This past Saturday and Sunday, we had the pleasure of hosting our nephew and grandniece during a college visit. The nephew is a 52-year-old extremely athletic man who initially had complained of pain and swelling in his left knee ten years ago. At the time, he had sent me his MRI imaging, the latter compatible with a partial tear of his lateral meniscus and a cartilage defect in his lateral femoral condyle. Both the local orthopedic surgeon and I advised a wait watch and see approach since the problem was not mechanical but rather inflammation leading to pain and swelling. After a single cortisone injection, physical therapy, and three months, the problem resolved. Ten years later after a soccer match, my nephew presented with recurrence of symptoms. While there still are no mechanical signs such as instability, clunking, giving way or locking; whereas ten years ago, he had no asymmetry in his range of motion, he now had a loss of full extension and full flexion. These latter two are the signs of osteoarthritic changes. Before advancing a treatment program, I asked him to complete a new set of images including an X-Ray and MRI.
It is more probable than not that the imaging will be compatible with grade 3 osteoarthritic changes where the lateral femoral articular defect had been initially seen associated with the lateral meniscal tear. The altered range of joint motion tells the story. What follows is my informed consent.
Cortisone has a short-term anti-inflammatory effect. We have learned it has a probable systemic effect as well as intraarticular since diabetics experience an increase in their management needs for up to 72 hours following the injection into a joint. The second option is a hyaluronic acid injection. While the latter may provide up to six months of pain relief in 60% of patients, the inconsistencies in patient response have led to an ever-increasing refusal of preauthorization by Medicare and private indemnifiers. What about the arthroscopic surgical option? Orthopedic surgeons have increasingly abandoned the notion of surgical cartilage restoration and joint preservation because of inconsistent or short-term success at best.
Is there any chance of postponing, perhaps avoiding a joint replacement, either total or partial? The answer to the question is why I “graduated” from joint replacement to the new discipline of Cellular Orthopedics or Orthobiologics. The attempt to relieve pain, improve function, restore motion, stop the progression of osteoarthritis with a needle instead of a knife is based on cells, platelets and proteins, the latter known as Growth factors. In order to be FDA compliant, the cells and platelets must be autologous; that is, they must come from you. While it is also most desirable and effective to use Growth Factors from your bone marrow or circulating blood, recently, Medicare and some private insurance carriers have preauthorized amniotic fluid as long as it is produced for pain relief and as a source of Growth Factors but, without stem cells. Returning to my nephew’s problem, is there the possibility of cartilage regeneration or is the goal, joint restoration?
As space is limited for posting my blog, you will have to “tune in” next time to learn more. In the meantime, to schedule an office consultation, call (312) 475-1893. You may watch my webinars by visiting my website at www.sheinkopmd.com and clicking on the Webinars dropdown menu.