One of the most exciting developments in the field of Regenerative Orthopedics is the advent of injecting a patient’s own stem cells to rebuild joints, ligaments and tendons. We harvest these stem cells from blood, fat and bone marrow as the case dictates. For common orthopedic problems such as osteoarthritis of the knee and hip, rotator cuff and degenerative disc problems of the back and neck our success rate is over 80%. Since these stem cell procedures are minimally invasive and, if done properly, are very safe, I recommend to patients that this option be fully explored before one undertakes the risks of surgical approaches.
Regenerative Orthopedics can be defined as the science (and art) of regenerating joints, ligaments and tendons using injections of natural substances. This concept and technique has actually been around for many years in a discipline known as Prolotherapy. Now we use the exact same injection techniques but with the added power and benefits of stem cells.
The most important determinant of success with this regenerative orthopedic procedure is that the patient finds a properly trained and experienced specialist who, by a detailed physical palpation exam, can correctly find the precise structures that need regenerating and then inject them properly. Once we identify the correct structures, Ultrasound can also provide guidance to specific defects. Although MRI is quite good at identifying meniscal defects, unfortunately it often misses many of the common defects in joint capsules, ligaments and tendons.
Depending on the severity of the problem, the strength of the proliferant solution (i.e. Prolotherapy dextrose solution, PRP with or without additional stem cells) and how fast the patient heals, it usually takes six to eight sessions to heal a problem. Patients have the option to start with a basic dextrose solution which is more economical and gentler or be more aggressive with PRP (platelet rich plasma rich in growth factors) with or without additional stem cells as required.
These procedures are very safe and generally well tolerated. If a patient is on Coumadin that should be temporarily interrupted prior to injections. The main adverse effect is the injections can be uncomfortable and the patient is likely to be stiff and sore for a day or two. Patients should understand that if you do these injections and you don’t feel them, chances are you missed the right spots. In Regenerative Orthopedics we adhere to the “Know pain, know gain” philosophy.
We do numb the area prior to injection and any discomfort usually passes quickly. We also like to prescribe some mild pain medicine for a day or two in case there is any post-injection discomfort. Most of our patients readily accept a temporary aggravation of their pain when they understand that these treatments are likely to permanently solve the root-cause of their pain and disability.
The Regenerative Orthopedic approach is also very useful and indeed may be the treatment of choice for a wide variety of conditions including sports injuries, whiplash, wrist problems Achilles tendonitis, plantar fasciitis and many other problematic orthopedic conditions. I believe that one day this little known but highly effective technique will become much more widely used as a form of primary care orthopedics that can save many people from risky and unnecessary invasive procedures.