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
As written a week ago, I attended a Regenerative Medicine International Conference in Las Vegas for the purpose of presenting a scientific paper that has generated a lot of interest and may influence how others practice Regenerative Medicine for arthritis. The meeting also served as a vehicle of continuing Cellular Orthopedic Education. The science of cellular biology is dynamic. It has been a major undertaking for me these past several years not only to have exchanged the scalpel for a trochar needle when managing arthritis but to reeducate in the basic science cellular biology.
Three years ago, the Adult Mesenchymal Stem Cell was thought of as a precursor cell directly responsible for replacing cartilage in the arthritic joint. The thought at the time was that the Stem Cell would take on the characteristics of whatever environment into which it happened to be placed and morph into that tissue or organ. In just three years, scientists have changed their thinking based on continuing research. The Mesenchymal Stem Cell (MSC) is no longer looked at as a progenitor but rather, a Medicinal Signaling Cell directing the body’s response to injury. When placed into a joint, it signals molecules and cells from the local environment and from distant locations to alter the bio-immune response of osteoarthritis, act as an anti-inflammatory, relieve pain, improve function and perhaps regenerate cartilage. We have also learned that while one Bone Marrow Aspirate Concentrate intervention causes improvement, several may be the answer over an 18 to 36 month period. In addition, there is increasing evidence that not only should the joint itself be addressed but the bone immediately adjacent to the joint as well. In the orthopedic community, Subchondroplasty has been applied over the past several years for the patient with a painful joint, relatively “normal” X-ray and an MRI compatible with bone marrow changes in the bone adjacent to the painful joint. That core decompression might be visualized as a dentist relieving the pain and pressure of a cavity by drilling. In the case of the dentist, the resultant void is filled with a synthetic material. In the case of the orthopedic surgeon, the cavity created by drilling is filled with calcium phosphate. At Regenexx Chicago, – my practice, I will introduce the subchondroplasty, a minimally invasive needling for the bone adjacent to the joint in addition to the joint itself filling the voids created in the bone as I fill the arthritic joint with Bone Marrow Aspirate Concentrate. The Europeans have documented success and I will be able to improve results and extend indications with Bone Marrow Aspirate Concentrate for the arthritic joint and now the surrounding bone.
Tags: arthritis, athletes, Benefits and Risk, bone marrow, Bone Marrow Concentrate, Hip, Hip Replacement, Interventional Orthopedics, joint replacement, Knee, Knee Pain Relief, Mature Athlete, medicine, Microfracture surgery, Orthopedic Care, Orthopedic Surgeon, Orthopedics, Osteoarthritis, Osteochondritis Dissecans, Pain Management, stem cells, treatment
With the increasing data supporting biological repair of certain forms of ACL injury and with the increasing evidence supporting cartilage repair in an injured joint, is there a case for expanding the scope of Bone Marrow Aspirated Concentrate to these increasingly common injuries in the adolescent? For one, the healthiest resource for active and large numbers of mesenchymal derived stem cells is the marrow of an adolescent. There are all kinds of operative approaches for the adolescent presenting with Osteochondritis Dissecans from debridement to whole segment cartilage grafting through open procedures. The net result though of OD in a weight bearing zone is early onset osteoarthritis. There is ever increasing scientific evidence that the adverse long term outcome of joint trauma may be reversed by early application of mesenchymal stem cells. If you add to the treatment algorithm, the cartilage restoration potential of stem cells in the joints of patient’s under age 40, the fact about stem cell repair in adolescents speaks for itself
Turning our discussion to the adolescent Anterior Cruciate Ligament injury, there is no question that said surgical repair has limited survivorship and is only the beginning of a series of revisions over a lifetime. With the recent evidence reported by Regenexx at its annual network meeting, there is a roll for stem cell management of ACL injury in selected cases. Presented were several successfully repaired ACL ruptures in adolescent girls who had sustained recent injury on the athletic field. While we are early in the development of Regenerative Medicine and stem cell treatment for orthopedic injury is still investigational, there are no bridges burned; and just maybe, a lifetime of repeat surgical procedures avoided.
I had occasion on Monday to discuss the stem cell debate with a writer for an orthopedic weekly newsletter. I pointed out that we have been using stem cells in orthopedics for over 70 years whenever we harvest tissue from elsewhere for repairing a defect be it traumatic or degenerative. Bone graft is a means of delivering stem cells to foster bone healing from any cause. Tendon graft is a means of facilitating healing of a traumatic instability, another application of stem cells to effect healing. It just maybe that the legal and payer bottlenecks are the result of lack of clinical understanding of what orthopedics is all about. Would a repackaging of terminology change the stem cell debate in the USA? Stay tuned!
Mitchell B. Sheinkop, M.D.
1565 N. LaSalle St . Chicago . Illinois . 60610
Tags: ACL Injury, Osteochondritis Dissecans