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When Aging Athletes Wait Too Long to Hang It Up

When Aging Athletes Wait Too Long to Hang It Up

The PERSPECTIVE section of the Chicago Tribune / Wednesday, February 11, 2015 ran the headline and an article written by Gerald D Skoning. It was well thought out, I have kept the page on my desk since February thinking that this was a marvelous subject for me to Blog about and how to possibly extend the career of injured or aging athletes, be they amateur or professional.

I am surrounded by several good friends who want to continue skiing, cycling, wadding up a stream with fly rod in hand, or spend an hour each day in the health club. Unfortunately, most of my contemporaries in their sixties and seventies have hung up their athletic gear but maybe it isn’t too late for you. An athlete doesn’t have to win but you might still enjoy competing and participating. Our mission statement is our ethos. Mary, the research coordinator and physical therapist in our office wore her medal to work on Tuesday earned as a cycling participant in the Co-Ed relay division of the Chicago Triathlon two weekends ago. I have recently returned from a week of cycling and fly fishing in Southwest Wisconsin. I am not injury free nor have I avoided the effects of arthritis after a lifetime of athletic participation. When the time came where I was surrounded by “ I am just a used to be”; I opted for a cellular orthopedic intervention to my left knee and here I am. Grit and determination can prolong your recreational and athletic enjoyment; so can Orthobiologics. Our regenerative offerings contain an enhanced profile of ant-inflammatory cytokines, anabolic growth factors, and adult mesenchymal stem cells. Our data clearly documents improved function of the knee. With the introduction of Subchondroplasty, we hope to do even better. Whereas our initial hip outcomes did not compare to those of the knee, the several patients who returned for a second procedure are doing extremely well. Now I am happy to note that patients presenting with arthritic shoulders and ankles are very improved from our interventions,

You must decide if you want to be a “still” or “used to be”. When four of us rode up and down the hills of the Driftless Area two weeks ago for hours at a time, you couldn’t match that camaraderie. I did the same four weeks earlier with my wife and two sons; the time has not come and I won’t quit because the next orthobiologic intervention for the other knee is waiting.

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When Aging Athletes Wait Too Long to Hang It Up

The Rational for Subchondroplasty

In a more recent understanding of the arthritic joint, science now tells us that it is not only loss of cartilage that leads to pain, loss of motion, altered function and a progressive downhill course; but rather an involvement of the entire joint as well as the bone supporting the joint. The mechanism is probably bio-immune in nature and the reason for our success in treating the arthritic joint with orthobiologics is based on addressing molecular changes within the joint. The Europeans however have taught us that almost as important as intervention inside the joint is addressing the bone supporting the joint. In a recent scientific meeting, Spanish and French Orthopedic Surgeons demonstrated improved overall results within the arthritic joint by treating the changes outside of the joint as seen in an MRI. These changes are frequently described as bone contusions or bone marrow lesions. When followed, it becomes apparent that the altered bone fails to support or protect the cartilage within the joint. By drilling into the subchondral bone, one stimulates a healing process and by adding orthobiologics, one hastens the healing of those bony lesions.

Subchondroplasty is accomplished with a specially designed drill bit and the orthobiologic is introduced through a specially designed trochar needle that slides over the drill bit serving additionally as a guide wire. The entire process is accomplished through a small skin puncture with accuracy enhanced through fluoroscopy, real time X-ray. Because the drill bit causes little structural damage, there are few alterations in the rehabilitation process when compared to the joint intervention alone. While Orthopedic Surgeons have been addressing these bony lesions by a macro system for several years with documented success, our work, as was seen on the Fox News airing last Thursday night, is based on minimally invasive means thereby eliminating the need for prolonged restriction of weight bearing and crutch dependency. Additionally, by introducing Bone Marrow Aspirate Concentrate in addition to the present Calcium Phosphate adjunct, the patient should anticipate healing in weeks, not months. The first target was the knee but we have expanded subchondroplasty to the ankle and soon to the hip and shoulder.

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When Aging Athletes Wait Too Long to Hang It Up

Complications of Arthroscopic Labral Repairs

In both the shoulder and the hip, there is a structure called the Labrum that since the introduction of the MRI and the arthroscope, has received exponential surgical attention. In the hip, the acetabular labrum is a ring of cartilage that surrounds the socket of the hip joint. Its function is to deepen the acetabulum and make it more difficult for the head of the femur to slip out of place. At the shoulder, the Glenoid Labrum is soft fibrous tissue that surrounds the socket to help stabilize the joint. Injuries to either structure may occur from acute trauma, repetitive impingement or as part of the degenerative osteoarthritic process. Symptoms of a tear in either location include pain, may be mechanical in nature (catching, locking, popping, or grinding), a decreased range of motion and loss of strength.

Herein is the diagnostic and therapeutic dilemma; does the orthopedist address the history and physical examination, the results of imaging, all of the above or some of the above? On the one hand, it has been clearly established both at the shoulder and at the hip, labral injury as demonstrated on the MRI or CT arthrogram may not be the source of the pain. If the problem is pain and there are arthritic changes in the joint, the results of arthroscopic surgery are poor. Even when there are mechanical symptoms such as catching, locking, grinding and popping, arthroscopic clean outs do not succeed in the presence of arthritis. When it comes to the shoulder, the arthroscopic attempt at repair of the labrum as part of the rotator cuff injury has only a 50% success rate. Even when done correctly, poor patient selection and complications can be devastating resulting in injury to cartilage, injury to bone, and chronic irritation of the joint lining.

Assume if you will that a 45 to 55 year old or even older patient presents with pain in the shoulder or hip. The MRI is interpreted as compatible with a labral tear. There is an option which may very well eliminate the pain and affect healing of the torn structure, Bone Marrow Aspirate Concentrate followed by physical therapy. The procedure is done with a needle and not a scalpel; the complication rate in my experience is extremely low and the success rate extremely high. Let me cite an example of a patient who presented at age 67 with bilateral chronic shoulder pain for which he had undergone multiple prior attempts at arthroscopic surgical remedy. Four months after having undergone bilateral Bone Marrow Aspirate Concentrate Stem Cell intervention, he is off his chronic opiate containing pain medication and playing golf while having returned to his unlimited fitness routine. This is only one success story, there are many more. If you want to learn more about the potential options for your painful shoulder or hip, call for a consultation:

847 390 7666

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When Aging Athletes Wait Too Long to Hang It Up

On Stem Cells, Bone Marrow Concentrate and Non-unions of Bones

With all of our attention directed to arthritis, patients need to be reminded of the continued successes we are experiencing when using Bone Marrow Concentrate in fractures that fail to heal. When a fracture fails to heal in the expected average time, that is a Delayed Union. When it looses the ability to heal all together, that’s a Non-Union. The reasons that a fracture might fail to heal are beyond the scope of this Blog but non-union is not a rare complication. Areas of predilection toward difficulty in healing have to do with blood supply. The upper end of the femur (hip), navicular bone at the wrist, upper end of the humerus (shoulder), and clavicle as well as the tibia are areas of predilection. Historically, the only remedy has been a major operative procedure and even at that, there is a high failure rate with multiple complications including infection. It has been said that the only thing worse than an infected non-union is cancer. Let me share with you the story of two recent patients for whom I successfully intervened with Bone Marrow Concentrate when prior attempts at achieving fracture healing, one through surgery had failed.

VDVR is a 46-year-old woman who ten years ago sustained multiple fractures to her spine and lower extremities while serving in Iraq. She had undergone numerous surgical procedures, all successful except the inability to cause healing of fractures to her left calcaneus and talus. She had been left with Oxycontin addiction and crutch dependency. After several further orthopedic consultations she had a choice of amputation or more major surgical repair attempts with only 50% chance of success. Twelve weeks ago, I performed a Bone Marrow Concentrate/ Stem Cell intervention to her left calcaneus and talus. Last week she called and indicated she no longer required narcotics and could walk without crutches. The X-ray I received a day or two after the call was indicative of fracture healing.

JM is a 76-year old man with an established non-union of the left clavicle, of several years duration. He was experiencing arthritic changes in his left shoulder and asked me to try and achieve healing of the clavicle, even after several years while I was injecting Bone Marrow Concentrate into his arthritic left shoulder.  About 16 weeks ago, I completed a stem cell intervention to his left shoulder and into the area of non-union of the outer one-third of the left clavicle. When I saw him in follow-up last week, the collarbone was completely healed. He had been afraid to undergo a surgical repair because of the high incidence of infection, failure and neurovascular injury associated with surgery of non-union at the clavicle.

These are but two illustrations of what is happening in the new world of Cellular Orthopedics. The initiative is gaining traction in the orthopedic world as I more and more success stories are realized

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On Stem Cells and Atraumatic Rotator Cuff Tears

Every month, I receive The American Academy of Orthopedic Surgeons News Magazine; in the Clinical News and Views Section, timely issues are reviewed. The November magazine devoted two pages to Surgical vs. Nonsurgical Treatment for Atraumatic Rotator Cuff Tears. The message is “The jury is still out on best course.” Basically, rotator cuff disease is increasing in an aging and active society but the orthopedic surgeon has a difficult time in clinical decision making. The benefits of conservative and surgical options are still controversial.

Our goal of treatment is to relieve pain, restore and maintain function, and provide lasting, durable relief. First of all, imaging studies continually document a high number of Rotator Cuff Tears in patients over 60; but most patients have no symptoms and thus need no treatment. Although the clinical management of Rotator Cuff Tears is highly successful in the short term, the repair often fails in those over 60.

The American Academy’s Clinical Practice Guidelines on “Optimizing the Management of Rotator Cuff Management” found a lack of definitive evidence.  The number one recommendation is “exercise and anti-inflammatory medications may be useful in the management of rotator cuff symptoms in the absence of a full-thickness tear.” Highlighted and emphasized is the fact that surgical repair fails in 35% of cases.

An article that appeared in International Orthopaedics , (SICOT); 2014 reviewed Recent Data Showing the Positive Healing Effects from Augmenting a Rotator Cuff Repair (10 Year Follow up). The study documented that significant improvement in healing outcomes could be achieved by the use of Bone Marrow Aspirate Concentrate containing Mesenchymal Stem Cells. More important, studies by Regenexx demonstrated the healing of both symptomatic Atraumatic and Traumatic Rotator Cuff Tears with Bone Marrow Concentrate derived Stem Cells without surgery if the retraction of the torn tendon were minimal. The take home message, if you have shoulder problems, you need a physical examination, X-ray and MRI. For over half of the patient population with symptomatic rotator cuff tears, a BMAC/Stem Cell intervention may relieve symptoms and result in healing

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When Aging Athletes Wait Too Long to Hang It Up

On Bartolo Colon, his shoulder and stem cell therapy

My wife and I celebrated our anniversary with a trip to her brother and sister-in-law in the East Bay just South of Walnut Creek, California.  After a Thursday of Wine tasting in the Livermore wine country and fine dining in San Francisco, Friday was at the health club and swimming pool; while Friday night we watched Bartolo Colon pitch a masterful game again as the best pitcher in baseball. He is 40 years of age and couldn’t pitch any longer in 2009 because of a torn rotator cuff. In 2010, he underwent a stem cell procedure to his right pitching shoulder. From the Saturday San Ramon Valley Times: “More Colon Mastery”. ” The last seven starts have come since his 40th birthday, making him the first big league pitcher ever to win his first seven starts after turning the big 40″.

Rotator Cuff Stem Cell Therapy Returns Colon to Top Form

The story of Bartolo Colon is a great testimonial for the potential of stem cells. In baseball terms, he is old but his shoulder was rejuvenated through cellular orthopedics. Shoulder impairment may be secondary to several possibilities including degenerative arthritis and rotator cuff disease. There are distinct differences in therapeutic approaches. Bartolo Colon had a rotator cuff tear that was successfully treated with his stem cells. The key to success in treating rotator cuff damage is the earliest possible intervention. Once degenerative arthritis develops in addition to the cuff tear, there is little likelihood of successful intervention. The corollary also applies, if degenerative arthritis is present without rotator cuff disease, it lends itself to stem cell intervention. Colon in 2010 went to the Dominican Republic for his procedure. While that may have been necessary then, you may have stem cell care of your rotator cuff or degenerative shoulder disease in my office now

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