On Monday, the annual migration for attempts at the physical Restoration and Regeneration of the NFL players injured bodies began. While in the past, the losers would chant “wait ‘til next year”; very soon, the NFL winners and losers alike will take flight to Orthopedic Surgeons around the USA and world, on occasion, some will even find their way to my office, seeking both operative and non-operative repair of the injuries incurred over the last eight months. What I will offer is Regenerative and Restorative initiatives using either the patient’s bone marrow, circulating blood or body fat. While I use a needle and not a knife in my practice, at times it takes arthroscopy and open surgical procedures to assist the athlete in returning to play or extending a career. The fall NFL 2019 schedule is already on line; there is a sense of urgency. These attempts at restoring and regenerating anatomic and physical well-being are not limited to the professional football player. To the best of my recollection, it was Tiger Woods in 2008, who brought regenerative medicine to the attention of the American public. When in 2011, Kobe Bryant traveled to Dusseldorf, Germany for a highly publicized orthobiologic treatment of his arthritic knee, returning to play for another six seasons, he was soon after followed by the professional golfer Fred Couples, baseball player Alex Rodriguez, and NFL star Payton Manning. All returned to their respective sport and extended playing careers; many more have followed. Now Cellular Orthopedics, Regenerative Medicine and Joint Restoration are available around our country as well as at my office for professional, college, high school, amateur athletes and fitness enthusiasts of any age.
Orthobiologics and Cellular Orthopedics are a dynamic approach to body injury and arthritis using the individual’s own (autologous) platelets, molecules and proteins circulating in the blood (Cytokines and Growth factors), adipose tissue, or bone marrow to effect healing and eliminate pain. At this time, it is FDA Compliant to use such in the care and treatment of injury and arthritis as long as that which is to be used has been harvested from the patient herself or himself, not cultured or expanded, and not treated with additional agents. The successes are no longer merely anecdotal; there is an ever-increasing body of scientific evidence to validate the emerging discipline of Cellular Orthopedics. For instance, in my office, I integrate patient care with documenting outcomes and that has led to several recent scientific publications contributing to an evidence-based orthobiologics practice. You may find those publications and more at my web site www.sheinkopmd.com. To schedule a consultation call (847) 390-7666.
There is a way of still being an athlete and significantly reducing your risk of injury, take up esports. Marquette University is adding varsity esports, a competitive video gaming team in the fall of 2019. The team will have tryouts, coaches and regular practices just like any intercollegiate sport
Tags: arthritis, athletes, autologous, avascular necrosis, bone marrow, cellular orthopedics, cytokines, esports, Growth Factors, injury, joint pain, joint replacement, joint restoration, knee pain, meniscus tear, MSC, OA, orthobiologic, Orthopedic Surgeon, Osteoarthritis, Pain Management, pain reduction, patyon manning, platelets, PRP, sports injury, sports medicine, stem cells, superbowl, surgery, tiger woods, torn labrum
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
You may recall from my last several Blogs that The American Journal of Orthopedics published my paper in November: Safety and Efficacy of Micro-Fractured Adipose Tissue for Knee Arthritis. While surfing the internet this morning, I noted that many physicians are labeling the procedure a source of stem cells; it is not.
Lipogems is now U.S. Food and Drug Administration (FDA) approved for use in Orthopedics. The proprietary name is applied to a Micro-fragmented Adipose Tissue Transplant System that was the technology I introduced and monitored in a scientific clinical trial dating back three years leading to the publication. Federal regulators have now cleared the way for the device and technology that uses a patient’s own body fat (known clinically as adipose tissue) to assist in the healing process. Lipogems is attractive to orthopedic physicians because it is compliant with the latest FDA guidelines and is cleared for use in orthopedics. Unfortunately, clinics and physicians are erroneously, describing the procedure as a source of stem cells; I will emphasize again it is not. Even the Lipogems company uses term reparative and not regenerative.
The Power of Fat
When I grew up, my grandmother and mother fed me chicken soup for whatever ailed me. Many patients are looking for another option to major invasive surgery. Fat has many important cells and is easy to get from the patient’s body. Micro fragmented adipose tissue may be an option for patients who have tried physical therapy, nonsteroidal anti-inflammatory drugs, or steroid injections, and other treatments that have not provided enough relief.
In November 2017, the FDA finalized its rules guiding the use of Human Cellular and Tissue Products. The Agency reaffirmed that the Lipogems system meets the new guidelines’ criteria for minimal manipulation of the tissue, and that it is intended for homologous use. “Fat has been used for many years in support of the repair or replacement of damaged or injured tissue,” according to Dr. Arnold Caplan of Case Western Reserve University in Cleveland, Ohio. “Fat has a high concentration of reparative cells and is a very powerful tissue. How the fat is processed makes a huge difference on the quality of the tissue and if it meets the new FDA guidelines.”
To schedule an evidence-based consultation for your arthritic joint, call (847) 390-7666.
You may access my website at www.sheinkopmd.com
If you schedule before the end of the year, I will share my wife’s chicken soup recipe on request
Tags: arthritis, athletes, Clinical Studies, Clinical Trial. Mitchell B. Sheinkop, FDA, Interventional Orthopedics, knee pain, lipogems, Micro-fragmented Adipose Tissue Transplant, Osteoarthritis, stem cells
My Blog has frequently addressed the false ads claiming Amniotic Fluid, Chord Blood, Wharton’s Jelly and the like contain living stem cells emphasizing that the processes of preservation and sterilization followed by freezing kills off any living cells. Sylvia Perez first addressed the issue on Fox News’ Conversation in Health, January 29, 2018 and Pam Zekman posted her investigative report on WBBM-TV, the week before Thanksgiving. Yet patients continue falling for the hoax.
In contrast, let’s address the positive, cellular orthopedics; the ongoing practice of evidence- based medicine. Below are two statistically significant scientific studies that play a role in helping determine the best possible outcomes to a regenerative intervention
November 21, 2018
Safety and Efficacy of Micro-Fractured Adipose Tissue for Knee Osteoarthritis
New research published by TOBI Faculty suggests autologous, micro-fractured, minimally manipulated adipose tissue may represent a nonsurgical treatment option for knee osteoarthritis patients seeking alternatives to total knee replacement.
Congratulations Jay Panchal, MD, Gerard Malanga, MD, Mitchell Sheinkop, MD on this new publication in The American Journal of Orthopedics.
Safety and Efficacy of Percutaneous Injection of Lipogems Micro-Fractured Adipose Tissue for Osteoarthritic Knees
To download or read the publication: https://www.amjorthopedics.com/article/safety-and-efficacy-percutaneous-injection-lipogems-micro-fractured-adipose-tissue
Treatment of Knee Osteoarthritis with Autologous Bone Marrow Concentrate and Cytokine Concentrate – A Prospective Clinical Case Series Study
Abstract submitted to the Orthopedic Research Society Annual Meeting, 2019
Mitchell B. Sheinkop1 , Marry Langhenry2 , Jizong Gao3 1. Orthopedic Surgery, Rush University, Chicago, IL.2. Cellular Orthopedics, Chicago, IL 3. Celling Biosciences, Austin, Texas.
INTRODUCTION: Osteoarthritis (OA) is an organ disease that affects most structures of the joints including cartilage, synovium and subchondral bone. The pathophysiology of knee osteoarthritis can be broken down into pathoanatomy, cell biology, and genetics. Although fibrillation of articular cartilage is regarded as the primary changes and potential cause of clinical symptoms, the synovium and capsule undergo progressively inflammatory changes and secrete proteolytic enzymes that may contribute to the progression of OA. Meanwhile, the subchondral bone tissue develops lytic lesions with edema, sclerosis, and cyst formation. Therefore, it has been recommended that the treatment of OA should be a comprehensive approach to create a homeostatic environment to facilitate the OA treatment with a long-lasting outcome. Bone marrow contains mesenchymal stem cells (MSCs). Different cytokines such as alpha 2-macroglobulin (A2M) (Wang et al) and growth factors have been identified in the blood and bone marrow aspirate. Either bone marrow concentrate (BMC) or MSCs have been injected into the knee joint to treat OA with promising clinical outcomes. Hernigou et al reported that injection of BMC into the subchondral bone area was able to delay or eliminate the need for total knee arthroplasty (TKA) and clinical outcome was comparable to TKA in the contralateral knee. Cytokines and growth factors in the blood or bone marrow aspirate were concentrated by filtering method to prepare autologous therapeutic biologics. In the current study, a consecutive series of patients with moderate to severe OA were treated by intra-articular and intra-subchondral bone injection of BMC and autologous concentrated cytokines/growth factors. The quantity of representative cytokines and growth factors in the concentrate were also measured. Patients were evaluated for the improvement of systems and knee functions by following up to 6 months after injection. METHODS: This prospective case series study was approved by the Institutional Review Board.
To learn more or to schedule an evidence-based consultation call (847) 390-7666
You may visit my web site and read my blogs at www.sheinkopmd.com
Regenerative Medicine is an option for those with arthritis but don’t be fleeced by the hucksters and camp followers.
Tags: autologous bone marrow concentrate, biologics, BMC, cellular orthopedics, cytokine concentrate, Growth Factors, knee pain, lipogems, Micro-Fractured Adipose, MSC, OA, Orthopedic Surgeon, Osteoarthritis, PRP, regenerative medicine, stem cells, suchondral, TOBI
In general, a Growth Factor is a term used to describe a protein produced be a variety of different cell types that binds to specific receptors on different cellular surfaces. They may on the one hand stimulate cell growth; on the other hand, some growth factors may block actions on target cells of a different protein. Cytokines are another class of signaling proteins more closely related to hormones. The subject matter is quite complex; but, I wanted to introduce the subject of Growth Factors into my Blog as growth factors are increasingly gaining attention in combating and reversing the progression of arthritis.
Already in use is Tissue Necrosis Factor-alpha blocker, frequently prescribed in a proprietary form as Humera, for inflammatory arthritis and arthropathy such as Rheumatoid Arthritis, Psoriatic Arthropathy and Ankylosing Spondylitis. It works by blocking a protein (TNF-Alpha), found in the body’s immune system and responsible for joint swelling and inflammation. By so doing, Humera reduces symptoms, prevents bone and cartilage damage and improves physical function.
Outside of the United States, Interleukin 1 Receptor Antagonist Protein (IRAP) is used for the symptoms of grades 2 and 3 Osteoarthritis by binding to the cell surface and preventing IL-1 from sending a proinflammatory message to that cell. IRAP is currently the basis for a clinical trial taking place in the United States to document its safety and efficacy. The sponsors of the trial hope for full enrollment and outcomes analysis in the not too distant future; so, the Growth Factor might be used with FDA approval in clinical practice. It was for IRAP that one-time basketball great Kobe Bryant, travelled to Dusseldorf Germany, ten years ago with grade 4 osteoarthritis of the knee thereby prolonging his career by six years.
On Tuesday of this week, I received a call form a company exploring a safety and feasibility trial for yet another growth factor approach with the latter derived from another human biologic resource. Last March, there was a contact from a global pharmaceutical company asking my help in developing a trial for yet another type of a growth factor approach in dealing with the symptoms and limitations of arthritis. I introduce the Growth Factor subject matter now to better update my reader as well as prepare you for the coming debate that Growth Factors are equal to; perhaps more important as we age than stem cells for dealing with the symptoms, functional limitations and progression of arthritis.
To learn more, you may call for a consultation. (847) 390-7666 or visit my web site at WWW.Sheinkopmd.com
Tags: autologous, bone marrow, Growth Factors, Interleukin 1 Receptor Antagonist Protein, IRAP, joint pain, OA, Osteoarthritis, PRP, stem cells