It’s always nice to share success stories. We had a 57 year old female patient recently present to our office with knee pain. She had X-rays that showed moderate to severe medial joint space narrowing. She had prior arthroscopic knee surgery and corticosteroid injections with decent but temporary relief. She wanted to avoid further surgical intervention if possible. We discussed the risks of additional corticosteroid injection, indicating the relief was temporary and came at a cost of toxicity to the cells in the knee. She opted to pursue an orthobiologic option. Orthobiologics are interventions that typically use the patient’s own tissue (platelet rich plasma or bone marrow concentrate) to help assist with the body’s natural recovery process. After the procedure, we typically see a window of 4-8 weeks where the procedure takes effect. For this case, the patient mentioned that she had about 70% relief at the 2 month check in mark. I feel that anything above 50% improvement is a successful and satisfactory result. There are often secondary benefits including, resuming enjoyable activities that were previously limited by pain, improved sleep, and decreased reliance on medication.
At Black Stone Physical Medicine, our primary goal is to help our patients minimize their pain and by doing so we hope to improve their quality of life. Optimizing nutrition to minimize pain and inflammation is often part of our recommendations for treatment. For most people the science behind nutrition seems to be a moving target. We hear all sorts of different recommendations from doctors and online. It doesn’t help when these recommendations can be night and day different, for example, ketogenic diet vs vegan diet. You will find both extremes supported by experts quoting medical studies and reporting anecdotal success stories. We also realize that each individual is different and that it may be too good to be true to have a perfect diet. A few things we can do with these limitations are allergy testing, genetic testing, and microbiome testing. We have been recommending Viome recently (blackstone15 for 15% off) for our patients.
In the realm of orthobiologics, every passing year brings us additional understanding of the disease processes that we are treating as well as new possible treatment options. For years we have known that using bone marrow aspirate concentrate, which contains mesenchymal stem cells, may help certain conditions, such as knee osteoarthritis. The experts had their theories on how injecting the concentrate from bone marrow could help pain. Initially they thought that these mesenchymal stem cells were honing in to the area of injury and changing into cartilage cells where they would then create more cartilage and repair site of injury.
Currently, exosomes are not FDA approved for any treatments in humans. More research is needed before we can use this treatment for any human condition. There are ongoing trials using exosomes to assess safety in humans.
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These injuries are often treated conservatively with rest, NSAIDs, and physical therapy. If symptoms don’t improve with conservative treatment or if they are severe enough, surgery is the next option. For symptomatic degenerative meniscal tears that are non-surgical, corticosteroid injections are standard of care.
With surgical options being limited, there has been a lot of interest in regenerative medicine treatments for meniscal tears. Platelet rich plasma (PRP) research in meniscal injuries is limited but encouraging. PRP is known to release growth factors, cytokines, and chemokines which can facilitate the healing process. There have been animal studies investigating the role of bone marrow derived mesenchymal stem cells (BM-MSCs) in the treatment of the avascular zone of the meniscus. There is early high-level evidence for the use of BM-MSCs after partial meniscectomy that show improvement in meniscal volume at 1 year. There have also been numerous studies involving regenerative medicine during surgical intervention.
If you suffer from a meniscus injury, schedule a consultation with Black Stone Physical Medicine to discuss what your best treatment options for you condition. We serve the surrounding area including Albany, Newport, Salem, and Eugene.
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Symptomatic knee osteoarthritis begins with pain. Pain will be present with certain activities such as running, climbing stairs, and walking. Pain at night, joint swelling, knee stiffness, and locking/catching are other symptoms of knee osteoarthritis.
Conservative management for knee osteoarthritis includes ice/heat, non-steroidal anti-inflammatories (ibuprofen or naproxen), bracing, weight loss, and physical therapy. Often when conservative treatment fails, physicians will often move on to corticosteroid injections which can help decrease pain and improve function temporarily. When symptoms and severity of arthritis become severe enough physicians will often refer to orthopedic surgery for possible joint replacement. Corticosteroid injection combined with anesthetics can be toxic to chondrocytes, the cells that produce cartilage, and joint replacement comes with the risk of a major surgical procedure. According to the American Academy of Orthopedic Surgery (AAOS), complication rate is around 5% and the chance of dying within 30 days of surgery is 1 out of 400.
Orthobiologics, also known as regenerative medicine, is a new area of medicine that harnesses the healing ability of our own tissues. These regenerative cells, often called stem cells, have the ability to decrease pain, improve function, and slow the degenerative process. Platelet rich plasma (PRP) and mesenchymal stem cells from bone marrow aspirate concentrate (BMAC) have been used for knee osteoarthritis.
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