Special Announcement - Now Enrolling for FDA Approved Stem Cell Study
Dr. Mitchell Sheinkop has completed training and is credentialed for the first of its kind FDA approved stem cell clinical trial for knee arthritis. Our clinic is now enrolling patients in this trial. Contact us at 312-475-1893 for details. Click here to learn more.

Must yesterday’s joint injury lead to tomorrow’s arthritis?  

My column regarding ACL ruptures appeared last Friday. That afternoon, I received the following inquiry and comment from a reader, regarding the prognosis and possible early preventive interventions for a significant knee injury.

“I am one of relatively few patients who has had the Bone Marrow Concentrate treatment for a fully-torn (not-retracted) ACL tear and to date, I’ve had what I’d consider to be an amazing recovery.  I read your latest blog post and just thought I’d let you know that I’m back to very aggressive skiing (including small but non-trivial jumps).  However, I did want to ask, if you would be willing to comment, if there are actions or periodic diagnostics, you’d recommend to maximize the chances that I’m still happy skiing 10,20,30 years after the injury?  I understand you probably can’t comment but nevertheless wanted to let you know I was also a real-life person who had a significant knee trauma with multiple surgical consults all agreeing it was fully torn and required surgery (to return to high-level skiing) and now have a fairly normal looking ACL in MRI (per independent radiologist) and am back to 100% with activities that require a lot of knee stability.  I did do two rounds of same-day BMA reinjections and a bunch of platelet injections but no surgery.”

The answer is an orthopedic assessment at three-year intervals to look for markers of post traumatic osteoarthritis such as loss of terminal extension and asymmetrical flexion. The MRI is helpful in detecting moderate arthritic changes but the latest development, the needle scope, allows an orthopedic surgeon to directly examine the meniscus and cartilage in an office setting. The concern is post traumatic arthritis, cartilage defects that will progress, and meniscal damage not always seen on the MRI. Here are some thoughts on early intervention with Cellular Orthopedic and Regenerative Medicine options.

A recent Study Compared the Efficiency of Needle Arthroscopy Versus MRI for Meniscal Tears and Cartilage damage. Needle arthroscopy (NA) may be a less costly and more accurate option for diagnosis and treatment of meniscal tears and early onset post traumatic arthritis than MRI, according to a study published in the February issue of Arthroscopy. Researchers collected data on costs for care and accuracy, including procedures for both false-positive and false-negative findings well as private payer reimbursement rates. They compared outcomes using the global knee injury and osteoarthritis outcome score (KOOS). Patients were followed and evaluated over a two-year period. 

There are several restorative options now available when conservative therapies for the treatment of knee degenerative processes, such as non-pharmacological interventions, systemic drug treatment, and intra-articular therapies offer only short-term benefits or fail. Before resorting to surgery; be aware that encouraging preliminary results have been reported using mesenchymal stem cells (MSCs), either alone or in association with surgery. My clinical published research documents success with using your Bone Marrow Concentrate for joint restoration and combating progression of posttraumatic arthritis. Additionally, I have published an article concerning another source for joint restoration, micro-fractured adipose tissue. The latter has created a huge interest in the context of cartilage regeneration due to its wide availability, ease to harvest and richness in mesenchymal cell elements within the so called stromal vascular fraction. Moreover, MSCs from adipose tissue are characterized by marked anti-inflammatory and regenerative properties, which make them an excellent tool for regenerative medicine purposes.

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Updates from you Cellular Orthopedic Town Crier

For those unfamiliar with the designation, it is for the one who makes public pronouncements though I don’t dress elaborately by tradition nor do I carry a handbell saying “Oyez, oyez” (hear ye, hear ye)

“Twenty percent of knee replacement patients are not happy with their total knee replacements.”                                                                              Orthopedics, This Week Tuesday, June 12, 2018

“Arthroscopy for knee OA did not reduce or delay the need for a TKA”                                                                           Journal Arthroscopy. Sept 23, 9 2017

“Dr. Atul Gawande, a surgeon who was named this week to head the company being formed by Amazon, Berkshire Hathaway and JPMorgan Chase to trim employee healthcare costs, on Thursday cited surgery as the single biggest U.S. healthcare cost and said there are ways to both cut costs and improve patient care” “We need to act through data tracking … to see when treatments are benefiting and when they are not,” Gawande said.                                                                                                          – Headline News Now June 25, 2018

There is an appropriate time and place for a joint replacement; a symptom such as pain in the knee should not be the solitary indication. Neither should every patient with a joint complaint be told by a surgeon “you have bone on bone and need a joint replacement”. My office evaluation before I make an evidence-based outcomes recommendation includes a history and physical before I look at the images. Joint range of motion is equally important as is the review of symptoms prior to reviewing your images for determining if I can help you postpone a joint replacement though my menu of Regenerative and joint Restoration alternatives or whether you should proceed to a total joint replacement. Please be reminded that before I evolved into my present approach to musculoskeletal afflictions, I was an orthopedic surgeon at a major medical center where I headed the joint replacement program for many years. Every patient who goes to a physician is not necessarily an automatic candidate for a procedure offered by that physician. Yesterday, I submitted an application for an FDA monitoring of one of our newest offerings and a good deal of the application was not only based on the scientific basis but the inclusion and exclusion criteria.

There is a time and place for doing something or doing nothing. To determine what is in your best interest, call for a consultation (847) 390-7666 or visit one of my two websites; www.sheinkopmd.com  or www.Ilcellulartherapy.com

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