Posts Tagged ‘didn’t work’

Knee Stem Cell Injection in a Cyclist and Runner with a Meniscus Deficient Knee with ACL Laxity

Monday, January 3rd, 2011

GK is a middle aged long distance runner and cyclist who had knee surgery several years ago to “repair” a meniscus tear. Regrettably there wasn’t much repair and the surgeon removed most of his remaining medial meniscus. As discussed in earlier posts, the removal of knee meniscus tissue during arthroscopy can lead to big problems down the road and an advancement in the pace of wear and tear arthritis. This left him with pain on running, cycling, going up/down stairs, and an inability to exercise at high levels. He sought our help for stem cell injections into the knee, hoping to rebuild the meniscus. While we informed GK that rebuilding his largely absent meniscus was highly unlikely with a stem cell injection, he also had an ACL ligament that was likely stretched at the same time as his knee meniscus was injured and chondromalacia under the knee cap. We felt that that the injection of stem cells using the Regenexx-SD procedure into the ACL may provide better tissue integrity for the ligament and better stability for the knee. In addition, using the same cells and injecting these under the knee cap may improve the overall health of this deteriorating cartilage. The patient underwent several injections of his own bone marrow aspirate derived stem cells into the ACL and patello-femoral joint using sophisticated imaging guidance to ensure that the cells were in the correct location, with his last on 11/17/10. Here’s is his report of progress to date:

While Dr. Centeno informed me that he couldn’t help me on the meniscus, since most of it had been removed, he was able to diagnose, and resolve other issues in my knee that were causing me pain.  I had significant laxity in my ACL, and cartilage issues on the back on my patella.  I’ve since undergone two stem cell treatments to address these two problems.  I had the last injection on 11/17.  I’m happy to report that my knee is doing GREAT.  Before the procedure, my knee felt completely unstable going down steps.  I also had significant pain cycling.   Now I’m able to do just about anything without any pain at all.  I’m absolutely thrilled with the results I’ve experienced.

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Regenexx-AD Fat Graft Survival

Monday, December 20th, 2010

Regenexx-AD is a procedure that uses fat and bone marrow stem cells for the treatment of an arthritic knee. Fat stem cells have been all the rage lately in cosmetics. One issue is that stem cells from fat dramatically under perform bone marrow or synovial stem cells for orthopedic purposes. As a result, the Regenexx-AD procedure allows us to use fat for where it performs the best: a structural graft.  The fact that it has stem cells embedded in it is a plus. For stem cell source, the Regenexx-AD procedure uses the same bone marrow aspirate source used in Regenexx-SD. Regenexx-AD involves taking a small fat sample from the side of the thigh and injecting that fat between a collateral ligament and the meniscus, to help prevent the meniscus from spitting out the side of the knee joint. This spitting knee meniscus syndrome is common after meniscus surgeries and has been discussed in earlier posts. However, does that fat graft survive? Above is an ultrasound picture of a fat graft one month out from injection, as the patient returned for his second procedure with Regenexx-SD (first procedure was Regenexx-AD to buttress this meniscus and prevent it from being spit out of the joint). It shows as marked, the fat graft still in place and the meniscus in better position inside the joint. The patient also reports significant improvement, all with a series of injections with minimal downtime, without the need for another knee surgery.

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Knee Surgery to Repair the Meniscus Shows High Failure Rate

Friday, December 17th, 2010

In a recently published study, where surgeons repaired a certain type of medial meniscus tear and then went back at a later time to look at the meniscus under arthroscopy, almost none of the repaired tears healed. This was despite many patients reporting relief. Why? A meniscus tear usually doesn’t heal well due to a poor blood supply. In addition, recent research shows that many meniscus tears may not even be the cause of pain. So in this study, the non-healing of the meniscus may have little to do with the patient’s resolution of pain, which may be due to the prolonged immobilization of the knee after surgery and the post-op rehab devoted to the knee. In addition, many medial knee pain syndromes may be due to other factors outside of the knee meniscus, such as: pes anserine bursitis, a loose MCL ligament, or trigger points in the quadriceps and other thigh muscles. The upshot of this study seems to be that getting a meniscus to heal with surgery is difficult and the patient’s report of relief after surgery may have little to do with meniscus healing. For those that have read Orthopedics 2.0, this may not come as a surprise.

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