoarthritis in patients who were candidates for knee replacement.  Many of the patients at the Centeno-Schultz Clinic are concerned about the risks of knee replacement.

Listed below are some of the risks which have been discussed in  previous blogs.

1)  44% of patient s/p knee replacement continue to have knee pain.

2)   1 in 10 patients who have a knee replacement suffer a serious complication.

3)    Blood clots and potential pulmonary embolism.

4)     Premature failure as noted in hip replacements.

5)      Alteration in gait, creation of new pain and degeneration when incorrect prosthesis size is utilized.

6)      1 in 10 continue to have knee cap (patella) pain.

7)      Post operative pain in patients s/p knee replacement may have pain originating from structures other than the knee

8)      Patients who smoke are at increased risk for complications and death.

9)      Association with wear particles.  Wear particles are microscopic pieces of metal, ceramic, or plastic that break off of from the knee replacement or hip prosthesis and irritate the local tissues and/or enter the bloodstream.

10)   Increase in serum metal ion levels.

11)   Increase risk of death after age 70  The odds of dying from the surgery are 4 times higher in patients aged 70-79 years old.

13)  Patella resurfacing does not improve outcome