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Bone Marrow Concentrate for Arthritis; the potential benefits and risks
Posted in Hip Pain, knee, Osteoarthritis, Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on March 8, 2012
Musculoskeletal Care of the Mature Patient
The potential benefit of regenerative medicine is avoidance of orthopedic surgery. That’s the goal and I am the orthopedic surgeon leading the charge. I have spent several years now investigating, meeting, traveling, learning and preparing for that reality with the start-up anticipated in mid-April. While there is anecdote about subjective improvement following autologous, mesenchymal, Bone Marrow Concentrate derived stem cells for management of arthritis, there are no peer reviewed published long-term clinical outcomes to the best of my knowledge. There have been testimonials by orthopedic surgeons that following the adjunctive use of stem cells in conjunction with arthroscopic micro fracture of an arthritis knee, when the patient subsequently underwent knee replacement, hyaline cartilage was observed growing rather than fibro cartilage. This is not good enough for me, as I want a procedure that will postpone the need for a joint replacement or possibly eliminate that need. Is it a matter of when to intervene with regenerative medicine? When there is major deformity of an arthritic joint, significant alteration in function and a “bone on bone” X-ray, it probably is too late. Will regenerative medical intervention delay the joint replacement by a three to five year control of pain by the anti-inflammatory nature of bone marrow concentrate or will the joint cartilage actually re-grow? These are unanswered questions and what I seek to learn as I embark on my clinical project
Recently, the orthopedic surgical spine community became aware of a fourfold risk of cancer in patients who underwent spinal fusion using Bone Morphogenic Protein to increase the likelihood of successful fusion. As a result, attention quickly was redirected to stem cells as an adjunct in spinal surgery to replace human BMP. As of this writing, I have found no evidence of carcinogenesis in conjunction with autologous, mesenchymal Bone Marrow Aspirate Concentrated stem cells used in the skeleton and certainly not when used in a joint. The same might not be said when embryonic stem cells have been injected into the blood of patients to treat probably what shouldn’t be addressed with stem cells in the first place. Desperate people are not infrequently victims of charlatans as has been repeatedly pointed out on 60 Minutes. Contrast the risks of stem cell misdeeds with the benefits of scientific application. Today, the AMA News headline covered the potential for stem cells to eliminate the need for long-term anti-rejection pharmaceuticals in organ transplant recipients.
How to avoid orthopedic surgery by an orthopedic surgeon? Not just a mission statement by an ethos. Call to see if you are a candidate.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street, Chicago, Illinois 60610
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Surfing the Internet for stem cell updates
Posted in knee, Osteoarthritis, Stem Cells on February 29, 2012
The New York Times (2/27, A8, Wade, Subscription Publication) reports, “Researchers at Massachusetts General Hospital say they have extracted stem cells from human ovaries and made them generate egg cells.” The report, “if confirmed, might provide a new source of eggs for treating infertility, though scientists say it is far too early to tell if the work holds such promise.”
The AP (2/27) reports that lead researcher Jonathan Tilly of Massachusetts General Hospital “collaborated with scientists at Japan’s Saitama Medical University, who were freezing ovaries donated for research.”
Bloomberg News (2/27, Flinn) reports “stem cells from the ovaries were injected into human ovarian tissue that was then grafted under the skin of mice, which provided the blood supply that enabled growth.” In less than “two weeks, early stage human follicles with oocytes had formed.”
The Boston Globe (2/27, Johnson) reports, however, that “scientists not involved with the Mass. General research said such an approach – if it is even possible – sits far in the future and will require considerably more work.” A number of “scientists said Tilly, who cofounded a company focused on developing novel infertility treatments, had not yet made a convincing case that the stem cells he discovered can yield viable eggs, a critical first step.”
The Wall Street Journal (2/27, Naik, Subscription Publication) reports that the research, published in published in Nature Medicine, was funded by the National Institutes of Health, among others.
HealthDay (2/27, Goodwin) reports that although “it was long believed that women were born with a lifetime supply of eggs, which was depleted by menopause,” an increasing “body of research,” such as this study, “suggests egg production may continue into adulthood.” Also covering the story are MedPage Today (2/27, Bankhead) and WebMD (2/27, Goodman).
Regenexx Web Site KJ is in his late 70′s and was evaluated by us in 2008, after a lifetime of knee problems since a torn meniscus in the 1960′s. After multiple failed arthroscopic knee surgeries through the 2000′s, he was told he needed a knee replacement. His MRI showed complete loss of the meniscus in the left knee (which had been surgically removed in the 1960′s) and severe cartilage loss (bone on bone), so he was told that he was a fair-poor candidate for the procedure (his knee is featured in this prior blog post). He didn’t want a knee replacement, so he decided to give the procedure a try. We treated him with the Regenexx-C knee stem cell treatment as well as a barbotage procedure to remove bone spurs and some injections to tighten his very loose ACL knee ligament. His last update on how the knee did with stem cell treatment is here. I examined him today, more than 2.5 years after his knee stem cell injection and his knee still feels great. He walks several miles a day, climbs ladders and stairs, and works on home improvement projects, all without significant pain other than mild stiffness now and then. His exam showed no significant tenderness or swelling. Looks like KJ was able to dodge the knee replacement bullet long-term because of an injection of his own stem cells and an Interventional Orthopedics approach
I am off to Regenexx on Friday.
Hand Surgery Alternative for Arthritis and Injury
Posted in Hand, Osteoarthritis on February 21, 2012
I have recently seen an increasing number of patients with altered function of their hands because of pain or reduced range of motion due to common injuries, overuse, basal joint arthritis/osteoarthritis, or other degenerative problems.
Thumb arthritis (or basal joint arthritis) can appear early in life. Because of the constant swiveling and pivoting motions of the basal joint–the joint at the base of the thumb, or thumb CMC (carpometacarpal) joint–the thumb joint tends to wear out easily. Basal joint arthritis is also common in people who have osteoarthritis. As well, tendinitis in the wrist and hand is rampant because of over use of the computer mouse and improper ergonomics.
One way to treat the arthritic condition is with total joint reconstruction surgery. Perhaps over use syndromes may be reduced via voice recognition software but I personally still need to edit and then correct about 15% of my dictations. While surgery may improve the condition for some, this is not the case for all. New problems in the thumb joint may redevelop over time, causing such symptoms as numbness or tenderness. Then there is amazing increase in the occurrence of trigger finger and De Quervains Disease; both which lend themselves to ultrasound guided injection.
A reasonably successful approach to all of these wrist and hand problems is to start with an ultrasound guided intraarticular cortisone injection. Should the latter be of short-term relief, then platelet rich plasma may be successful for a longer period. Before considering the surgical alternative, be aware that Regenexx has published the outcome of 6 patients who were just under a year out (11.3 months) from treatment with their own stem cells 83.4% of thumb patients are reporting greater than 50% improvement after a simple injection of their own stem cells, 66.7% of thumb patients are reporting greater than 75% improvement and the average change is 70% improved. No significant complications in this group were reported.
If you have pain in your hand or wrist, start with a change in the ergonomics in your work place. Most office suppliers have the necessary mechanical devices available. The next step is an arthritic glove available in most large drug stores. If unsuccessful, the next step is an ultrasound guided injection of cortisone, platelet rich plasma and then stem cells in that order when all else fails.
Mitchell B. Sheinkop, M.D.
847-390-7666
1565 N. LaSalle Street, Chicago, Illinois 60622
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Stem Cells and the Lawsuit That May Shape Our Medical Future
Posted in Stem Cells on February 14, 2012
Musculoskeletal Care of the Mature Patient
Forbes , 02/10/2012 Gergana Koleva
Regenerative Sciences, a medical company that pioneered a procedure to treat orthopedic injuries using patients’ own stem cells, is fighting the Food and Drug Administration tooth and nail over a claim that human cells should be federally regulated as drugs, in a landmark case that has far-reaching implications for the future of regenerative medicine.
At the heart of the debate is a therapy that uses stem cells derived from bone marrow to repair damaged joints. It was developed in 2005 by the Colorado-based company, which began offering it to patients around 2007, and has since gathered a raft of clinical evidence and testimony about its safety and efficacy. The FDA is questioning its legality, alleging that the stem cells it uses are more than minimally manipulated drugs and should be regulated and subject to approval as drugs. In 2008, the agency accused Regenerative of practicing medicine without a license required for the introduction of a new drug, and in 2010 sued to stop it from performing the procedure.
Despite the controversy, a number of clinics from coast to coast have licensed their physicians as recently as last month to provide the cell therapy, called Regenexx. This has led to renewed interest by consumers and would-be patients, and prompted the company to publish a sharply worded blog post on its website condemning the FDA’s reasoning.
The lawsuit is “concerning for every American who considers their body not to be an FDA regulated drug factory,” the blog says.
While the treatment that is the focus of the lawsuit is not used for life-threatening injuries, the company claims this case goes beyond a particular procedure to shed light on a misguided push by the FDA to establish authority over aspects of medicine never allowed it by Congress.
Regenexx works by taking a blood sample and a bone marrow sample from a patient and separating out the stem cells via centrifuge, then re-injecting those cells directly into the injured area, where they assimilate into the bone or cartilage and begin to regenerate it. Physicians for the company have shown in clinical studies cataloged at the U.S. National Library of Medicine that the therapy produces fewer and less severe complications than the more invasive and costlier surgical procedures it helps many patients avoid.
You may read the entire article on the Forbes web site. On March 2, I will be visiting Regenexx to explore my joining their network of physicians using stem cells.
An experimental treatment offered for sale is not the same as a clinical trial.
Posted in knee, Osteoarthritis, Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on February 6, 2012
Musculoskeletal Care of the Mature Athlete
As I move closer to actually starting up the Bone Marrow Concentrate Stem Cell Pilot Study, I will continue to educate the perspective patient seeking to enjoy relief from arthritis of the hip and knee without a joint replacement. The delay is based on our having to wait for Institutional Review Board approval of our clinical trial. The fact that a procedure is experimental does not automatically mean that it is part of a research study or clinical trial. A responsible clinical trial can be characterized by a number of key features. There is preclinical data supporting that the treatment being tested is likely to be safe and effective. Before starting, there is oversight by an independent group such as an Institutional Review Board or medical ethics committee that protect patients’ rights, and in many countries the trial is assessed and approved by a national regulatory agency, such as the European Medicines Agency (EMA) or the U.S. Food and Drug Administration (FDA). The study itself is designed to answer specific questions about a new treatment or a new way of using current treatments, often with a control group to which the group of people receiving the new treatment is compared. While historically, the cost of the new treatment and trial monitoring is defrayed by the company developing the treatment or by local or national government funding; to date that has not occurred with stem cell trials in the United States. It takes an average of seven years and $750,000,000 to develop a new pharmaceutical therapy. With the rapidity in evolution of regenerative medicine, so far, no company has been identified that is willing to underwrite the expenses of a stem cell Trial. At the same time, beware of expensive treatments that have not passed successfully through clinical trials.
Responsibly conducted clinical trials are critical to the development of new treatments as they allow us to learn whether these treatments are safe and effective. I believe there is enough clinical experience to support a Pilot Study with Adult, Autogenous, Bone Marrow Derived Stem Cells. First no harm and a then reasonable chance of restoring function. To find out if you would qualify for the Pilot Study, contact Jennifer at 312-475-1893 ext.15
Stem Cell Crier
Posted in Regenerative Pain Center, Stem Cells on January 30, 2012
Musculoskeletal Care of the Mature Patient
I’m back from a short Blog sabbatical, refreshed and with much to discuss. During the time away, I spent a week skiing in Colorado with my wife, read a book, The Immortal Life of Henrietta Lacks, a must read for anyone interested in or considering regenerative medical care, and kept up on issues that I believe would be of interest to readers. While I was gone, my staff continued to work and both finalized and submitted the request to The Institutional Review Board that will enable us to begin The Bone marrow Aspirate Concentrate Stem Cell (BMAC) management of osteoarthritis. I will share with you what I read, watched and observed.
From the American Medical Association Morning Rounds of Tuesday, January 24, Leading the News “Stem cell treatment may help patients with macular degeneration”
On NBC’s The Doctors-Jan 25, a Regenexx stem cell procedure is featured for a patient with a failed microfracture in a woman with an arthritic knee seeking return to an active life style.
The Immortal Life of Henrietta Lacks , written by Rebecca Skloot is the fascinating biography of a woman whose cells were harvested without her knowledge in 1956 at Johns Hopkins; and ultimately became responsible for the world of regenerative medicine today. Along with the factual history of how the first cell cultures of human cells has evolved into the practice of medicine as we know it today, one learns about the evolution of medical ethics, government mandated patient protection and informed consent processes that govern contemporary medicine. You will better understand my approach to regenerative medicine when you finish this book named by more than 60 critics as one of the best books of 2010.
We arrived in Vail on Saturday afternoon, January 21, just as a snowstorm was starting. By time we ventured out on Sunday morning, there was 12 inches of fresh powder at the top of Rivas Ridge. It snowed again two more times during the week with another 14 inches of fresh powder by time we headed down Shangri-La in China Bowl. During the week, a friend came over from Breckenridge with his snow- board. By the end of our Wednesday skiing, I needed regenerative care for my entire body; almost no one was on the slopes besides us.
Over the next two weeks, I am scheduled to do site visits to observe and compare notes with centers involved in BMAC. If you want to move forward with learning whether you might be a candidate for regenerative medical care of your arthritis before scheduling that joint replacement, make an appointment or make a call. While no authority can promise success, there is an accumulating body of global information suggesting autogenous, autologous, adult bone marrow derived mesenchymal cells my be an effective, long term, anti-inflammatory and perhaps alter the natural history of degenerative arthritis.
Mitchell B. Sheinkop
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
FDA Warning on Stem Cells
Posted in Osteoarthritis, Regenerative Pain Center, Stem Cells on January 12, 2012
Because of the 60 Minute Television program exposing fraud in the marketing of Stem Cells last Sunday, I feel it necessary to preempt the previously announced blog for this week with a word or more of caution. Sometimes called the body’s “master cells,” stem cells are the precursor cells that develop into blood, brain, bones and all of your organs. When used as a medical treatment, there is the potential to repair, restore, replace and regenerate cells and thereby treat many medical conditions and diseases including arthritis.
But the Food and Drug Administration (FDA) is concerned that the hope, which patients have for cures not yet available, may leave them vulnerable to unscrupulous providers of stem cell treatments that are illegal and potentially harmful. Witness the Sunday night episode of 60 Minutes.
FDA cautions consumers to make sure that any stem cell treatment they are considering has been approved by FDA or is being studied under a clinical investigation that has been submitted to and allowed to proceed by FDA.
Regulation of Stem Cells
FDA regulates stem cells in the U.S. to ensure that they are safe and effective for their intended use.
Stem Cells that come from bone marrow or blood are routinely used in transplant procedures to treat patients with cancer and other disorders of the blood and immune system.
Why my Pilot Study and then Clinical Trial? As part of these studies, I must show how the product will be harvested and prepared so that FDA can make certain appropriate steps are being taken to help assure the product’s safety, purity and potency.
Consumers need to be aware that at present—other than cord blood for certain specified indications—there are no approved stem cell products.
Advice for Consumers
- If you are considering stem cell treatment in the U.S., ask your physician if the necessary FDA approval has been obtained or if you will be part of an FDA-regulated clinical study. This also applies if the stem cells are your own. Even if the cells are yours, there are safety risks, including risks introduced when the cells are manipulated after removal.“There is a potential safety risk when you put cells in an area where they are not performing the same biological function as they were when in their original location in the body. Cells in a different environment may multiply, form tumors, or may leave the site you put them in and migrate somewhere else.
- If you are considering having stem cell treatment in another country, learn all you can about regulations covering the products in that country. Exercise caution before undergoing treatment with a stem cell-based product in a country that—unlike the U.S.—may not require clinical studies designed to demonstrate that the product is safe and effective. FDA does not regulate stem cell treatments used solely in countries other than the United States and typically has little information about foreign establishments or their stem cell products. China has recently announced a governmental mandated regulation of a prior free for all in the stem cell market.
- To reemphasize my approach to realizing the promise of stem cell management of arthritis; treatment at the Regenerative Pain Center will only be offered via Pilot Study or Clinical Trial under FDA governance and IRB regulation. Your cells will be harvested from your own bone marrow, concentrated, and administered to your arthritic joint.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
On Proteins, PRP, Bone Marrow Concentrate, Stem Cells and Orthokine
Posted in Platelet Rich Plasma, Regenerative Pain Center, Stem Cells on January 4, 2012
The difference between platelet-rich plasma therapy, also known as PRP, and the Orthokine treatment that Alex Rodriguez, Kobe Bryant and other athletes have received in recent months in Germany is fairly straight forward. I personally treat athletic injuries and arthritis with PRP; but, do not use the Orthokine procedure because it is not approved in the United States or Canada.
With PRP, I withdraw 20 cc blood, spin it in a special kit and inject plasma that is rich in platelets and lymphocytes into joints, thereby introducing growth factor and hopefully helping the body to heal itself. In the Orthokine procedure, 20 ccs of a patient’s blood are mixed in a tube with ‘factors,’ incubated for a time , the blood is spun down, and the substance is injected much in the same way as PRP.
The theory of Orthokine, which has also been used by Alex Rodriguez, Kobe Bryant and golfers Vijay Singh and Fred Couples, among other athletes, is that Orthokine addresses one of the possible triggers of joint disease; thought to be the protein interleukin. The theory is an attack on one of the culprits behind arthritis. The protein is an important part of the body’s immune system and has the ability to alter the function of other cells. IL-1 can be positive when it allows the body’s ‘repair troops’ to move in quickly to fight infection or other kinds of damage; but it can also trigger inflammatory processes that lead to degeneration and breakdown of cartilage. These negative effects are primarily responsible for the pain and stiffness of osteoarthritis.
The Germans say that another protein that counteracts the effects of IL-1 is a ‘good protein’ in the body called anti-IL(1) produced by blood cells that protects cartilage by keeping the pro-inflammatory proteins in check. It is the body’s own natural anti-inflammatory and that is what gets mixed in prior to incubation.
In none of these treatments, PRP, stem-cell therapy Yankee pitcher Bartolo Colon had performed in the Dominican Republic. Is there good published research readily available that confirms they are effective, although it could turn out to be so. Individual anecdotes suggest they work. The procedures are not banned by the World Anti-Doping Agency or by Major League Baseball. However, Rodriguez was given the go-ahead by MLB and the Yankees to have it done in Germany. While PRP is available throughout the United States, the Regenerative Pain Clinic Bone Marrow Concentrate Stem Cell Pilot is now open for enrollment. Bone Marrow Concentrate has all the right proteins but does it work? Why am I advocating Bone Marrow Concentrate?
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What’s in Bone Marrow Concentrate: Both pro- and anti-inflammatory cytokines and the factors: Fibroblast Growth Factor-b, PDGF-AB, TGF-B, and VEGF. |
Call to see if you might qualify for the clinical pilot trial.
Mitchell B. Sheinkop, M.D.
1565 N LaSalle Street
Chicago, Illinois 60622
847-390-7666
From Anecdote to Clinical Trial
Posted in Regenerative Pain Center on December 28, 2011
If you watched the Los Angeles Lakers play the Chicago Bulls over the Christmas weekend, you would have heard the story repeated many times during the broadcast of how Kobe Bryant had traveled to Germany for a Platelet Rich Plasma treatment for his arthritic knee and how PRP is not available in the United States. My congratulations to Kobe Bryant and his doctors, it looks like the treatment worked although the Bulls did win. He played well and there was no visible sign of the bone-on-bone arthritic knee affecting him. To correct the announcers though, you should be aware that platelet rich plasma injection, not unlike that used in the case of Kobe Bryant, is widely available in the United States and FDA approved. Since April of this year, I have personally treated 28 patients with Platelet Rich Plasma including the knee, hip and shoulder. Improvement in arthritic symptoms and increased function has been observed in about 70% of those patients so far. That’s a reasonable improvement for arthritic impairment but is there something better? Might a non-surgical stem-cell treatment for people suffering from knee pain due to common injuries or other degenerative problems be a substitute treatment for arthroscopy or total knee replacement?
Original Article
Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons
Martin Englund, M.D., Ph.D., Ali Guermazi, M.D., Daniel Gale, M.D., David J. Hunter, M.B.,B.S., Ph.D., Piran Aliabadi, M.D., Margaret Clancy, M.P.H., and David T. Felson, M.D., M.P.H.
N Engl J Med 2008; 359:1108-1115September 11, 2008
Results
The prevalence of a meniscal tear or of meniscal destruction in the right knee as detected on MRI ranged from 19% among women 50 to 59 years of age to 56% among men 70 to 90 years of age. Among persons with radiographic evidence of osteoarthritis, the prevalence of a meniscal tear was 63% among those with knee pain, aching, or stiffness on most days and 60% among those without these symptoms. The corresponding prevalence among persons without radiographic evidence of osteoarthritis was 32% and 23%. Sixty-one percent of the subjects who had meniscal tears in their knees had not had any pain, aching, or stiffness during the previous month.
Conclusions
Incidental meniscal findings on MRI of the knee are common in the general population and increase with increasing age.
Because of the aforementioned scientific study, I have determined the following Inclusion criteria for the Bone Marrow Concentrate Pilot Study
1. Age over 50. For patients with an osteoarthritic defect on MRI
2. Near normal knee alignment
3. Symptoms referable to the cartilage defect:
Swelling
Pain
Giving way
Locking
Crepitation
4. Early OA with no evidence of inflammatory arthritis
5. >2mm residual joint space on X-ray
6. Unicompartmental osteoarthritis
a. ROM >-10 to 110
b. Mechanical axis <12 degrees varus or valgus
c. Minimal involvement of patella femoral joint
d. No >2-3mm laxity in any plane
To find out if you qualify for the study, call and make an appointment. For those who don’t qualify for inclusion in the Pilot Study, you still may be a candidate for Bone Marrow Concentrate treatment of your arthritic joint.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
Stem Cell and Adjunctive Therapies
Posted in Stem Cells on December 20, 2011
Between May of 2001 and November of 2009, I was an invited visiting professor teaching joint replacement surgery in 76 cities around the world at hospitals, in operating rooms, and at orthopedic conferences in 37 countries including Japan, China, Singapore, Russia, Turkey, Israel, Jordan, Lebanon, Qatar, The United Arab Emirates, Saudi Arabia, Bahrain, North Africa, and the emerging newly independent countries of Central and Eastern Europe. My introduction of American joint replacement methodology extended through most of Asia, Central and Eastern Europe, North Africa and the Middle East. During that span, I hosted in Chicago, several hundred visiting orthopedic surgeons from around the globe to teach them my joint replacement techniques as well introduce basic arthroplasty technique, minimally invasive surgery and new prosthetic made in America designs. I still maintain active scientific exchange serving on the editorial board of orthopedic journals both in Serbia and Poland. All these initiatives have provided me with the unusual opportunity not only to stay abreast of and participate in orthopedic developments in the United States but to stay on top of the orthopedic developments around the world. It is time I believe to adopt an Active Ageing approach to orthopedics in this country and that’s why my Blog has been so directed over the past 36 months.
It has taken us almost three years of study and global observation to allow for announcement of a Pilot Study for the treatment of arthritic joints with Bone Marrow Concentrate; now is the time. Last week, I used my Blog to announce the opening of The Regenerative Pain Center with the sole purpose being an attempt at pain control through Regenerative Medicine in contrast to operative intervention. This week, I am announcing the start up of the first Pilot Study made possible because of the Regenerative Pain Center. A Pilot Study is the standard scientific tool for “soft” research, allowing me to conduct a preliminary analysis before committing to a full-blown clinical trial. I will investigate the validity of Bone Marrow Concentrate in treating arthritis of the hip or the knee in compliance with the FDA governance as described in CFR21 Part 1271 falling under the same day surgical exemption discussed in 1271.15(b).
To date, it has been patient testimonials and anecdote supporting regenerative medical care in the musculoskeletal system. That’s all changing, yesterday I received a new course announcement from the American Academy of Orthopedic Surgeons in Phoenix, April 20 to 22, titled Advances in Care of the Aging Athlete. Among the hot topics will be stem cell updates.The course will cover a broad array of topics, including degenerative, arthritic, and traumatic conditions that result from injuries, and take an expanded approach to the treatment of aging female athletes. I will use this course to help me better counsel active patients on managing their participation in sports as they age. Christopher J. Centeno, MD has gone further than anyone in this country, to the best of my knowledge, in advancing the regenerative field with his publication of Orthopedics 2.0. How Regenerative Medicine will Create the Next Generation of Less Invasive Orthopedics.
My intent is to advance the scientific process with the introduction of a pilot study using Bone Marrow Concentrate in the hip and the knee. Next week I will focus on the several pilot studies and who qualifies.
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle Street
Chicago, Illinois 60610
847-390-7666
