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Regenerative Medicine Therapy


 

Knee pain is a very common condition that afflicts millions of Americans every day.    It is estimated that 100 million Americans suffer from chronic pain, and that knee pain is the second most common cause.    1/3 of all American adults reports knee pain at some time or another.

One of the most common causes of chronic knee pain is obesity, too much weight and stress on the knees chronically.    Another is improper technique during activity, causing stress or strain on the knee.    Sports injuries such as ligament sprains and tears are common especially in the active population, and inflammatory and degenerative conditions such as osteoarthritis afflict the aging population as a result of chronic wear and tear.

While surgery is ultimately required in some cases, non invasive and emerging minimally invasive techniques can treat knee pain successfully in most cases, without the risks and recover time of surgery.   Diet and weight loss, physical therapy and reconditioning can effectively reduce knee pain over the long term, while bracing can offload stress from a painful degenerative arthritis and provide stability to the joint.    Corticosteroid injections to reduce inflammation of the knee, and can be injected with ultrasound or fluoroscopic guidance directly to the point of inflammation in the knee.    Hyaluronic acid injections are gel injections that provide increased cushion for a painful degenerating joint.   Regenerative medicine injections such as platelet rich plasma injections, amniotic fluid injections and stem cell injections harness the bodies ability to heal itself and can provide long term relief of pain, especially when combined with rehabilitation.

Diets low in sugars, carbohydrates, and processed meats, with healthy amounts of fruits and vegetables and high fiber can reduce oxidative stress on the body, lower weight, and improve energy levels.   This combined with physical therapy and rehabilitation and modified exercise to offload the knee can improve the level of chronic stress on her knee, and ultimately resolve knee pain naturally.  

Using a knee brace can actively use chronic stress and strain on a degenerating knee as the knee degenerates, force is applied unequally up on the knee, and modern custom knee braces are designed to absorb that unequal force, and distribute weight more evenly upon the knee.   When worn during activity, this reduces stress and pain, and allows individuals to be more active, when previously knee pain has affected mobility.  This combined with exercise and diet helps weight loss, and improves the conditions which worsen knee pain.

When the knee pain is severe, or persistent despite these modifications in diet and exercise, minimally invasive image guided injections can effectively reduce inflammation, and induce healing.

Cortisone injections are common for knee osteoarthritis, and involve an anti-inflammatory corticosteroid that can be injected in a targeted way to the knee, under ultrasound or x-ray visualization.  This helps to reduce inflammation and pain, and helps to restore activity and function several months at a time.  Once the effects wear off, if function has improved, has been strengthening, weight has been lost, and the conditions are better for long-term improvement.

There are times where simply reducing inflammation is not enough to substantially reduce pain.  In a degenerating joint, the natural synovial fluid that acts as a lubricant and shock absorber is reduced.  Injecting hyaluronic acid, also known as a gel injection, allows for lubrication of the joint, cushion, and can reduce pain or a year or more with osteoarthritis.  In addition to providing motion, the hyaluronic acid can induce the body to continue to produce its own synovial fluid that has been suppressed in the process of degeneration.  Like cortisone injections, injection of hyaluronic acid should be performed with direct visualization of the knee under ultrasound or x-ray to provide confirmation that the target point of the knee is being treated successfully.

Regenerative medicine is an emerging and exciting set of therapies that allow the body to harness its own ability to heal, and can provide improved pain and life-changing improved function and activity over the longer term.    Many of these treatments are in their early stages, and lack long-term  trials and evidence, but they are now being commonly performed, with low risk and promising individual results.

Platelet rich plasma is obtained from an individual's own blood.  The blood is drawn from the patient’s vein, and then spun in a centrifuge, to concentrate the platelets, growth factors, signaling cytokines  and other healing molecules in the blood that in the setting of an injury focus the body’s attention on healing.    When these are concentrated and then injected back at the site of an injury or chronic pain in the knee under image guidance, an amplification of the healing process can occur.   This process utilizes the body's own power to heal itself and provides a natural means to address and treat knee pain.    In recent years, it has been reported that pro athletes will use this technique to reduce recovery time following an acute injury, to get back on the field or court faster.    Increasingly patients have found similar success in treating both acute and chronic injuries, and have combines this treatment with physical therapy and rehabilitation to achieve lasting improvements in pain and function.

An even more potent way to harness the body's ability to heal itself is to extract the body’s own stem cells.  This can be performed by accessing the patient's stem cells from their bone marrow in the hip and pelvis or extracting them from the patient’s fat, withdrawing them, processing and concentrating them and injecting them back into the knee.   Stem cells are part of the body's natural self repair system, that can differentiate into different kinds of cells, causing potent healing response that can be particularly effective for degenerative conditions like osteoarthritis of the knee or soft tissue degeneration.    Studies have shown improvement in regeneration and tissue following these stem cell injections, and marked reduction in pain.    This is an exciting and emerging field that needs more study, but in many ways the future is now, and this treatment provides a lower risk alternative to surgery.

Other biologic injections like amniotic allograft are products that can be injected at site of pain and degeneration, and can help with body trigger response.   These products are obtained from healthy donor amniotic fluid from a healthy pregnancy, and are commonly processed by biological company as medical product, with signaling molecules and growth factors that help with healing.   This is a way to obtain the benefit of the bodies healing response, without the invasiveness of obtaining stem cells from the body.  It is important to know that these products are commonly called stem cell therapies, they do not actually contain stem cells, and that in the United States, cells are not allowed to be manipulated.     It is also important to have a trusted and established manufacturer of this medical product.    This is increasingly becoming the most common form of regenerative medicine treatment.   The types of injections are performed under ultrasound or x-ray guidance to target the affected area of the knee directly, and are increasingly being performed with very promising results in terms of long-term reduction of pain and restoration of function.

 

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