Stemcelldoc's Weblog

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.

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March 12, 2014

Supercharged Platelet Rich Plasma

The Centeno-Schultz Clinic utilizes a special advanced platelet rich plasma (PRP).

The injection of platelet rich plasma is a successful treatment option for joint, tendon, ligament, muscle and joint injuries.  The concentrated blood platelets contains critical growth factors that increase the body’s ability to repair itself.

In most clinics and hospitals and clinics, PRP is created by a bedside centrifuge that separates the plasma and concentrates the platelets.  Bedside centrifuges typically create a PRP with platelet counts of 3-5 times the normal.  Unfortunately they also contain white and red  blood cells which can cause inflammation.

bedside

Are there differences in PRP treatments?

YES!

Regenexx has a superior PRP  called Regenexx SCP (Super Concentrated Platelets).  It is created by cell biologists in a state of the art laboratory and results in a 10-20 fold concentration of platelets.  Higher concentration of platelets has been shown to have a positive effect on the stem cells responsible for repairing damaged tissue.

White and red blood cells within platelet rich plasma can result in excessive inflammation, pain, restriction in range of motion and inhibition of  repair cells.

Bedside centrifuges are not adept at removing white and red blood cells whereas cell biologists at Regenexx are very capable of separating these cells. The image below demonstrates the cardinal difference.  The PRP on the left is red in color due to the red blood cells whereas the Regenexx SCP on the right is amber in color due to the successful removal of most red and white blood cells.

scp_vs_prp

PRP is an effective treatment of many ligament, tendon, joint and muscle injuries.  There are differences in platelet rich plasma concentrates.  Regenexx SCP which is produced in a state of the art lab by a cell biologists affords a much higher level of platelets with reduced red and white blood cell contaminates which ultimately results in  best possible outcomes.

March 9, 2014

Another Reason to Avoid NSAID: Delayed healing in rotator cuff after surgical repair

burning-flames-yellow-fire1

At the Centeno-Schultz Clinic we acknowledge the negative impact of NSAID on repair.

NSAID have been reported to affect bone metabolism,  fracture healing and increase the risk of sudden death heart attack.

Unfortunately NSAID medications continue to be prescribed for musculoskeletal pain including pain subsequent to surgical rotator cuff repair.

Does this medication make a difference in healing?

Checkik in a recent article examined the impact of NSAID on rotator cuff healing after surgical repair.  39 rates underwent rotator cuff injury and surgical repair.  Group A received meloxicam for the first 10 days whereas Group B recived meloxicam from postoperative day eleven.  Group C received saline injections.

Results:  Group B displayed lower maximal load which is consistent with delayed healing.

Bottom Line:  Avoid NSAID as they delay healing.

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.

February 21, 2014

Autologous, Allogenic and Artifical Stem Cells

Opening Flower Bud

At the Centeno Schultz Clinic we utilize a number of regenerative therapies which include bone marrow derived stem cells.

Regenexx utilizes a patient’s own bone marrow derived stem cells to treat common orthopedic conditions which include:

Knee osteoarthritis

Knee meniscus

Hip osteoarthritis

ACL injuries

Non-Union fractures of long bones.

Stem cells can be divided into two principal classes:  autologous vs allogenic.

Autologous cells are a patient’s own stem cells.  One individual is both  the donor and  the recipient

Allogenic cells are cells that are from someone else.

Artificial embryonic stem cells from natural cells are receiving increased attention.  There are two principal methods to create artificial stem cells:  IPSC(induced Pluripotent Stem Cells)  and STAP (Stimulus-Triggered Acquisition of Pluripotency) which are discussed in Dr. Cenento’s video.

January 29, 2014

Pitfalls of ACL surgical reconstruction: Consider Stem Cell Therapy

ACL tear illustration

At the Centeno-Schultz Clinic we understand that injury to the anterior cruciate ligament (ACL) can be a game changer.

Repair of anterior cruciate ligament (ACL) tears with stem cells  is an alternative to traditional surgery.

Regenexx SD utilizes a patient’s own stem cells to repair ACL injuries.  Case reports have demonstrated the successful repair of ACL injuries without surgery utilizing a patient’s own stem cells.

The anterior cruciate ligament is the most commonly injured ligament in the United States with a prevalence of 100, 000-200,000 case per year.  There are in excess of 150,000 ACL reconstructions performed per year.

A surgically repaired ACL is not like the original ACL.

What are the risks associated with surgical repair of ACL tears?

-Infection

Graft failure ranges from 3-27%.

Development of osteoarthritis ranges from 51-78%

-Failure to restore movement back to pre-injury baseline.

Increased cartilage load and higher risk of re-injury

-Significant postoperative physical therapy

Bottom Line:  Know that there are non operative options utilizing your own stem cells to repair ACL injuries.

January 26, 2014

Effect of Amide Local Anesthetics on Stem Cell Viability: Patient BEWARE !

At the Centeno-Schultz Clinic ongoing research and publication is a cornerstone of the practice.

Multiple articles have been published in peer-reviewed journals.

A new article just published examined the effect of amide type local anesthetics on human mesenchymal stem cell viability and adhesion.

Why?

cell death

Local anesthetic are commonly utilized in joint and injections.  Local anesthetics combined with high dose steroids are commonly injected into the joint.  The local anesthetic provides numbing which gives the patient several hours of pain relief.

Do the injected local anesthetics affect stem cells?

Four amide local anesthetics were examined in varying concentrations:  ropivacaine, lidocaine, bupivacaine and mepivacine.

Each anesthetic in different concentrations was incubated with human mesenchymal stem cells for 40 minutes, 120 minutes and 360 minutes and 24 hours.  Cell viability was assessed at each time point.

Conclusions

Extended treatment with local anesthetics for 24 hours or more had signficant impact on both stem cell viability and adhesion.

Stem cells treated with lidocaine, bupivacaine and mepivacine resulted in cell death via apopotosis after brief exposures.

Amide local anesthetics induce stem cells apoptosis(cell death) in a time and dose dependent manner.

Bottom Line

Patient beware!  Know that injected local anesthetics can negatively impact your repair cells.  If you medical provider wants to inject your joint ask why and with what acknowledging that your repair cells and cartilage are at risk of damage.

November 30, 2013

Another ACL Tear Successfully Treated With Stem Cells

The Centeno-Schultz Clinic has previously reported on the successful treatment of ACL tears with stem cell therapy.

Stem cell treatments are an alternative to traditional knee surgery.

S.D. is 38 y/o world-class extreme skier who sustained a complete tear of his ACL and declined surgery.  He underwent 5 prolotherapies in Mexico with minor improvement.

drake stephan

On 7.31.2013 S.D. underwent the Regenexx SD procedure where bone marrow derived cells were injected into the torn ACL.  Due to abnormal neurologic examination and history of intermittent lower back pain also underwent Regenexx PL-Disc where concentrated platelet growth factors were injected around the exiting spinal nerve roots and lumbar discs.

On 9.13.2013 S.D. underwent a booster injection with Regenexx cSCP  injected into the ACL under direct x-ray guidance.

A new MRI was recently performed approximately 4 months post stem cell therapy.

The pre and post treatment images are posted below.  The ACL is outlined in yellow.  Note that the ACL fibers are disorganized and loose in the pre treatment images whereas post treatment the ACL fibers are uniform and tightly organized.  This is consistent with his clinical progress as he reports a reduction in pain and increase in stability.  Muscle weakness remains an issue but is improving with MAT techniques.

Drake. ACL pre and post 2013.sagittal

Drake. ACL pre and post 2013.Coronal

Congratulations to SD who declined surgical repair and opted to utilize his own bone marrow stem cells to repair his torn ACL.  Updates to follow as snow continues to fall and the depth of the powder increases.

November 10, 2013

Suprascapular Nerve: A Key Player in Shoulder Function and Pain

At the Centeno-Schultz Clinic we understand shoulder pain.

Stem cell treatment is an alternative to traditional shoulder and rotator cuff surgery.

The suprascapular nerve is a key player in shoulder function and pain.

The suprascapular nerve is derived from upper trunk of brachial plexus typically C5 and C6.  It contains both motor and sensory components.  The sensory branches innervate the GH and AC joint whereas the motor branches innervates the supraspinatus and infraspinatus muscles

The suprascapular nerve runs lateral and beneath the trapezius and enters the supraspinous fossa through the suprascapular notch.  The suprascapular notch or referred to as the scapular notch is a notch in the superior border of the scapula through which the suprascapular nerve descends.  The supraspinous fossa is a concavity above the spine on the dorsal surface of the scapula that gives origin to the supraspinatus muscle.

supraspinus fossa

suprascapular nerve

MSK ultrasound is utilized to identify the nerve and any possible entrapment which can lead to pain and or weakness.

Suprascapular Nerve US. jpg

Sites of entrapment and clinical presentation will be discussed in future posts.

Ablation of the nerve utilizing radiofrequency has been described by Liliang as an effective treatment in the management of chronic shoulder pain.

Upshot:  the suprascapular nerve and its visualization is critical to the successful management of shoulder pain.

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