Thu, Feb 13, 2014 07:30 PM
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
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
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
"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
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.
"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.
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 firstname.lastname@example.org.)
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
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.