Stemcelldoc's Weblog

March 10, 2009

Trendelenburg Test

trendelenburg-test1

Positive Trendelenburg Test with Weakness of Left Gluteal Muscles

The Trendelenburg test is a simple maneuver to evaluate the strength of the gluteus medius and gluteus minimus muscle.  It is performed by having the patient stand unassisted on one leg while the other leg is raised off the ground.  The examiner places their fingers on the posterior ilaic spine.  If there is a significant drop of the hip on the side of the raised leg,  their is weakness in the gluteus medius and minimus muscle.gluteal-muscles

The gluteus medius and mimus muscle are responsible for rotating the hip inward and extending it outward(abduction). 

They are critical in stabilizing the trunk and  keeping it in an upright position when one’s foot is raised while walking.

If there is weakness in the glueus medius and minimus there is structural instability with disproportionate forces placed on the hip and knee.  These forces can ultimately result in excessive wear of the joint cartilage and pain. knee-cartilage-22Often times surgery is the recommended therapy.

At the Centeno-Schultz Clinic we emphasis structural integrity.  If a patient has a positive Trendelenburg, they will be scheduled for therapy to restore gluteal strength which  typically is in the form of intramuscular stimulation(IMS).  If there has been hip or cartilage damage, a novel technique using your own stem cells can used to assist in the regeneration the cartilage.

March 5, 2009

New Knee Cartilage

The knee is covered with cartilage.

Normal and Damaged Knee Cartilage

Normal and Damaged Knee Cartilage

Cartilage is living material that produces glycosaminoglycans (GAG’s),  which allow for lubrication as well as holding onto water within the cartilage.

mogul-skiing

Bye, Bye Cartilage Cells

Maintenance of cartilage is a dynamic process.  Each time we cycle, ski the bumps or run, a number of cartilage cells perish.  The cells are then replaced by circulating mesenchymal stem cells which differentiate into new cartilage cells.  When the amount of damage exceeds repair, the cartilage starts to dry up and degenerate.  When the balance is reversed so that repair exceeds the damage, the cartilage remains healthy and full of GAG’s.  It is the balance that is key.  Unfortunately, all the issues regarding regeneration and degeneration of cartilage have yet to be fully understood.  What is known is that with age, the number of circulating repair cells (mesenchymal stem cells) decreases.

At Regenexx we attempt to restore a normal balance by injecting  autologous bone-marrow-derived mesenchymal stem cells into the area of damaged cartilage.  This is performed under x-ray guidance and a small needle.  Regenexx is unique in that we utilize a patient’s own stem cells, and therefore avoid the risk of disease transmission or rejection.  Unlike bone marrow aspirate concentrate therapies, we expand the number of mesenchymal stem cells so as to afford the patient the best outcome.

The MRI below outlines one of our recent knee successes.  This is a patient who had undergone microfracture surgery on her knee due to significant loss of cartilage, without success.  The top images are prior to the procedure,  bottom images are 16 months after therapy.  The red arrows identify breaks in the cartilage (white area in the gray cartilage).  The yellow arrows point to the areas of previous cartilage damage which have now been repaired.  Note the white areas which indicated cartilage damage have significantly resolved.  Clinically, the patient is now pain free and was last seen somewhere in Vail.

Knee Cartilage Before and After Regenexx Procedure

Knee Cartilage Before and After Regenexx Procedure

February 23, 2009

Administration of Stem Cells

Patients are becoming increasingly aware of the use of adult stem cells in the treatment of various disorders.  In a previous blog I have outlined the critical differences between allogenic adult stem cells and autologous stem cells where the former is associated  with a risk of disease transmission.

Another key issue to consider is the route of administration.  Some companies outside the United States are currently offering the intravenous delivery of adult stem cells for regenerative tissue therapy.

IV Infusion

IV Infusion

 How effective are these therapies?  Unfortunately,  Fischer et. al.  demonstrated that the majority of the administered stems cells failed to make to their targeted destination because they were trapped in the lung.  This is similar to the first-pass effect seen in drug delivery systems where a disproportionate amount of a drug is trapped as it passes through the liver.

A reliable stem cell delivery system is essential to the success of the stem cell therapy.  If you have a knee problem, for example,  you want the autologous stem cells injected directly into the area of damage.  At Regenexx, autologous mesenchymal stem cells are injected under fluoroscopic (x-ray) guidance to ensure accurate placement. 

Fluoroscopic assisted injection

Fluoroscopic assisted injection

 Regenexx enables a patient the opportunity to use their own stem cells to repair damaged tendons, ligaments and damaged cartilage surfaces via a needle-in, needle -out procedure, which  eliminates the risks associated with surgery and anesthesia.

February 19, 2009

Mesenchymal Stem Cells

There are various types of adult stem cells. The type of adult stem cells which are associated with tissue repair are called mesenchymal stem cell (MSC). These specific stem cells are capable of repairing damaged tendons, ligaments, intervertebral disc and fractured bones. There are two major sources of mesenchymal stem cells:  bone marrow derived and adipose (fat) derived.  Bone marrow stem cells are obtained via a needle which is inserted into iliac crest.  Adipose stem cells are typically collected during a liposuction.

Why is this important?  Bone marrow derived mesnechymal stem cells has been demonstrated to be superior in their ability to repair cartilage, tendon and ligament when compared to adipose derived cells.  Bunnell demonstrated  that  adipose stem cells are biologically similar, although not identical, to mesenchymal stem cells derived from the bone marrow. Vidal demonstrated that equine bone marrow derived mesenchymal stem cells have far greater regenerative properties for damaged cartilage than adipose derived cells.  Kisiday also demonstrated  that bone marrow derived mesenchymal stem cells have superior ability to repair and change into cartilage.

If you have an orthopedic condition and elect to use stem cell therapy, bone marrow derived stem cells offer the best success.  Regenexx exclusively utilizes autologous bone marrow derived mesenchymal stem cells  for damaged  ligaments, tendon, and cartilage.

February 18, 2009

Adult Stem Cells

Stem cell therapy and its applications continue to expand on a daily basis.  The use of your own  stem cells is termed autologous.  The use of someone else’s stem cells is termed allogenic.  Animal studies demonstrate a significant problem when utilizing allogenic therapy: the transmission of genetic diseases.

Ueda et. al.,  demonstrated that is was possible to give osteoporosis to a normal young mouse by implanting them with stem cells from an old mouse with osteoporosis.  This is very concerning and warrants caution when considering the use of allogenic stem cell therapy.  Until we understand all the complexities of genes, injecting stem cells and their inherent genes from one patient into another is a significant risk.

Regenexx utilizes a patients own stem cells and therefore there is no risk of transmission of disease.  Regenexx has demonstrated clinical successes in the treatment of lumbar disc bulges, tendon and ligament tears and healing of fractured bones.

stemcelltherapy.alogenicsetemcell.autologousstemcelltherapy.osteoporossistransmission.

February 15, 2009

Stem Cell Accountability

Human nature being what it is, there has been an unfortunate increase in the number stem cell therapies which are available and proclaim success  for a large number of disorders.  This has occurred domestically as well as internationally with hybrids  which recruit the patients here in the Unites States only to ship off the cells overseas.

In response, the International Society Stem Cell Researchers (ISSCR) has created a comprehensive set of guidelines for  stem cell therapy.  Patients and their physicians must be aware of these guidelines.  I will summarize two of the guidelines and comment how Regenexx has addressed the standard.

1)  Stem cells from other people (allogenic) are more risky and require closer monitoring.  Research would suggest that stem cells from a donor  may carry a  genetic disease transmission risk.  What does this mean?  Stem cells from one patient when used in another patient may transmit serious diseases.  In the animal model for example when a young mouse is injected with stem cells from a mouse with known osteoporosis, the younger mouse develops osteoporosis.   Regenexx acknowledges this significant risk and therefore only uses a patients own stem cells.  These  cells are referred to as autologous.

2)The use of animal components to grow stem cells must by replaced human components.  Stem cells are commonly cultured in Fetal Calf Serum (FCS).  There are multiple concerns with this practice including transmission  of infectious processes such as mad cow disease.  Fetal Calf Serum is not appropriate for human use.  Regenexx uses  a patient’s own blood to grown and expand their stem cells.  Regenexx has not and never will use fetal calf serum.

February 14, 2009

Adult Stem Cells

What are adult stem cells? They are cells within our body that can renew themselves and turn into other cells (differentiate).   Conceptually they can be thought of as the repairmen of the body. They live inside us in various tissues, poised to leap into action to repair damage as it occurs.  The problem is that as we age or get larger injuries,  our bodies are unable to recruit sufficient number of stem cells to fully  repair the area of damage.

There are many different types of adult stem cells but the most common are called hematopoetic stem cells.  What does this mean.  These are adult stem cells that will change (differentiate) into blood (hematopoetic)  products such as red blood cells or platelet.  Hematopoetic stem cells are easy to obtain from a peripheral blood or from bone marrow.  They are very plentiful in both blood and bone marrow. Unfortunately many ” stem cell therapies” are employing these hematopoetic stem cells due to the abundance and ease to access.  Such is the case with bone marrow aspirate concentrates which are bedside units that concentrate cells obtained from one’s bone marrow. 

Bone Marrow Aspirate Concentrate Unit

Bone Marrow Aspirate Concentrate Unit

 Unfortunately for patients, despite the advertised claims, these cells can only differentiate into blood products.

Stem cells associated with regeneration of damaged tendon, ligament, bone or disc are termed mesenchymal stem cell (MSC). 

Mesenchymal Stem Cell

Mesenchymal Stem Cell

 MSC’s can not be harvested from blood nor can they be obtained in clinically significant numbers from bedside bone marrow aspirate concentrates.  Herein lies the critical difference between current therapy and RegenexxRegenexx isolates MSC’s and then expands them so that you as a patient have the critical number of MSC’s to repair damaged tissue.  Regnexx uses your own stem cells and expands them for a variety of orthopedic aplications.

January 6, 2009

Torn Tendon In Foot

Torn tendons in foot are a common cause of pain and disability.

The Achilles tendon is a frequently torn tendon in foot.

The Achilles tendon is a thick band of fibrous tissue that connects the gastrocnemius muscle to the heel bone. It is the largest tendon in the human body. Contraction of the gastrocnemius muscle tighens the Achilles tendon thereby pulling the heel up. This allows you to point your foot and stand on your tiptoes.

achilles-tendon3

The Achilles tendon can weaken and become thin with age and lack of use which predisposes it to inflammation, tears or rupture. Disease states such as arthritis and diabetes along with medications including steroids can also weaken the tendon . The FDA has issued a warning about an increased risk of tendon tear and rupture with flouroquinolone antibiotics (such as Avalox, Cipro, Factive, Floxin, Levaquin, Noroxin and Proquin XR). Tendon inflammation (tendonitis) can arise from tendon injury or overuse and lead to a tear or rupture.

Treatment options typically are surgical which involve the inherent risks of surgery, anesthesia and the extensive and often painful rehabilitation. The surgery involves reattaching the torn or ruptured ends together which can result in a shortened tendon. Shortening of the tendon can significantly changes the bio mechanics of a patient thereby giving rise to other problems including ankle, knee and hip pain.

achillesrupture-repair

A novel concelpt is now available in which stem cells are utilized to repair the torn tendon in foot. Regenexx allows a patient to use their own stem cells to repair torn or damaged tendons and ligaments. No surgery or anesthesia is required. The procedure is a simple needle in, needle out process utilizing x-ray to accurately place the stem cells in the area of damage. Please click on the video to review one of our patients success using Regenexx stem cell therapy.

January 4, 2009

Open Knee Surgery Blogs

Open knee surgery blogs are common.

Open knee surgery blogs detail many issues including the reason for the surgery, the postoperative pain, the rehabilitation and the results.

Some blogs highlight the ” success” of surgical procedures on well known athletes such as Jordan Farmar and Tiger Woods.

While open knee surgery blogs are often times insightful they lack evidence based information. Rarely are peer reviewed articles are cited. The information can be incomplete or biased leaving readers with little or no meaningful information. Two cases in point. No knee surgery blog I read today mentioned that knee arthroscope was found to be no better than physical therapy in patients with osteoarthritis. Nor did I see any mention that meniscal tears are not by default painful and are seen with increasing age on MRI. Both articles were published in the New England Journal of Medicine.

Open knee surgery blogs often fail to mention alternatives. Cutting ones knee open, cutting ligaments and meniscus and sometimes placing artificial grafts or screws into the bone is a serious undertaking with inherent risks and pain.

knee_alignment-surgery

Regenexx offers patients an alternative. Utilizing your own stem cells, knee cartilage can be regenerated. Centeno published these results in a peer review journal. Stem cells can also be utilized to repair torn or damaged ligaments including the collateral ligaments and the cruciate. The procedure is does not require anesthesia or surgery. Rather it is a simple needle in, needle out procedure.Click here to see a video from a patient that underwent the Regenexx stem cell therapy.

open surgery blogs. knee arthroscopy alternative. meniscal tears. stem cell therapy for damaged knee cartilage. stem cell therapy for cartilage damage in knee.autologous stem cell therapy

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