Stemcelldoc's Weblog

October 2, 2013

Continued Success with ACL Tear Treated with Stem Cells

MM is a 16 y/o athlete who torn her ACL and declined surgical repair.  She opted for Regenexx SD where bone marrow derived stem cells along with platelets are utilized to repair injured tissue.

Regenexx SD has been used successfully in the treatment of ACL tears in other patients.

MM tore her ACL in 2.2013 while playing soccer and underwent stem cell treatment in march 2013.

MRI 3 months post Regenexx SD demonstrated improvement which corresponded with her signficant clinical improvement.

Patient underwent x-ray guided injection of cSCP as a booster in July 2013.

I recently reviewed new knee MRI which is 6 months post stem cell treatment.   It demonstrates continued improvement and healing.  Most importatly there is no ACL tear.  MM is now active and without pain or instability.

Below are the pre, 3 month and 6 month post Regenexx MRI’s.  Note the serial improvement in the ACL fibers which are outlined in yellow.

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Most recent MRI report demonstrates no ACL tear.

MM MRI report 2.

Congratulations to MM and her family who embraced stem cell therapy and avoided surgery.

September 15, 2013

Anterior Crucuiate Ligament Stability: Tests

At the Centeno-Schultz Clinic stability of a joint is critical.  It is one of the four cornerstone’s in our evaluation.

SANS

SANS-Infographic

Stability

Articulation

Neurologic

Symmetry

Laxity of the ACL of the knee is commonly associated with complaints of instability while walking on uneven surfaces and descending hills.

On physical examination there are two principal tests to determine ACL laxity.

lachman test

Lachman Test:  with the knee flexed at 30 degreees the examiner pulls on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur.

Anterior drawer sign:

MRI, CT and x-rays of the knee do not identify laxity as this is a finding on dynamic testing of the joint.

Instability of the ACL predisposes to meniscus, cartilage and ligament injury , damage and pain.

There is an association between ACL integrity and osteoarthritis.

Keegan that looked at MRI’s on about 300 patient with known knee arthritis and found that 1 in 6 had ACL ligament abnormalities.

Stein in another study demonstrated that about 14% of knee OA patients had ACL abnormalities on MRI.

Treatment options include prolotherapy, platelet lysate and bone marrow derived stem cells.

The problems associated with surgical repairs have been previously discussed.

ACL tears have been successfully treated without surgery utilizing Regenexx SD, a bone marrow derived same day stem cell treatment.

If you have had an injury and your knee feels unstable understand that non surgical treatment options and evaluation is available to at Centeno-Schultz Clinic.

Specialized doctor discusses tests to determine ACL laxity and non surgical treatment options.

June 15, 2013

Understanding Peroneal Nerve Entrapment: Lateral Knee Pain and Weakness

At the Centeno-Schultz Clinic identifying the source of your knee pain and weakness is critical. There are many causes of lateral knee and leg pain. Entrapment of the peroneal nerve as it crosses the fibular head is discussed below.

ANATOMY REVIEW
The sciatic nerve, largest nerve in the body divides into the tibial and common peroneal nerve just above the level of the knee-joint (popliteal fossa).

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The common peroneal nerve travels laterally and courses around the fibular neck and passes through an opening in the  peroneus longus muscle. This opening can be quite tough and can result in the nerve angulating through it at an acute angle.

common_peroneal_nerve_entrapment

PREVALANCE

Peroneal nerve injuries are the most common peripheral nerve injuries of the lower limb to result from multiple traumatic injuries.  While the nerve can be injured at any site along its path, most peroneal nerve injuries occur at the region of the fibular head.

COMMON CAUSES

Habitual leg crossing

Trauma

Prolonged squatting (strawberry picker’s palsy)

Knee dislocation

Total knee and hip replacement and arthroscopies

PRESENTATION

ALTERED GAIT secondary to weakness or paralyzed muscles that control ankle extension (ankle dorsiflexors).  This can result in foot drop foot where dorsiflexion of the foot is compromised and the foot drags during walking.

PAIN

LOSS OF SENSATION over the lateral knee and leg.

Peroneal Nerve Sensory Distribution

Peroneal Nerve Sensory Distribution

At the Centeno-Schultz Clinic MSK Ultrasound is an essential part of the diagnostic evaluation and allows for direct visualization of platelets and stem cells therapies.

Below is an ultrasound image of the common peroneal nerve at the level of the fibular head.  The nerve is seen on cross-section and identified by the white arrow.  fh=fibular head and lhg is lateral head of gastrocnemius, a major muscle in the calf.

common peroneal nerve ultrasound

Successful Treatment of Knee Osteoarthritis with Prolotherapy

The Centeno-Schultz Clinic offers a variety of non surgical regenerative therapies to treat spine, knee, hip and ankle pain.  The therapies include prolotherapy,  platelet rich plasma and  bone marrow derived stem cells. (Regenexx SD and Regenexx C).

needle injection

Prolotherapy is the injection of a hypertonic solution into a joint, tendon or ligament with the purpose of creating chemical micro-injury.  The micro-injury leads to inflammation and subsequent healing.    At the Centeno-Schultz Clinic prolotherapy is performed under the use of x-ray or MSK ultrasound guidance.

Does prolotherapy work?

Traditional medicine has been skeptical due to lack of good quality studies.

Rabago et al recently published the results of a randomized control study comparing saline injections and exercise to prolotherapy for knee osteoarthritis.’

Ninety patients with known knee osteoarthritis  were randomized to undergo injection therapy of either prolotherapy or saline or in -home exercise.  No baseline differences existed between groups.  At 52 weeks there were statistically differences in the pain scores.  Patients receiving  prolotherapy  improved more (P <.05) at 52 weeks than did  scores for patients receiving saline and exercise .  Patient satisfaction was also high with prolotherapy.

CONCLUSIONS Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.

Prolotherapy is an effective alternative to common steroid injections in the treatment of knee osteoarthritis.

April 15, 2013

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.

ACL Stem Cell Regeneration pre

ACL Stem Cell Regeneration Pre 2

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January 12, 2013

Platelet Rich Plasma vs Hyaluronic Acid Comparison for Knee Osteoarthritis

knee pain

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.

January 9, 2013

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.Posterior Cruciate Ligament injection.final

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

November 7, 2012

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.

May 6, 2012

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.

May 5, 2012

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.

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