Dec 20, 2018
How long will the benefits last?
Yesterday, an individual presented in the office on a professional matter for a scheduled business meeting and during our discussions, related that he had undergone right hip arthroscopy, eight weeks earlier. He had an antalgic (painful) gait while walking into the meeting room so I discussed the rationale for undergoing a Platelet Rich Plasma concentrate/Growth Factor Concentrate intervention when he returned to his home base. The individual elected to become my patient on the spot so I performed a physical assessment and noted asymmetrical hip motion with limitation on the right side. His pre-arthroscopic diagnosis was a torn acetabular labrum. In 45 minutes, my team had drawn his blood and prepared the concentrated injectate followed by my completing an ultrasound guided intraarticular right hip injection. Within five minutes, his inability to fully spread his legs, flex and extend his hip, and tolerate internal and external rotation had been corrected. This is not an infrequent observation following a Cellular Orthopedic intervention to the hip; yet I have no explanation for the immediate pain relief and return of joint function. He left the office with almost no discernable limp.
This past Monday, the office received this communication from a patient who began treatment with Bone Marrow Concentrate to her knees about four years ago; returning on several occasions until she reached maximum medial improvement at 18 months post intervention.
“I wanted to write to you and Dr Sheinkop to congratulate you on the published study in the Journal of Translational Medicine in which I was a participant. It is really satisfying to see that results finally in print. I want to thank you both for allowing me to participate, even though I was outside of the Chicago area.
Just to follow up, my knees have been doing really well for the past year. I enjoyed a long summer of bicycling, including regular 20-30 mile rides as well as a 40 and 50-mile ride, without significant pain. I also have been able to use the elliptical pain free and just in the past two weeks I started running on the treadmill (alternating one minute of running & walking for about 20-25 minutes on a 4% incline). I’m starting really slow -but I never thought I would be able to run relatively pain-free again”.
There is no way of predicting how soon and for how long a cellular orthopedic intervention will have an effect. Our ongoing outcomes observations for over six years may eventually help answer the question; but in the meantime, we ask our patients to return periodically so we may learn from them and intervene if needed.
To learn how you may benefit from a Cellular Orthopedic intervention schedule a consultation by calling (847)-390-7666. My web site is at www.sheinkopmd.com.
Tags: Adult Mesenchymal Stem Cells, arthritis, Bone Marrow Concentrate, cellular orthopedics, Clinical Trial. Mitchell B. Sheinkop, Growth Factors, Interventional Orthopedics, Knee Pain Relief, Mesenchymal Stem Cell, micro-fractured fat, Orthopedics, Platelet Rich Plasma, Platelet Rich Plasma concentrate/Growth Factor Concentrate, stem cells, Subchondroplasty, torn labrum
Nov 15, 2018
Mesenchymal Stem Cells, or MSCs, are multipotent stromal cells that can differentiate into a variety of cell types or affect other cells by releasing the proteins categorized as Cytokines and Exosomes. Cytokines are small proteins that are important in cell signaling. The process is quite complex but this introduction allows me to help you better understand the Regenerative Medicine world.
The patient who called this morning indicated that she had not experienced any benefit form an orthobiologic intervention she had several weeks ago; yet on Friday, several patients reported satisfaction and our outcomes surveillance documented significant functional improvement as well. Why the variability in response? Perhaps it might or could be explained by the genetic makeup of the individual’s cartilage or the nature of the biologic intervention. In the current regenerative marketplace, I note advertisements for Amniotic Fluid, Cord Blood, Wharton’s Jelly, Exosomes, Adipose derived and bone marrow derived interventions.
The long-term durability of our cellular orthopedic treatment has been documented in patients for at least five years. The observation of this response is significant, as steroids and viscosupplementation have typically shown to be effective in relieving pain respectively for up to 6 weeks and 6 months. Our earlier research has documented a six-month average response to amniotic fluid and an average 18-month improvement to mechanically processed adipose tissue. Our current biologic interventions contain high concentrations of anti-inflammatory cytokines and anabolic growth factors in addition to Mesenchymal Stem Cells, all modifying the course of disease progression. The short-term pain relief observed is due to the anti-inflammatory effects of the biologics used in the interventions. The long-term pain relief is attributed to potential disease-modifying properties by improving joint homeostasis and cartilage quality. We believe our biologic interventions to be disease-modifying.
What is next? While most readers of this Blog are familiar with the regenerative alternatives, Exosomes are new and there is little if any clinical data available to allow me to opine about clinical usage including safety and efficacy at this time. They are cell-derived vesicles (a small membrane-bound sack that stores and transports substances though out the cell or outside the cell) present in bodily fluids as well as in extracellular matrix. Evidence is accumulating that they play a key role in signaling between cells and may function as a potent anti-inflammatory and disease modifier depending on the environment from which the Exosome is recovered. While the use of non-autologous stem cells is not FDA compliant, to the best of my knowledge, Exosomes produced by Mesenchymal Stem Cells are not restricted and are now being made available for clinical use in arthritis. Stay tuned as we continue to document successes, safety and efficacy in the world of Orthobiologics. To learn more, schedule a consultation by calling (312) 475-1893.
Tags: arthritis, biologics, cytokines, Exosomes, Growth Factor Concentrate, Growth Factors, Mesenchymal Stem Cell, MSC, OA, viscosupplementation
Jun 22, 2018
My regenerative and restorative Cellular Orthopedics practice is for the most part, evidence based. By that I mean, the outcomes data collected over these past five years regarding the several thousand patients with skeletomuscular afflictions that I have treated with a selection of alternatives using a needle and not a knife is generally based on regenerative and restorative interventions. While not everyone has experienced a dramatic change in symptom relief and functional improvement, many have. The statistical outcomes evidence follows a bell shaped curve with some experiencing immediate improvement as I have in both my hips and knees, while most take several weeks or longer with a continuing improvement up to 18 months post intervention. While it is true that five percent of patients are not satisfied after several years and have gone on to a joint replacement, 95% of my patients are well satisfied and have returned to, or never quit doing what they love.
At the onset of my cellular orthopedic initiative, the interventions were solely based on Platelet Rich Plasma options and Bone Marrow Concentrate; today, our menu of services can be customized so as to meet the needs of all seeking to improve the quality of life and avoid a major surgical procedure. Not only can I concentrate PRP as needed, I can customize the concentration to meet a patient’s particular needs using hemo-analysis. Bone Marrow Concentrate rich in Adult Mesenchymal Stem cells, Platelets, Growth Factors and Precursor Cells is still the foundation of my practice, however for the past year, I am able to offer a Platelet Concentrate derived Growth Factor and Protein Solution option when indicated.
Then there are those whose co-morbidity or prescription medication dependency excludes them from the aforementioned autologous choice of options. As of this upcoming Tuesday, I have acquired an intervention technology that will help patients seeking to a void a total joint replacement who are not candidates for existing regenerative medial offerings. There are many reasons to explain a 5% failure rate including genetic cartilaginous variations, any bell shaped curve will have a small number who don’t pass the final examination. Incidentally, if and when such occurs, I offer another intervention frequently at no charge or certainly at a discounted rate.
Should you want to learn more or schedule a consultation, call
(312) 475-1896. You may visit my web site where you will find the webinar at www.Ilcellulartherapy.com.
Tags: bone marrow, cellular orthopedics, Growth Factors, Hip pain, joint pain, joint replacement, knee pain, Mesenchymal Stem Cell, Osteoarthritis, platelets
May 31, 2018
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
Tags: arthritis, Bone Marrow Concentrate, bone on bone, Cartilage, Hip pain, joint pain, knee pain, Mesenchymal Stem Cell, Osteoarthritis, PRP, Regenerative Pain Center
Apr 5, 2018
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
Tags: ankle pain, bone lesion, bone marrow, Cartilage, joint pain, Mesenchymal Stem Cell, Osteoarthritis, osteochondral defect, osteochondral injurie, Osteochondritis Dissecans, Subchondroplasty, Talar Dome lesions
