Stemcelldoc's Weblog

April 29, 2014

Successful Treatment of AVN of Femoral Head with Stem Cell Therapy

Avascular necrosis of the femoral head is bone death thought to arise from interruption of the blood supply.

Progression of the disease is characterized by flattening of the femoral head with eventual collapse of the hip joint.

Stem cell therapy is a non surgical option in the treatment of AVN of the femoral head.

MFH is a 50y/o active female initially evaluated at the Centeno-Schultz Clinic with ARCO stage 2 AVN of the femoral head.

On 4.2009 she underwent core decompression where bone marrow derived stem cells were injected directly into the area of necrosis.

Clinically patient has done extremely well as reflected in her 5 year follow up questionnaire which she permitted us to share.

Her hip x-rays demonstrate successful treatment of AVN with Regenexx treatment.  Note that the contour of the femoral head has not changed, flattened or collapsed.





April 21, 2014

ITB: Iliotibial Band Dysfunction and Treatment Options

At the Centeno-Schultz Clinic we approach pain and dysfunction in a systematic fashion which is outlined in Ortho 2.0.

We employ the acronym SANS:  symmetry, articulation, neurologic and stability.

This approach can be utilized for any joint.

The iliotibial band (ITB) is a fibrous band that extends from the hip (ilium) to the knee (tibia).

It is a critical in the stability of the hip and pelvis.

There are both anterior and posterior forces on the ITB.

Posteriorly it connects with the gluteus medius  muscle which when contracted pulls the ITB posteriorly.

Anteriorly the ITB connects with the tensor fasciae latae muscle which when contracted pulls the ITB anteriorly.


Biomechanics of ITB:  Supports and stabilizes the hip and pelvis when the opposite foot is suspended and off the floor such as when we are walking.

Lumbar spinal nerves provide essential information to the gluteus medius, tensor fasciae latae and other muscles that support the ITB.

Irritation or compression of lumbar nerves can result in a reduction in the nerve signal to the muscles and ensuing weakness.

This weakness can be witnessed on physical examination when the patient is asked to stand on one leg and the pelvis shifts.  Weakness in the ITB compromises the stability of the pelvis and hip with resultant shift of the pelvis as illustrated below.


ITB weakness



An excellent analysis and summary of the iliotibial band is presented below by Dr. Centeno.









April 10, 2014

Avascular Necrosis of Femoral Head: Stem Cell Treatment Options

Avascular necrosis (AVN) is bone death thought to arise from interruption of the blood supply.  The MRI below illustrates bone death (AVN) in the left hip characterized by irregular shape of the femoral head and dark black bone.  This is in contrast to the normal hip on the right.



Stem cell therapy is a non surgical option in the treatment of AVN of femoral head.

Core decompression is a x-ray guided procedure that places bone marrow derived stem cells directly into the area of necrosis.

Hernigou demonstrated the clinical efficacy of core decompression with bone marrow derived cells in the treatment of hip avascular necrosis.  534 patients with early stages of AVN were treated and best clinical outccomes were noted in patients without collapse of the femoral head (stage 3).

 Prior blog posts have discussed clincial successes.

Common causes of AVN include excessive alcohol, steroid use, trauma, vascular compression and chemotherapy.

Classical presentation involves the head of the femur, neck and talus and scaphoid.

Typically affects individuals between 30 and 50 years of age.

The two most commonly used classification system used are the Ficat andArlet Staging and ARCO staging.

AVN staging

A cardinal finding is the crescent sign which is seen on x-ray and refers to a linear area of subchondral lucency most frequently in the anterolateral aspect of the proximal femoral head.  The sign indicates a high likelihood of collapse.  The crescent sign is best seen in frog leg position (abduction).

crescent sign

Prognosis depends upon severity of the bone death.

Non surgical options utilizing bone marrow derived stem cells are available for patients with avascular necrosis at the Centeno-Schultz Clinic.

April 6, 2014

Treatment of Knee Arthritis Pain: Curcumin vs NSAID

At the Centeno-Schultz Clinic we understand the limitations, physical and emotional drain associated with pain.

Curcumin is an active ingredient in the Regenexx Advanced Stem Cell Support Formula.

It is an innovative formula of nutritional supplements that helps maintain and support normal joint health and functioning.  In Regenexx laboratory studies, the supplements within the formula helped to maintain the health of the cell environment and provide support for the joint’s natural cartilage growth (chondrogenesis) process.

What is Curcumin?


Curcumin an extract from the Indian spice tumeric.  Research has shown curcumin to modulate inflammation.

Is Curcumin as effective a Ibuprofen?


Kuptniratsaikul et al recently compared the efficacy and safety of Curcumin with Ibuprofen in patients with knee osteoarthritis.  In a multicenter study, 367 patients with knee osteoarthritis were randomized to receive 1,200 mg/day of ibuprofen or Curcuman extracts 1500mg/day for 4 weeks.  Curcumin was as effective as Ibuprofen in improving pain and function in patients with knee osteoarthritis.  While the number of adverse events was not different between the groups, there was a higher number of abdominal pain/discomfort in the ibuprofen group.

Are there other differences?


The chart below outlines the key differences.

NSAID have significant side effects which include reduced bone healing, increases in systematic inflammatory markers, increases in oxidative stress and increases in deadly heart attack risk by 200-300%.

Know the risks and natural alternatives for management and treatment of knee arthritis pain.



April 5, 2014

Saphenous Nerve Entrapment as a source of knee pain

At the Centeno-Schultz Clinic we acknowledge that there can be many causes of knee pain.

In our online book, Ortho 2.0 a systematic approach is discussed: SANS.

N references neurologic dysfunction.

Irritation or dysfunction of the saphenous nerve can be cause of knee pain.

The saphenous nerve is a pure sensory nerve compromised of fibers from L3 and L4.  The saphenous nerve is the longest branch of the femoral nerve.


femoral nerve division


Above the knee joint the infrapatellar branch arises whereas below the knee the medial crural cutaneous branch provide sensation to the front and medial aspect of the knee.

Dermatomes of Saphenous Nerve

A common site of entrapment is adductor (Hunter’s) canal which is an aponeurotic tunnel in the middle third of the thigh.  Adductor canal contains femoral artery, femoral vein and branches of the femoral nerve which include the saphenous nerve.

The Adductor canal has the following boundaries:

  • Anteriorly – Sartorius
  • Postermedially – adductor longus and adductor magnus
  • Laterally -vastus medialis
adductor canal

adductor canal


Ultrasound image of saphenous nerve in Adductor canal

saphenous nerve ultrasound image adductor canal

A systematic approach with diagnostic tools that include MSK ultrasound ensure maximal patient outcomes.  Treatment options of saphenous nerve irritation/entrapment include MSK ultrasound guided hydrodissection with platelet growth factors.

March 26, 2014

Common Causes of Chronic Knee Pain: A systematic Approach

At the Centen0-Schultz Clinic we utilize a comprehensive approach to patient care.    Our online ORTHO 2.0 discussess a systematic approach to common orthopedic conditions.

Don’t assume that loss of cartilage is the source of all knee pain.

Below is an infographic which outlines the common causes of knee pain.

Tendons:  patellar, distal quadriceps and pes anserine.

Spine:  Lumbar disc disease with compression of L5 and or S1 nerve root.

Peripheral nerves:  compression and or irritation of saphenous and tibial nerves.

Muscles:  Dysfunctional muscles resulting in weakness or imbalance.

Ligaments:  key stabilizers of the knee joint include the ACL, MCL and LCL.

Knee Joint:   medial and lateral meniscus

Bottom Line:  prior to undergoing any treatment ensure that the principal pain generator has been identified to maximize clinical results.





March 25, 2014

ACL Tear Stem Cell Study: Free Care for Those Who Meet Criteria and can Travel

tree with clouds

The Centeno-Schultz Clinic is a research based medical practice that acknowledges the importance of research.

Our publications to date are multiple and easily identified in the U.S. Library of Medicine.

Stem cell therapy is a successful alternative to traditional surgery in the treatment of ACL tears.

Successful cases of ACL repairs have been discussed in prior blogs with comparisons of pre and post MRI’s illustrating the healing afforded by autologous stem cell treatment.

Regenexx currently has an ACL stem cell study which is available for patients that qualify and can travel to our Broomfield clinic.

Full Inclusion criteria is listed on web site and includes:

  1. Physical examination consistent with lax ACL ligament (Anterior Drawer Test)
  2. Abnormal Telos Arthrometer measurement
  3.  Positive diagnostic MR imaging of the affected knee with at least 1/3 of the ACL ligament at any area along its length having high signal on MRI PDFS/Fat Sat images.

Exclusion criteria is also listed and includes:

  1.  A massive ACL tear or one that includes more than 2/3’rds of the ligament that’s retracted.
  2.  Previous surgery to the affected ACL
  3. Concomitant meniscus tear or cartilage injury that occurred at the same time as the as the ACL tear and which is considered a pain generator.

If you or family or friends are interested please contact us at 303 963-9528 or complete the Regenexx candidacy form.





March 17, 2014

Regenexx ACL Procedure Featured in Outside Magazine

outside magazine logo

Regenexx ACL procedure is dynamic new technology that enables a patient to use their own stem cells to heal ACL tears.  This procedure was featured in Outside Magazine.

Extreme skier and founder of DPS Ski, Stephan Drake, tore his ACL while skiing a steep face in Alaska.  He rejected surgical repair and opted for Regenexx ACL at the Centeno-Schultz Clinic in Colorado.

Regenexx ACL is a alternative to traditional knee surgery.  Bone marrow derived stem cells are injected under direct visualization into the ACL.  Patients are fitted with knee brace and undergo 4 weeks of physical therapy.

Complications of ACL surgeries have been discussed previously and include graft failure, infection and acceleration of arthritis.

Successful clinical cases with detailed pre and post treatment MRI’s outlining improvement have been presented in previous blogs.

It is a new day in orthopedic medicine with new opportunities.  Not long ago open heart surgery with bypass and coronary grafting was the standard of practice.  Then interventional cardiology with a new skill set including balloon angioplasty became the new standard of care making coronary bypass surgery a less prevalent and less attractive procedure.

March 3, 2014

Groin Pain: Consider Iliopsoas Tendinitis

At the Centeno-Schultz Clinic we acknowledge the pain and restriction in motion associated with groin pain.

Inflammation of the iliopsoas tendon can be a cause of groin and anterior hip pain.  Treatment options include prolotherapy and platelet rich plasma injections.

The psoas and iliacus muscle originate from the lumbar spine, converges to form the iliopsoas muscle and its tendon  attaches onto the lesser trochanter of the femur.

Iliopsoas Tendon

The musculotendinous junction can be found in a groove between the anterior inferior iliac spine and the iliopenctineal eminence.

Major causes of iliopsoas tendinitis are  trauma and overuse resulting from repetitive hip flexion.

In adolescents the combination of inflexible hip flexors and tightness of the iliopsoas muscle and tendon can lead to anterior pelvic tilt and increased stress on the lower lumbar discs and facets.

Groin or anterior thigh pain is a common presentation as illustrated below in red.

iliopsoas referral pain pattern

Physical examination may be significant for anterior pelvic tilt, tenderness of the iliopsoas tendon and a snapping hip sign.

At the Centeno-Schultz Clinic  a diagnostic ultrasound is utilized to confirm the diagnosis.  Below is an ultrasound image identifying the iliopsoas tendon and adjacent femoral artery.

Iliopsoas Tendon Ultrasound Image

March 2, 2014

Successful Repair of Anterior Cruciate Ligament Tear with Stem Cells

At the Centeno-Schultz Clinic we recognize that tears of the Anterior Cruciate Ligament (ACL) can be game changers.  Surgical repair is associated with significant complications which include infection, graft failure and alteration of biomechanics.  Many patients who undergo surgical repair do not return to high level competition.

Stem cell therapy is a viable alternative to traditional surgical repair.   The Regenecxx  SD procedure enables a patient to forgo surgery, the lengthy rehabilitation and utilize their own stem cells to heal tears in the ACL.

HK is a case in point.  He is a 44 y/o athletic weekend warrior who sustained a hyper-extension injury with near complete tear of the ACL.  He declined surgical repair and underwent Regenexx SD.  6 months post injection of his stem cells he had complete return to normal activities and sports.  His professional and scholastic endeavors delayed follow-up MRI which accounts for the gap in pre and post imaging.

Pre and post stem cell treatments are posted below.  The pre-injection images are on the left and the post injection images are on the right.  The first images are taken from the side (sagittal) whereas the second set are frontal (coronal).

The thigh bone is on top (femur) and the tibia is below.  The ACL stretches across the knee-joint and prevents excessive forward motion.  The ACL is outlined in dashed yellow lines.  On the pre-injection images note the disorganized quality of the ACL fibers and the disruption of the ACL towards the top.  On the post injection images the ACL fibers are well-organized, tight and uniform extending from the tibia to the femur.  The formal MRI report post stem cell injection notes no tear in the ACL which is consistent with HK’s clinical results.

Keel Successful ACL Stem Sag

Keel Successful ACL COR

In 2014 stem cell treatment is an alternative to traditional surgery for tears of the ACL.

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