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

“My doctor told me that I have bone on bone”

It is the most banal, recurring, boring, ordinary and meaningless phrase that my assistant and I have to listen to on the phone or at every office setting. Osteoarthritis is a disease that affects almost all persons to some extent as they age. It may affect one joint, some joints or many joints. The causes may include genetic predisposition, trauma, or any of varying diseases at different ages. No matter the causation be the arthritis primary or secondary, the presentation is progressive pain and decreasing function. The X-ray is diagnostic in most cases: loss of cartilage joint space, subchondral sclerosis and osteophyte formation. The pain generator is inflammation and not bone on bone. Images help with diagnosis; but the degree of arthritic change on X-ray does not necessarily correlate with the severity of the symptoms or the functional impairment.

A normal joint has a bony support, a cartilage interface, a synovial lining, a capsular envelope, stabilizing ligaments and surrounding muscle. All these anatomic structures are affected by the inflammation associated with degenerative changes on a bio-immune basis. When a physician undertakes the care of an arthritic joint, the management is based on addressing the inflammatory pain generators and not until the subchondral bone is severely altered and the cartilage gliding surface has been severely destroyed is a joint replacement indicated (Grade 4 OA). Until that time the classic approach has been weight loss, anti-inflammatories either by mouth or via injection, bracing, strength training, range of motion therapy; that is, until the new world of cellular orthopedics came into being.

My initial approach in my practice is to address pain and altered function from inflammation of osteoarthritis, not “bone on bone”. By a combination and concentration of platelets and growth factors, I now have the ability to reverse the pain generating arthritic inflammation and alter the bio-immune basis for degeneration of the joint; this is called joint preservation. On the other hand, my initiative for joint regeneration is based on autologous bone marrow concentrate; the latter containing in addition to platelets and growth factors, adult mesenchymal stem cells, precursor cells, hemopoietic stem cells and more. The attempts at joint regeneration are directed both to the joint itself by intraarticular injection and subchondral injection; the latter to help repair the supporting bone.

There is a lot to process here so let me address your needs best and answer your questions following an office assessment and a review of images. Call (312) 475-1893 to schedule a consultation. You may learn more on my website www.Ilcellulartherapy.com where you will find our webinar

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The foot bone’s connected to the ankle bone

If you remember those children’s song lyrics, you will march right up the skeleton. The orthopedic message is that what’s happening in your foot and ankle will affect the well-being of your knee and hip. I was reminded of the continuum on Tuesday when a patient I had treated in November of 2017 returned for follow up this past Tuesday. Once a prominent running back at the college level, he had presented 20 years after a “high ankle sprain” with a Talar Dome Lesion at the right ankle and early onset post traumatic arthritis; in plain speak, an injury to the cartilage and underlying bone. Not only did the right ankle impairment affect his foot and ankle, he was experiencing progressive pain in his knee and hip thus altering his gait, his fitness pursuits and forcing change in his recreational profile. Running was no longer possible nor was snowboarding.

Increasingly, these Talar Dome lesions or osteochondral injuries are being diagnosed long after what was thought to have been a sprained ankle. In the case of my patient, last November, I performed a minimally invasive procedure wherein bone marrow was aspirated from his pelvis, concentrated, processed, and injected into both the ankle joint and bone marrow defect of the talus under fluoroscopic guidance. Osteochondral injuries and bone marrow lesions are a continuum of small posttraumatic defects that pathologists have shown represent a failed healing response. Most readily diagnosed on an MRI, with time, a rim of sclerosis may develop so the abnormality may lend itself to diagnosis with an X-ray. This type of defect is not limited to the ankle and may be found throughout the extremities and pelvis. They may be found in any joint region that sees weight bearing or repetitive stress though; most commonly, they are associated with trauma as was the case, though long removed in my patient.  

In the case of this vignette, on Tuesday I had determined that ankle and subtalar joint motions had become symmetrical. He no longer complained of pain; equally important, the bony defect and joint changes could no longer be seen on X-ray. In short, he had healed. In the past six months, I have followed two other equally rewarding Bone Marrow (stem cell/growth factor/platelet) intervention outcomes at the talus and more than six around the knee.

If you are experiencing joint pain and altered function without an explanation or in spite of a course of “conservative” treatment, it may be time to learn more about how Bone Marrow Concentrate, that is stem cells, platelets and growth factors, may relieve bone and joint pain, restore function and help you postpone, perhaps even avoid a major surgical procedure.

Call 312 475 1896 to schedule a consultation or visit my web site and watch the webinar at www.ilcellulartherapy.com

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    Why the Stem Cell interventions work for some but not all?

The scientific facts do not support one “stem cell” treatment for all. Osteoarthritis is a complex process and we now know for what there has been recently identified two distinct genetic subgroups. OA is a joint disease with variable causes, symptoms and outcome. It is estimated that genetic makeup accounts for about 50% predisposition while major risk factors also include aging, trauma and obesity. Disease changes in most joint tissues include cartilage, bone, synovium, ligaments, and adjunct tissues, secondarily muscle, leading to pain and altered function. The progression of OA leads to abnormal intra-articular failure of repair as a result of biochemical, biomechanical and aforementioned genetic factors.

Over the last several days, three patient related encounters have captured my attention and I thought it would be worth examining in this blog. I received a phone call from the husband of a patient who had undergone a regenerative procedure in California some months earlier on both knees; and while the procedure had benefitted one side, the other knee was actually worse than prior to the procedure. He was looking for an explanation. Not ever having assessed the patient in my office, it is most difficult to opine as there are multiple possibilities including the genetic subgroup stratification factor. Most recently, I have observed that patients with swelling (effusion) at the time of an intervention do not do as well as those without effusion. There are several reasons behind the negative influence, but I now make sure to remove the unwanted fluid prior to the delivery of cellular product.

The second patient related issue called to my attention was the result of a question “may I use a cane?” If ever there were an uncomplicated adjunct for an osteoarthritic hip or knee, the tried and proven benefit of a walking stick needs to be reemphasized. There are no side effects from a cane; no ulcers, strokes, heart attacks, kidney failure, etc., and so forth. The cane or walking stick has no downside. They enhance pain relief while walking, assist in stability, prevent falls and are readily available, should it be needed as a defensive facilitator. When you watch the annual screening of the movie classic Moses, Prince of Egypt next Passover and Easter weekend, you may be reminded about the history of the use of a walking stick. The Pharaohs did it, Shepherds used them, Moses did, Jesus did and so do I (when I fly fish or I used to).

Finally, let’s relive my own personal weekend experience. It was Saturday afternoon in the Driftless area of Southwest Wisconsin on Tainter Creek. I parked the car and walked down a gravel road, semi vaulting a barbed wire fence, thus gaining access to a very long stretch of the creek. Though the cow pasture was fenced off, the posted DNR sign indicated that public fishing was legal. I walked for 20 minutes down the uneven, rocky trail until I decided it was time to enter the stream. As a climbed down the embankment, I reached back for my walking stick and immediately realized it in the trunk of the car. This marks the first time in seven years I was able to do what I had just done without my walking stick. The event took place 12 weeks after my cellular orthopedic right and left knee procedures and 10 weeks following those in my hips.

If you want more information, call and schedule a consultation:   (312) 475-1893

You may visit my web site and watch the webinar   www.ilcellulartherapy .com

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When it comes to Stem Cells and cartilage, Use it or Lose it

When it comes to Stem Cells and cartilage, Use it or Lose it

Thickening and increase of area of cartilage have been proposed as two alternative mechanisms of cartilage functional adaptation. The latter has been reported in endurance sportsmen. In weightlifters, extreme strain applied to the articular surfaces can result in other forms of adaptation. The aim of this research is to determine whether cartilage thickness is greater in elite weightlifters than in physically inactive men. Weightlifters (13) and 20 controls [age and body mass index (BMI) matched] underwent knee Magnetic Resonance Imaging (MRI). A single sagittal slice of the knee was taken and cartilage thickness was measured in five and six regions of the medial and lateral femoral condyles, respectively. The analyzed segments represented weight-bearing and non-weight-bearing regions. The tibia cartilage in the weight-bearing area was also measured. The time of training onset and its duration in the weightlifter group were recorded. The cartilage was found to be significantly thicker in weightlifters in most of the analyzed regions. The distribution of cartilage thickness on the medial and lateral femoral condyles was similar in both groups. The duration of training was not associated with cartilage thickness, but the time of training onset correlated inversely with cartilage thickness. It is possible that in high-strain sports, joint cartilage can undergo functional adaptation by thickening. Thus, mechanical loading history could exert a postnatal influence on cartilage morphology. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.”

Although, many physicians warn against jogging, to the best of my knowledge, there is no scientific evidence that running or jogging injures cartilage. Now there is evidence that loading cartilage is beneficial. Certainly, there is still much to be learned about maintaining joint health when it comes to the musculoskeletal care of the aging athlete. Remember, as I have stated many times in my Blogs, cartilage is only part of what makes up the joint. The cartilage joint space as determined by the space between bones is hyaline in nature. Then there is meniscal cartilage that is of a different cellular and chemical makeup. The lining of the joint is synovium and this can become a source of chronic inflammation. Next are the ligaments and capsule so injury and arthritis affect the entire joint and not just what is seen or not seen in an X-ray; arthritis is the result of a bio-immune response and not simply mechanical injury. That’s where stem cells may come to the rescue along with weight loss and strength training. Stem Cells seem to have a place in influencing the well being of the joint at any age; first as an anti-inflammatory, then as an immune modulator. What about cartilage regeneration? I don’t know for sure yet, there is probably an inverse relationship with the potential for cartilage regeneration and age. On the other hand, if a bone marrow aspirate concentrate intervention in an injured or arthritic joint helps maintain the well being of the mature athlete, I am not concerned about the MRI 18 months later.

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