Nonobstructive meniscal tears
There is increasing evidence to suggest that patients with meniscal tears at the knee that do not cause “clunking”, giving way, or locking; hence nonobstructive, may benefit from Cellular Orthopedic intervention coupled with physical therapy. Previous studies involving patients over 45 years of age comparing arthroscopy with physical therapy for nonobstructive meniscal tears as seen on an MRI justify an initial conservative approach; but patient satisfaction may require 24 months to achieve. For those patients who undergo arthroscopic surgery, there is a significant increased risk of repeat knee surgery. In our practice, those patients electing to use the Physical Therapy option without surgery but with a Cellular Orthopedic intervention minimized the length of time needed to return to full activity.
Number of stem cells in amniotic fluid
The functionality of stem cells in amniotic fluid as sold today is a myth. Research shows that 250cc of fresh C-section delivered amniotic fluid, when introduced immediately into culture, only yields 40 stem cells. This means there are 0.16 stem cells per 1 cc of full-term amniotic fluid. Scientific literature referred to by the amniotic fluid marketing forces is based on amniotic fluid collected early in pregnancy.
Acetabular Labral Tear
A hip (acetabular) labral tear is damage to cartilage and tissue in the hip socket. In some cases, it causes no symptoms. In others it causes pain in the groin. Just because a tear is seen in the hip labrum on an MRI, it does not mean the tear is necessarily the cause of the pain. Before initiating treatment, the orthopedic surgeon must exclude that an underlying arthritic condition within the hip is not the real pain generator. More recently recognized is predisposition for a tear in those with abnormal acetabular architecture.
On biologics for knee osteoarthritis
Orthobiologics may become a mainstream treatment for knee osteoarthritis. While Platelet-rich plasma and hyaluronic acid injections are the most established biologics-based treatments for knee osteoarthritis so far, it’s not too early to make confident use of stem cells. At the same time, I must continually warn patients to be particularly careful about claims for these substances. All recommendations for intervention must be FDA compliant and evidence based. (To learn about my contributions to the cellular orthopedic scientific evidence, visit www.sheinkopmd.com. Under the information bullet on the top, you will find published articles)
Eventually, I believe the science and FDA will triumph over quackery and orthobiologics will become an essential part of every knee surgeon’s armamentarium. Available orthobiologics, include:
- Hyaluronic acid
- Platelet-rich plasma
- Cytokine modulation
- Stem Cells
- Adipose tissue
To learn more or to schedule an evidence based consultation, call (847) 390-7666
Tags: adipose tissue, amniotic fluid, biologics, bone marrow, cytokine modulation, Exosomes, fat, hyaluronic, joint, labral tear, Micro-Fractured Adipose, orthobiologics, Osteoarthritis, pain, Platelet Rich Plasma, PRP, renovation, stem cell, torn meniscus
The truth about reparative medicine in orthopaedics and why it matters to you is that in the USA, millions of people suffer from orthopedic conditions and are looking for options to major surgery. At the same time, there is a segment of the population that can’t safely undergo a major joint replacement procedure. Then there are those who are highly active and are looking to keep up with their sporting activities and an unlimited life style. The older generation is living longer and very active. The younger generation is also participating in sports and playing for a longer period. The wear and tear in joints cause pain and ultimately may cause or aggravate an arthritic process. There is an option to surgery and a means of postponing, perhaps avoiding a Total Joint Replacement. While Cellular Orthopaedics (Regenerative Medicine), offers a reparative technology, it is important to recognize that all therapies in the marketplace are not equal. There are many different types of tissues: fat, bone marrow, amniotic fluid, placental tissue, cord blood, Wharton’s Jelly, and circulating blood marketed for intervention but only concentrate from your own bone marrow, concentrate and filtered platelet product from your own blood, and now micro-fractured fat from your own adipose tissue meet FDA compliance requirements.
Over the past ten years, advances in reparative medicine have resulted from science and research behind the different options. You may read about my role at www.sheinkopmd.com/published-research-articles/ to learn more. I was one of the first orthopaedic surgeons to study the effects of Micro-fractured Fat (Lipogems) in patients with Grade 4 Osteoarthritis of the knee who were en route to a Total Knee Replacement. Now that the FDA has granted clearance, many physicians are showing up with claims of offering adipose stem cells. While fat has reparative qualities and can help promote a healing environment, it is not a resource for cartilage regeneration.
As always though in the current health marketing environment, a patient must guard against misrepresentation of product, effect and outcomes. The article I published in November of 2018, is the only scholarly article of which I am aware that has true clinical adipose outcomes data. https://www.amjorthopedics.com/article/safety-and-efficacy-percutaneous-injection-lipogems-micro-fractured-adipose-tissue. Those clinics offering a type of fat technology that is processed using enzymes and manipulates the cells are doing so by failing to abide by FDA Guidance. Additionally, some providers are offering “Stem Cell Treatments” at very high costs and thus mislead the public along with the parasites, camp followers and charlatans promoting amniotic fluid, cord blood and Wharton’s jelly. Our goal is to provide the right treatment options for a patient with solutions that have strong scientific evidence behind the technology and are cleared by the FDA. I am happy to be a leader in the Evidence Based initiative.
To schedule a consultation call (847) 390-7666 You may visit my web site at www.sheinkopmd.com
Tags: adipose stem cell, fat, lipogems, micro fracture, orthopaedic, PRP, stem cell