What prompted the subject matter for this blog is the article appearing in the December 25, 2013 issue of the New York Times by Pam Belluck: Common Knee Surgery Does Very Little for Some, Study Suggests. What the writer is citing is a scientific article that appeared in The New England Journal of Medicine “suggesting that thousands of people may be undergoing unnecessary surgery”. The study reported from Finland recognized that about 80% of tears seen on the MRI of patients develop from wear and aging. In the study patients were randomized with some undergoing arthroscopy and the others having a sham operation. All received physical therapy. A year later, most patients in both groups felt the same.

Assume if you will that you are seen in my office for knee pain without a history of a major athletic trauma. My first question, “ Are you having mechanical symptoms; that is clunking, locking or giving way? Before I write the prescription for the MRI, a complete orthopedic history and a physical examination is performed. Our research at Regenexx has documented that the treatment recommendations for adult non-traumatic knee pain should be based on the history and the physical findings, not on the MRI alone. The physical findings of significance include the range of motion and the mechanical axis. Is the patient developing inability to fully straighten, symmetrically bend, bow leg or knock-knee? Next comes the request for the imaging.

Based on the results of history, physical examination and imaging, I propose a therapeutic approach almost always beginning with physical therapy. I might suggest an ultrasound guided cortisone injection to control discomfort for more effective PT. When the X-rays and MRI are reviewed, I more often than not will discover a torn meniscus of some type with degenerative arthritic changes elsewhere in the joint. The treatment will be directed to the entire arthritic process and not targeted to the frayed meniscus. That’s what I have been doing over the last ten years and that’s what the Finnish study confirmed is the correct approach. More likely than not, the next step will be a visco-supplementation program.

With an emphasis on advancing the care of the aging athlete, you will receive an informed consent regarding cellular orthopedics based on stem cells, should the aforementioned measures not succeed. While Regenerative Medicine is not presently indemnified by Medicare or the private insurer, compared to your anticipated out of pocket expenses in the new world of affordable insurance, your costs for symptomatic relief from arthritis while actually reversing the degenerative process will be comparable to that which you will have to pay for hospitalization or out of network care starting in 2014.

Having introduced the New Year, what are so exciting will be the next initiatives taking place in the processing of Bone Marrow Aspirate Concentrate. We now have the technology to increase the number of stem cells available by a 7X to 200X multiple via a revolutionary development of how we manage the bone marrow in the laboratory prior to injection into your arthritic joint. Have a happy and healthy 2014 and just call to learn more about advances in the aging athlete.

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