Knee Pain? Facing Knee Surgery?
Knee problems are one of the most common problems I deal with in my practice. The two main types of problems are meniscal tears/ with or without ligament damage and degenerative Osteoarthritis with moderate or severe cartilage loss and joint space narrowing.
Meniscal Tears: For meniscal tears, unless they are very large and cause locking of the joint can generally be handled by stem cells. If they are very large, sometimes patients will require arthroscopic trimming. All patients with meniscal tears should also have their ligaments carefully examined since they are often damaged also and the diagnosis is missed. It is very important that the doctor palpate the medial collateral ligaments and other supporting structures because these can often be the main pain generator. Meniscal tears are often blamed because we see them so well on MRI. The only way to pick up the very common ligament sprains is by a specific palpation exam of the connective tissue structures that looks for the “jump sign”.
Osteoarthritis: In the case of degenerative arthritis, patients often arrive saying that their x-rays revealed bone-on-bone and they were given the options of a cortisone shot, anti-inflammatories and, when they couldn’t stand the pain anymore, knee replacement.
Stem Cell Therapy
An Extraordinary Solution to Knee Problems
With Stem Cell Therapy we have a totally different approach. Our goal is to regenerate the damaged structures. When we evaluate a knee it is very important to not only look at the bones and cartilage but also the surrounding ligamentous support. Every joint has a capsule that surrounds the whole joint and gives it stability. If the capsule is damaged and “stretched” this can be a huge pain generator. Unfortunately theses capsular problems do not show up on xray and MRI. As with the meniscal problems above, the only way to identify them is with a specific connective tissue palpation exam. If I examine a patient and say, palpate the medial collateral ligament attachments and the patient has a positive jump sign (i.e. jumps off the table) those ligamentous attachments must also be in addressed and should also be injected with stem cells.
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Our success rate, even for bone on bone situations is 80%. What do I mean by success? We mean that we will either solve the problem completely so the patient can do their activities of daily living without pain or at least improve their symptoms better than 50%. As a side note, there is a lag of about 9 months before the x-ray picture will improve. We are actively trying to document radiographic improvement but patients are often too busy enjoying life to come in for follow-up.
As an additional note I think it is important for almost all patients with knee, hip and/or low back problems to get optimal orthotics (arch supports). As we age the foot arches weakens and we start to pronate as we put weight on the foot. This in turn causes extra stress on the knee, hip and pelvic/low back. By supporting the feet with proper orthotics we maintain the foot in anatomic position at impact and optimize the biomechanics so there isn’t undue stress on specific structures. In an ideal world we would all present ourselves for biomechanical analysis at age 25 and get appropriate orthotic support. In so doing I think we could save an untold amount of orthopedic issues later on in life as we wear down.