Archive for the ‘Barbotage’ Category

Treating Ankle Arthritis with Stem Cells

Friday, August 12th, 2011

ankle stem cells

JM is a 41 year old WM from Europe who was seen in our Colorado clinic in July of last year seeking an ankle surgery alternative. His initial injury was a fracture of the talus bone (one of the major structural bones that makes up the big ankle joint). This fracture eventually lead to significant arthritis in the main ankle joint (tibio-talar). When he was first seen, he was diagnosed with significant impingement of the front of the ankle due to large bone spurs from the ankle arthritis. He also had significant tendon swelling from an overload of his tendons and a stretched ankle ligament. We knew that just throwing stem cells into his ankle joint wouldn’t solve the fact that big bone spurs in the front of the joint were preventing normal ankle motion and causing excessive forces in the ankle joint, nor would it solve his ankle tendon swelling or ligament instability. As a result, he was offered Barbotage, a procedure where we can remove bone spurs through a needle without the need for surgery. This procedure has much faster recovery time than traditional open surgery, as it’s simply a more complex injection. He underwent three Regenexx-SD stem cell injections into the large ankle joint and 2 of the Barbotage procedures. His recent e-mail to Dr. Hanson is below:

“I’d thought I’d give you a quick update on my ankle..

I’ve made significant improvement  over the last 3 months and am able now to participate in many of the sports that I was hoping for.  I’ve started windsurfing again (after a 2.5 year layoff), surfing and have also been skiing a couple of times.  My dorsiflexion is now way better than the neutral position I had prior to the treatment, Its taken quite a while for all the inflammation in ligaments and tendons around the front of my foot to reduce, but now it has and this has meant that my calf muscle has really developed which in turn has lead to further improvements.

I can run short distances but I’m trying to take it slowly so as soon as I have any swelling I back off on any activities.  I’m thrilled with the results especially as simple things (like walking!) are so much easier – I try and walk for 45 minutes each day, mostly on sand to keep the muscle mass building.”

What we think is important about JM’s story is that in order to help him, it was more than just placing “magic” stem cells somewhere in the vicinity of an ankle joint. Instead, we had to solve his tendon issues, take off his bone spurs, and ultimately place stem cells in the ankle joint under imaging guidance. Again, this is the an “Interventional Orthopedics” approach.

 

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New Study: Calcium Deposits in Shoulder Tendons can be Treated Effectively without Surgery

Saturday, February 12th, 2011

shoulder calcific tendonitis treatment avoid surgery

Calcific tendonitis means that your tendon has “dead” areas that have turned to bone. These calcium deposits in the tendon obviously make the tendon less compliant and more stiff. A tendon is the part of the muscle that attaches to bone and often acts like a rope going through a pulley or being pulled over a fixed point. Think about what would happen if you cemented portions of the normally supple rope so that they were stiff. As the rope was pulled through a pulley, it would more easily get stuck. This is what happens in calcific tendinitis. As a result, these areas of calcium deposits in the tendon can also cause irritation of the surrounding tissues which can cause pain and swelling. Traditionally, these areas have been cut out using open surgery, but this method is very invasive and has all the possible complications and side effects associated with a big shoulder surgery. A new study confirms what we’ve known for awhile, which is that a trained physician can get rid of these calcium deposits in the tendon with an ultrasound machine to guide a needle, rather than surgery. In this study, 34 shoulder tendons were treated and 6 other tendon areas. There was a reduction in the size of the calcium deposits on follow-up imaging and 80% of the patients had more than a 60% reduction in the size of their lesions. A very low complication rate was found and good clinical results. This technique is also known as “barotage” and can also be used to get rid of bone spurs through a needle. So for calcium deposits in your tendons, surgery doesn’t appear to be the best choice, instead using a needle to break-up and dissolve the area is likely a less invasive choice to help you avoid more invasive surgery.

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Getting Rid of a Bone Spur with a Needle

Friday, December 17th, 2010

Bone spurs come in two flavors, functional and non-functional. Despite this, many patients consider a “bone spur” a bad thing. Patients often believe that bone is like inanimate cement. However, it’s really more like living hard plastic. It responds to new forces placed on it. Bone spurs occur when the joint is unstable or a part of the joint needs “shoring up”. Two interesting examples are in the knee. When a patella (knee cap) is pulled too much to one side, the joint responds by adding new bone (essentially extending the joint out further in the that direction). We call this new area a “bone spur” but it’s really just a new part of the joint that’s been created through local stem cells. Another example is when the post-surgical meniscus starts spitting outside the joint and bone spurs are created out in that direction to take advantage of the new position of the meniscus. In both of these examples, these bone spurs are functional, because they allow the joint to work better.

Non-functional bone spurs can begin life as functional spurs, but at some point too much bone is laid down and this dramatically reduces the range of motion of a joint. Literally the new bone gets in the way of normal joint motion. These can be removed surgically, but did you know they can be removed through a needle? This new technique is called barbotage. The area is numbed and then a needle is placed under ultrasound guidance to break up the bone spur. The spur is then naturally reabsorbed by the body and the joint can now move freely. This is a great example of how stem cell therapy can be combined with advanced image guided needle techniques to help restore normal joint function. Here’s what a patient, about two months out from this treatment had to say:

Overall My ankle  feels much better. Range of motion – 20% better – Overall pain relief – 40% better.  Now I can stand for long periods of time (e.g. 2 hours) , whereas before I could only manage 30 mins max. I can also manage cycling (no pain) and some elliptical trainer (running machine work –approx 15 mins). I’m hoping for further improvements in the range of motion as the strength is (slowly) restored. Overall I’m very pleased with progress to date.

So, in this case, it appears that treatment of a non-functional bone spur can be performed without surgery and that this can improve range of motion and function. Since this was non-surgical, recovery time is also shorter.

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