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Plain Language Summary of Regenerative Medicine

Plain Language Summary of Regenerative Medicine

Cellular Orthopedics for the Musculoskeletal injury and Degenerative Arthritis

What is the problem?

Trauma and Osteoarthritis are part of the cycle of life. Muscle, ligament and tendon injuries frequently occur during sports related activities or accidents; degenerative arthritis may be post traumatic by many years or occur as part of the aging process

What treatments are available?

As of today, it includes Platelet Rich Plasma (PRP) following several protocols and Bone Marrow Aspirate Concentrate (BMAC) rich in stem cells, growth factors and anti-inflammatories called Cytokines. As of next week, all may change as the Orthobiologic update taking place in Las Vegas over the weekend will potentially introduce an entire new menu of therapeutic intervention alternatives for musculoskeletal injury and disease.

What is Platelet Rich Plasma?

Platelets are part of your circulating blood producing growth factors that assist in repair and regeneration of tissue. When a high concentration of platelets are created via the centrifuge, healing may progress more quickly and pain may be reduced

What is Bone Marrow Aspirate Concentrate?

Taken form the back of your pelvis, aspirated bone marrow may be concentrated and prepared allowing for pain relief, improved function, a more rewarding quality of life, and possibly influence the Bio-immune response of degenerative arthritis

What is Amniotic Fluid Concentrate?

The source is the pregnant woman coming to term and delivering via Cesarean section. The recovered amniotic fluid is processed, concentrated, and now available as an alternative to Visco-supplemenation with hyaluronic acid. It is a new option and data concerning the length of pain relief is still being determined.

Do these Regenerative Medicine alternatives work?

When properly applied the answer is yes. What we don’t know is for how long? The effect of Platelet Rich Plasma in injury is intended to speed up the repair process. In the case of Amniotic Fluid, the outcomes are still being studied without a known end point. I have been involved in studying the clinical outcomes of Bone Marrow Aspirate Concentrate intervention for osteoarthritis. The paper I will be presenting this weekend confirms satisfactory results up to two years. The data collection continues.

Is there a downside side to Regenerative Medicine and Cellular Orthopedics?

In my experience the answer is yes and no. Yes because there is no indemnification for the new world of regenerative medicine; care is an out of pocket self pay undertaking because the field is new and five year outcomes data still not available. On the other hand, at three years, I have seen no adverse events and the vast majority have responded well with improved function and quality of life. Out of over 600 knees and over 100 hips, to the best of my knowledge, seven have gone on to a total joint replacement.

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Headline News From Around the Stem Cell World

Thursday, April 16, 2015 9:51 am

“Stem Cells working great. 4 days of skiing and 90,000 vertical feet already. Knees only slightly swollen. Using the new braces seems to really help. Last 4 to 5 runs of the day, it is very hard to get in and out of the heli-knees very sore by then. Hard to get up from a fall (so skiing carefully so as not to fall anymore). Pure powder last 2 days, so skiing itself has been easy. Biking every morning and after skiing, using Voltaren 2x’s/day, hot tub and ice-water on legs 3x’s after skiing and knee massage every day. Gary made his 3 million suit on Tuesday, and I missed mine yesterday by just 90 feet!! Huge Day of skiing yesterday-everyone exhausted. Skiing a half day today. Will see about tomorrow (only if all powder)”

This report was sent by a friend and patient who is helicopter skiing with CMH in British Columbia this week. I had originally planned to join the trip but work load prevented me. The skier-writer of the message had been unable to ski any longer until I completed a Bone Marrow Aspirate Concentrate/Stem cell intervention to his right knee two years ago; and for the left, last year. He is 70 years of age

Dwight Howard returns to Houston in time for NBA playoffs

In February, The Houston Rockets star center was sidelined by knee pain for which he underwent a Bone Marrow Aspirate Concentrate/Stem cell intervention. As I wasn’t his treating physician, I am not familiar with the details of his diagnosis, but suffice it to say from what I have gleaned from ESPN on the internet, it was cartilaginous damage with continued pain and inflammation. Last week, he returned to action and will be very much part of the Rockets quest for an NBA championship.

The Anti-Aging Movement Continues to Rise

By Terry Stanton

From the April, 2015 edition of AAOS Now/Clinical News and Views.

“During an Annual Meeting Symposium on considerations in treating the aging athletic patient, a panel of surgeons covered both injuries and treatment for “weekend warriors” and the science of aging.” I enjoyed the article in that it once again underscores how Regenexx is ahead of the pack with non operative, minimally invasive interventions with a needle for those sports injuries and the arthritic progression that alters function. The article cited above concludes “Field though legitimate, lacks science to support health benefits of treatment”. That this is partially true was emphasized by a patient from Hong Kong this week who had written me to tell me all the promises she had found while surfing the internet to seek non surgical options for her recently torn ACL. Her experience underscores the need for the Aging Athlete to ask the question: “show me your evidence”. There is only one Regenerative Medical Network that has the Data based on which your questions may be truthfully answered. It is called Regenexx and I am not only a part of, but a contributor to their scientific Outcomes process.

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The Intervertebral Disc and Regenerative Strategies with Stem Cells

Intervertebral disc degeneration is characterized by a gradual loss of cellular function and related breakdown of extracellular matrix. This process leads to a decrease in the mechanical stability of the spine and activation of molecules that trigger painful back and neck symptoms. Implantation of mesenchymal stem cells has been shown to counteract the degenerative process in animal models of disc degeneration and in some initial clinical studies. The regenerative activity of Mesenchymal Stem Cells when injected into the disc results in a reversal of that degenerative disc process. In addition, the injection of MSCs also releases trophic factors that may stimulate the metabolism of disc cells and suppress inflammatory reactions. However, in spite of these promising perspectives, clinical application of MSCs has certain limitations. Potential adverse events such as cell leaking and osteophyte (spur) formation are at present, the limiting factors. I am updating my Blog readers concerning what is on the horizon as every week I receive a question about the subject of the low back and stem cells. Low Back degenerative disease also is something I must consider in each and every patient for whom I perform a Cellular Orthopedic intervention in a hip or knee as there is no question about a Hip-Knee-Spine connection and I must understand its importance when I treat hip and knee pathology.  These areas are closely related in function and symptom distribution

The limitation at present of Cellular Orthopedic intervention for intervertebral disc degeneration is the need to further identify potential side effects. While an attractive target for future regenerative strategies, Bone Marrow Aspirate Concentrate/Stem Cell intervention is not ready for prime time. The logical question then is how to cope with the limitations of spinal stenosis and Degenerative Disc and Joint disease of the low back until stem cell care is proven safe and effective? First and foremost comes weight reduction. Next in line is core strengthening in conjunction with stretching. This may be accomplished through Pilates, Tai Chi, Yoga and any other program that follows the principles of strengthening and stretching the core. Incidentally, running and jogging are not injurious to an arthritic spine; just the opposite, both help rehydrate the dried out disc.

To learn more about your personal kinematic Knee-Hip-Low Back continuum, you need an assessment. That’s the only way I can determine the key problem and if one or all need to be addressed.

847 390 7666 to make an appointment

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Plain Language Summary of Regenerative Medicine

Regenerative Medicine and Spring Rejuvenation

At least it is spring on Astronomical chart although six inches of snow yesterday in Chicago causes one to take pause. Nevertheless, I am off to Southwest Wisconsin this weekend to initiate my fly fishing journeys for 2015. One doesn’t necessarily equate fishing with physical demand. Yet last Friday, at an 18 month follow-up of a Bone Marrow Aspirate Concentrate/Stem cell intervention in a 74 year old patient with arthritic knees, who incidentally had been told he needed knee replacements, I received a very serious thank you because my patient was planning several fishing trips to Canada this year with children and grandchildren; something he had not been able to do for several years as he couldn’t get in and out of a boat. Now he is able to do so and plans to enjoy every moment.  I plan to wade up the spring creeks and vault up and down the cliffs and boulders as a result of my own regenerative care last year. Two weeks ago, my wife and I returned from a fabulous week of skiing in Vail and the only runs I avoided were the cliffs.

I learned much over the winter about several golfers who had undergone stem cell care for both knee and hip. The post intervention rehabilitation regimen had resulted in their ability to travel to the South East and Southwest to play golf on multiple occasions when such had not been possible in the past several years for them. Of particular interest to me was the report from one patient who I had met two years ago when he was scheduled to undergo a hip replacement.  First he spent some time changing his swing and in particular the positioning of his leg so it would turn out. That seems to have taken the pressure off the area of missing cartilage and impingement. Next, he underwent a stem cell procedure and he is no longer considering a joint replacement. Not being a golfer, I checked it out on the internet and indeed, a change in golf mechanics may eliminate the painful swing. When followed by the stem cell procedure, there is something akin to bacon and eggs or love and marriage.

In looking back over the winter that hopefully was, a 45 year old man who had had to stop running because of “bone on bone” in his knee and who had received a recommendation elsewhere for a knee replacement, indeed turned out not to have “bone on bone” when I reviewed his images although he did have a problematic knee. 90 days after undergoing an SD Regenexx procedure, he ran the Madison 50 furlong-Race. Well, now it’s time to put air in my tires and start planning ahead. I did receive a call last Saturday by my cycling partner concerning a Sunday morning ride; but with a temperature forecast of 29 degrees, I respectfully declined the offer. For those with joint injury or arthritis, everything and anything is possible in fitness, recreation, sports and a pain free walk in this new world of Cellular Orthopedics.

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Plain Language Summary of Regenerative Medicine

Been there, done that with joint replacements; what’s the role of stem cells?

Last week, a call was placed to my office by the sponsor of a multicenter knee replacement clinical trial in which I had taken part since 2004.The FDA mandated Post Release Requirement for the Zimmer Mobile Knee had been fulfilled.  Because of my world wide teaching and visiting professorships starting in 2001, I had been asked to be a co-investigator in that initiative. My participation in part led to the release of the High-Flex Zimmer Mobile Bearing Knee in 2007 and several major clinical papers in which I was the Co-Author. As many readers of this Blog are aware, I had dedicated 37 years of my professional endeavors to integrating joint replacement research with my clinical practice at Rush for the care and treatment of the arthritic hip and knee. For the past two and a half years, I have dedicated my professional energies to assisting patients with osteoarthritis avoid or at least postpone the joint replacement.

I want to go on record; when a patient has altered function, unrelenting pain, and an image with a Kellgren/Lawrence Grade 4 osteoarthritic hip or knee, that patient needs a joint replacement. While I have called the readers’ attention to inherent risks of a joint replacement, the effected patient with medical approval will benefit from the joint replacement. On the other hand, the ever increasing evidence and my experience confirm that the patient with Grade 2 and 3 Osteoarthritis of a major joint may significantly benefit from a Bone Marrow Aspirate Concentrate /Stem cell intervention. The end result of an uncomplicated major joint replacement is pain relief, improved function, better motion, and correction of a deformity. The potential risks of a joint replacement gone badly require a revision or major reconstruction with major medical interventions for associated complications. The end result of a Bone Marrow Aspirate Concentrate /Stem Cell intervention is pain relief, improved function, better motion and continuation of or return to a very active recreational profile without risk of complication. While the stem cell procedure will not correct a deformity, it may alter the natural history of the arthritic process at the molecular level. Actually, the presence of deformity puts a patient in a Grade 4 setting and is an indication for a joint replacement; Grade 4 is a predictor of a poor result from stem cells.

Well it’s the week of Chanukah and Christmas so let’s celebrate this week of miracles with a wonderful stem cell story; it concerns hockey great Gordie Howe to be found in the Detroit Free Press. Freep.com:


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Active, Athletic, Then Why Have a Knee Replacement?

Let’s enter the new world of Cellular Orthopedics into which I graduated three years ago. Several months, ago, a long time friend was visiting his family in Chicago and stopped by to say hello. He told me about his skiing last winter and his hiking over the summer and fall. He also related he was seeing an orthopedic surgeon in the state where he now lived and that he had “bone on bone” in his knee. I launched into my customary spiel about his current level of athleticism, my cellular orthopedic initiative and the limits and risks of a knee replacement. Last week, a mutual friend told me that the out of state visitor had related “Mitch was right, I shouldn’t have done it”. He had undergone the Total Knee Replacement in spite of there being no limit in his recreational capacity and was now readmitted with an infected total knee prosthesis that might have to be removed to clear up the infection. Not being one to suggest “I told you so” but that’s what I am trying to get across to the patients I advise.

The Stem Cell Solution, Using the body’s almost magical repair kit to fix bad knees and hips-no surgery required is the title of an article appearing in the December, 2014, edition of The Saturday Evening Post, written by Sharon Begley, the senior U.S. health and science correspondent at Reuters. Last spring, the author had contacted me for an interview after having followed my Blogs unbeknownst to me. Ms Begley introduced herself and told me about an article she was writing for The Post to be published in June. I had forgotten about the interview until a patient came in last week and told me that she had read the article in the December issue. What I didn’t recognize at the time of the interview was that not only is the bone marrow a source of Adult Mesenchymal Stem Cells but of Growth factors and Cytokines as well that may be of equal importance. The opening of the article features my patient.  In 2011,”I was in a bad way.” ”He was diagnosed with osteoarthritis, a degenerative disease eating away at the cartilage in his knees writes Begley.”The patient: ”and now I’m climbing stairs, have gone on two skiing trips, planning another, and playing golf in the summer.” “I am way beyond pleased.”

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