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.
Ma ZJ, Yang JJ, Lu YB, Liu ZY, Wang XX. Mesenchymal stem cell-derived exosomes: Toward cell-free therapeutic strategies in regenerative medicine. World J Stem Cells. 2020;12(8):814-840. doi:10.4252/wjsc.v12.i8.814