I’m a pretty practical guy. At the end of the day, I try and relate everything to the real world, as in medicine, it’s easy to get caught up in the “medical bubble.” What do I mean? To get too caught up in the business or science of medicine and forget about how medical decisions impact patients. In fact, I love a saying by Confucius that intersects with that concept: “Never use a cannon to kill a fly.” Today I was e-mailed by a European professional footballer who tore his ACL and was offered a same-day stem cell injection, but the procedure would be an ACL stem cell surgery to accomplish an injection? Huh?
We invented a procedure many years back that used a same-day stem cell injection to heal the knee ACL. The first times we tried injecting the torn ACL, it wasn’t a reliable procedure. By this, I mean that sometimes we would hit the ligament and sometimes it would be a miss. We tried it both with fluoroscopic and ultrasound guidance and decided that using the X-ray was a better way to go. We also tried using a min-arthroscopy procedure to guide the needle, but in the end, as our injection techniques using fluoroscopy got better and better, we didn’t need the surgical approach. In fact, it just added risk without adding benefit.
Why would an injection with X-ray be better than an ACL stem cell surgery? After all, since the ACL ligament stabilizes the knee and lives deep in the middle of the joint and it can be easily seen using arthroscopic knee surgery, shouldn’t this be better? The problem with injecting this ligament with surgical visualization is that you have no idea how the cells are spreading inside the ligament. However, with fluoroscopy, you can see the contrast dye spread through the ligament. Why is this critical?
Since we developed this procedure, we’ve treated more ACLs with stem cells than any other clinic on earth. We’ve also had a chance to compare the results of how the injection spreads through the ligament. When we see complete coverage to all of both parts of the ligament, we see better healing on MRIs and overall success after the procedure. Hence, having a way to document that the cells are hitting all areas is essential.
The professional football athlete (what we call soccer here in the U.S.) who contacted me was told by a clinic outside the U.S. that he was a candidate for ACL stem cell surgery to perform an “injection” where arthroscopic surgery would be used to guide the needle. I know the clinic that told him he was a candidate for that procedure. They do a good job, but in this area, they can’t match our experience level with this technique. Hence, I told this athlete to send me his MRI films. This is where what he was offered was very different from what we do in a Regenexx ACL procedure.
The upshot? You don’t need knee surgery to get your ACL injected! In fact, this will only add risk and reduce the overall quality of the injection. However, injecting this ligament without surgery is difficult to do properly. So if someone tells you they can do this without having taken the IOF training and passed that course, they’re not qualified to do the injection. Make sure your doctor is properly trained! And one more thing, never use a cannon to kill a fly!
About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…