The Mountain Times

°F Thu, April 24, 2014

Central Vermont's Most Popular Weekly Newspaper

ACL and other injuries: Is there a better repair?

ACL Sidebar - For Web Small - I Stock _000015575390Medium Copy
Bob Wislow, a 68-year-old skier, experienced years of progressive degeneration of his knee cartilage. He could no longer ski hard pack and knee pain meant he couldn't get up and down the stairs at the lodge. A cortisone shot would help, but the shots were damaging his knees. He considered surgery, but that option meant he'd never ski again.  
Bruce Snyder, a 42-year-old runner, cyclist, and weekend warrior from Boulder, CO, tore his meniscus playing soccer. Instead of opting for another surgery-which he had discovered left many patients worse off - he sought an alternative.
Jacob Gillis, a 19-year-old student at Colorado U, was skiing last March when he landed awkwardly and heard a "pop" in his knee. An MRI of the anterior cruciate ligament (ACL) showed a partial tear. His sister had experienced a "pop" as she dove for a volleyball in year's past, she didn't have surgery and was now good as new.
Like that sister, all of the athletes above ultimately decided to undergo a new non-surgical procedure that enabled them to regain their high levels of activity and remain pain free.

The Next Thing
What they discovered is Regenexx, what Snyder calls "THE" next thing in medicine.
The Regenexx Procedures are a family of non-surgical stem cell and blood platelet treatments for common injuries and degenerative joint conditions such as osteoarthritis.
These procedures utilize a patient's own stem cells - obtained from bone marrow - or blood platelets to help heal damaged tissues, tendons, ligaments, cartilage, spinal discs, or bone.
Surgery was - and still is - the most common treatment for these injuries. But in a Colorado clinic, Christopher Centeno, MD, and his colleagues pioneered the use of adult stem cells to help skiers repair and regenerate ligaments and joints without surgery. The new therapy has been used on injuries to other joints- elbows, rotator cuffs, ankles, arthritic spines, etcetera - for about five years with over 5,000 procedures.
Dr. Centeno is a specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult stem cells to treat orthopedic injuries.
So how and why did he get into this research I asked him by email. "I got into this procedure because of the young athletes I saw in the office. They were teenagers when they had surgery for an ACL tear," he answered. "By their 20s to 30s, they had severe arthritis like a 50- or 60-year-old. I knew there had to be a better way - a method of prompting the body to heal the tear rather than extracting the ligament and trying to put a poor copy of one in its place.
"Today we're are on the forefront of a quantum shift in medicine and surgical procedures," he continued. "We're on the verge of a revolution in orthopedic care that will combine biologic therapies with new tools and devices that will allow most ACL tears, rotator cuff tears, meniscus tears, disc bulges and herniations, non-healing fractures, and arthritis to be healed by walk-in/walk-out injection procedures performed under exacting imaging guidance."

The ACL injury and its recovery
"The ACL is a strong ligament inside the knee that prevents forward and backward motion of the leg bone on the thigh bone and stabilizes the knee in other directions like rotation. It can be commonly injured in skiing when your skis don't break away in a fall. It's also common in football, basketball, soccer and many other sports that involve cutting and twisting motions," Dr. Centeno explained.
"The three main types of ACL tears are partial (only part of the ligament is torn), complete but not retracted (the whole ligament is torn, but some fibers are still present and prevent it from pulling apart like a rubber band), and complete retracted (the ligament is completely torn and retracted back like a rubber band). We can treat all three types through injection, but the last type only up to about 1 cm of retraction. We see the best results in the first two types of tears," Dr. Centeno said.
Recovery for surgery is commonly 6-12 months and includes physical therapy, loss of ability to maintain fitness, and the possibility of infection in the hospital. By contrast, Dr. Centeno said. "Assuming Regenexx Therapy, full recovery takes a few weeks to several months," depending on the severity of the tear.
Additionally, "ACL surgery changes the structural orientation of the knee joint" this then "puts more stress and wear and tear on the joint itself, making it more prone to re-injury," Dr. Centeno explained. (This finding is supported by high re-tear rates among ACL surgery patients. If you are following the Olympians, this story might resonate.)
The alternative procedure works for all ages and does away with the need for hospitalization and surgery. The Regenexx ACL procedure is a same-day "injection-based treatment that taps into a patient's own reserve of stem cells and then injects them back into the injured area. You walk into the clinic for treatment and walk out the same day," he said. "Patients can immediately begin walking or exercising in a non-jarring program like an elliptical trainer. This allows them to maintain fitness level and return to their desired level of activity sooner," Dr. Centeno added.
Jacob Gillis, the Colorado U student, is a good case study. He walked out of the procedure and went to a concert with friends later that night and has returned to skiing, cycling, rock climbing, and other activities.

Good to know
While stem cells are present in all of us - Dr. Centeno calls them the repairmen of the body - the problem is that "as we age or get injured, we sometimes can't get enough of these repair cells to the injured area. By injecting stem cells directly to the site, the repair process is turbo-charged and the body is able to heal itself," he said.
An MRI of the injured area tells the doctor whether the person is a candidate for this procedure. A complete tear requires surgery but a partial tear does not.
Women are much more prone to ACL tears for physiological reasons. There are exercises that can be done by men and women as well as certain preventative measures that can be taken for different sports. (See next week's Mountain Times for prevention tips and info on trials done at Killington on this very subject.)
This therapy costs less than traditional surgery, so orthopedists might have a bias. You might have to inquire as to whether you are a candidate, but Dr. Centeno is happy to have inquiries directed to the Colorado Centeno-Schultz Clinic, as well, so that could be a good place to start. (Contact the clinic at
 1-888-525-3005 or by emailing info@regenexx.com.)

New procedure in the news
The December 2013 issue of Duke Medicine Health News has a full-page article that notes in part, "current research at Duke suggests that stem cell therapy may one day completely regenerate worn joints." Mesenchymal stem cells can "shift the balance from inflammation to repair and when injected into the joint, reduce the progression to arthritis." While this research is geared at preventing Post Traumatic Arthritis, it corroborates Dr. Centeno's discovery of ways in which the body can heal itself.
Recent articles (CNN, WSJ, New England Journal of Medicine, etc.) cite a study that suggests knee surgery may not be of any real benefit with the conclusion: "In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure."
We can hope to escape ACL injuries - avoiding getting in the "back seat" through ski/ride lessons is a good start - but if we do experience one, the alternative procedure might get us back on the slopes in better shape sooner and cost less in the process.
Next week Dr. Centeno will share some prevention tips and we'll look at the research that was done at Killington and elsewhere in Vermont to come up with a prevention brochure.