Sep 11, 2014
From time to time, I feel it my responsibility to call the readers’ attention to the writings of others because of the constantly changing knowledge concerning Musculoskeletal Care of the Aging Athlete. The September issue of the Journal of the American Academy of Orthopedic Surgeons, featured a Review Article from the Department of Orthopaedics, Warren Alpert Medical School of Brown University: The Effects of Fitness on the Aging Process. The last sentence in the abstract states “A large segment of older sedentary adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles”; and that’s why I am writing this Blog
Decades of research support the fact that much age-related deterioration is the result of the effects of sedentary lifestyles and the resultant medical conditions rather than aging itself. A continually growing body of scientific and clinical evidence demonstrates how active persons modulate physical decline through training. There is a well recognized age related decline in the musculoskeletal system as bone looses density, the strength and flexibility of muscle decreases, ligaments and tendons stiffen up, and the structure of cartilage degenerates. At the same time, the aging process is accompanied by obesity, cardiovascular disease, type 2 diabetes and other leading causes of infirmity and death.
Earlier this week, I spoke with a patient whose family I have taken care or for over 35 years including having performed hip replacement surgery on her husband some years ago. Her chief complaint had to do with her knee discomfort that was increasingly limiting her fitness and recreational profile as well as her activities of daily living. I had requested that she complete imaging and I was following up with my recommendation. Her principle concern had to do with accelerated aging if she did not maintain her fitness regime.
In summary, a growing body of scientific evidence supports how active adults modulate age-related decline in various areas of the musculoskeletal system. Bone Marrow Aspirate Concentrate derived Mesenchymal Stem Cells may help intervene in a chronic and progressively limiting arthritic process or hasten the healing in an acute injury. For those who have tried MSCs once and not enjoyed the sought after outcome, come on back and let’s do it again. This time though with a full commitment to modifying the aging process though stem cell intervention and the pursuit of fitness.
Tags: arthritis, athletes, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Mature Athlete, Orthopedic Care, Osteoarthritis, Regenerative, stem cells
Aug 11, 2014
Last Thursday, I presented my Data on our minimum 12 month Outcomes regarding Marrow Aspirate Concentrate derived Stem Cells for Osteoarthritis of the knee to the Regenexx 3rd Annual Conference. It was held at the Scientific and Research Institute in Thornton, Colorado. The baseline number included 118 patients. While I presented the customary orthopedic objective data on the patient cohort such as point scores, Range of motion, patient satisfaction, psychological profiles and pain scores, I introduced two new Scoring parameters: 1) Activity Scores and 2) Comparison to Knee Replacement Outcomes.
Activity Scores are increasingly recognized as an objective outcome measurement documenting results without superimposed psychological disability, sociological factors, and serves as a quantitative measure of how much rather than how well. We measured impact sports breaking them down into very active categories, active, moderate and mild categories. In each category, the patients who had undergone stem cell intervention scored very well in either returning to a prior level of activity recently abandoned or actually advancing to a higher category of activity. As an example, I saw a patient last week six weeks past stem cell intervention for osteoarthritis of the knee. He had presented for treatment when his ability to walk was less than a city block. He marched in six weeks post treatment without a smile indicating that he was dissatisfied, as he still needed to use a handrail for stairs. When I asked him how he got to the office for the six-week follow-up, he responded that he had walked from home. I then inquired how far? His response ” 3 and 1/2 miles”.
In comparing knee replacement outcomes to stem cell interventions, the mean functional score for patients who had received Total Knee Prosthesis at a minimum of one year was 67. In comparison, the functional score for BMAC Stem Cell interventions was 90.5. While it may be that the stem cell population was not exactly comparable to those who had received a Total Knee Replacement, you decide, knee replacement or try stem cells first.
Tags: arthritis, arthritis treatment, athletes, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Hip Replacement, Interventional Orthopedics, Mature Athlete, Orthopedic Surgeon, Osteoarthritis, Regenexx-SD, stem cells
Aug 6, 2014
“Get this—K just tried a 100 mile race, at altitude (no acclimation) in Aspen w/13,500 vertical. Missed a turn (and missed steepest dirt road in America, approx 2,000 vertical) and “only” did almost 90 miles and over 11,500 vertical. Hard day, eh?”
This was an email I received yesterday from K’s father-in-law. What makes the setting so fabulous is that K (I won’t use his full name) was in his mid 30’s two years ago and was so impaired by arthritis of his hips that he was investigating total hip replacements, unable to walk a full city block let alone pursue his riding passion. Incidentally,that picture at the top was taken of me by my eldest son after a long bike ride up and down the hills of Southwest Wisconsin yesterday.
“Orthopedic Surgery is going through a serious paradigm shift: instead of simply removing and replacing damaged tissues with artificial devices and materials, autologous patelet-rich plasma in orthopedics are aimed at triggering and enhancing the natural in vivo tissue morphogenesis and regenerative capacity of damaged tissue” from The Journal of the American Academy of Orthopaedic Surgeons, August 2014
We have taken it much further over the past two years morphing into Bone Marrow Aspirate Concentrate providing the Adult Mesenchymal Stem cells potential that not only has the anti-inflammatory possibilities of Platelet Rich Plasma; but introduces the possibility of replacing damaged cartilage and altering the natural history of degenerative arthritis. I am aware that we must continue optimizing the procedure at the same time that I continue to offer my patients the healing power of Bone Marrow Aspirate Concentrate. To this end, I am off to the yearly Regenexx Network meeting in Colorado later this week where I will present our outcomes data. What’s amazing is how favorably, the measurement of Activity level after a Stem Cell intervention compares with a joint replacement. As you can see from the results of the cyclist identified above as K, there is reason to pause and consider the question when dealing with an arthritic joint; Total Joint Replacement or try Stem Cells first?
Tags: activity level, arthritis, athletes, Bone Marrow Concentrate, Clinical Trial. Mitchell B. Sheinkop, Mature Athlete, Osteoarthritis, Regenerative
Jul 21, 2014
Outside of our initiatives at Regenexx and a few others, it seems that all of the research of which I am aware using stem cells in joints is focused on trying to treat focal defects in cartilage and not degeneration of the whole joint. A focal defect is not unlike a pothole in a Chicago street; the approach is a patch. The challenge in the osteoarthritic joint is not only cartilage regeneration but also the whole structure. Cartilage, capsule, the synovial lining, the inflammatory component, and reversal of a bio-immune process must be addressed. Stem Cells can regenerate cartilage and stem cells are readily available in bone marrow. Bone marrow aspirate concentrate additionally has the potential to act as an effective anti-inflammatory agent, while reversing the bio-immune progression of osteoarthritis.
Recent advances in the understanding of the progression of degenerative arthritis have introduced the possibility of Mechanical Loading as a potential Preventive and Therapeutic Strategy for Osteoarthitis. The laboratory has demonstrated that mechanical loading is an extremely important factor in cartilage well being. Although over use and underuse are risk factors for cartilage degradation, moderate dynamic loading is not only associated with a healthy lifestyle, but they are very important preventive and therapeutic strategies for OA. Such activity suppresses inflammation, inhibits joint breakdown, and enhances joint regeneration. The biochemical explanation is the balance between Interleukin-1 and IL-1 Receptor antagonist (IL-1Ra). It may well be that Mechanical Loading increases IL-1Ra and lessens the presence of IL-1, the latter accounting for cessation of cartilage repair.
The definition of “Moderate” Physical Activity certainly may vary for a particular individual depending on that person’s age, genetics, gender, and physical activity history. This weekend, I ran on Saturday and cycled on Sunday. That may be a bit more than the average. Today, I row the ergometer and strength train. For those less obsessive, a new study funded in apart by the National Institutes of Health, examined whether walking could reduce the risk of functional limitations for people with knee OA. The result: 6,000 steps a day keeps knee OA limitations away. You don’t become inactive because you grow old; you grow old because you become inactive to paraphrase a great intellectual.
Tags: arthritis, athletes, Mature Athlete, Mechanical Loading, Osteoarthritis, Regnerative Medicine, stem cells
Jun 26, 2014
If you are watching the World Cup Games in Brazil, and how could you not (even I have become a soccer fan), you are very much aware of Critiano Ronaldo and his sudden exit from Brazil because of “tendinitis´”of the knees. I have never examined him and whether it is tendinitis or something else that has caused the Portuguese star to leave the team is uncertain. What is certain is his impact on the game of Portugal against the US last Sunday. Now the question is whether his career is over or whether his knee tendinitis will respond to treatment and rehabilitation? At Wimbledon, Rafael Nadal is having a difficult time as well on a grass surface.
So what is the answer? Assume if you will that the X-ray and MRI of Ronaldo’s knees with the physical examination confirm tendinitis. Is it a matter of physical therapy and anti-inflammatories? Whether I am describing the plight of world class athlete or involved in the musculoskeletal care of an aging athlete, Cellular Orthopedics has a role. When the usual and customary regimen of rest, physical therapy, anti-inflammatory medication, and cortisone injections don’t do the trick, Regenerative Medicine modalities have a role. There are two basic approaches in Cellular Orthopedics. One is blood based Platelet Rich Plasma (PRP); the other, bone marrow aspirate concentrate derived Mesenchymal Stem Cells (MSC)
PRP contains cytokines and growth factors that both recruit your own stem cells circulating in your blood as well as influence the healing process. MSCs from your bone marrow initiate a robust regenerative process as well as provide the most effective anti-inflammatory physiologic influence known to medicine. It is all done with a needle as an outpatient and both significantly reduce the healing time for an injury and cause healing of soft tissue, cartilage and bone when it might not otherwise happen. Ronaldo and Rafa, the Regenerative Pain Center is waiting for your call; more important, we are there to help with the Musculoskeletal Care of any aging athlete.
Tags: arthritis, bone marrow, Clinical Trial. Mitchell B. Sheinkop, Interventional Orthopedics, Knee, Mature Athlete, Osteoarthritis, stem cells
