(Courtesy of Magaziner Center for Wellness)
The age of regenerative medicine is here. We have utilized prolotherapy for decades, PRP is starting to gain traction in the medical community, and we are also now able to unleash the power of the stem cell. While we have these technologies available to help the body help itself heal to prevent surgery, eliminate pain, and restore joint function, it is up to the skill and knowledge of the physician to best utilize these treatments to achieve optimal results.
We will use a case illustration of knee pain in a 61 year old patient to demonstrate where stem cell, PRP and prolotherapy all have a place in treatment of knee pain. This patient has had chronic pain in her knee, and has been limping for as long as she can remember. She had undergone traditional injections of cortisone, which had limited benefit. An MRI of the knee showed complex tearing of the posterior horn of the medial meniscus along with arthritis of the knee, and the patient underwent arthroscopic surgery. After a month or so, the patient’s pain or function had not changed, and a dose of Euflexa (similar to Hyalgan, Supartz, Synvisc, and other forms of viscosupplementation) was injected into the knee, again with limited results.
When I examined the patient, her gait (walking cycle) was clearly off, and she was listing to the left with a severe limp. Excessive pronation was also found in the left foot, further exacerbating her knee condition. Her limp was caused by a functional leg length discrepancy (pelvic tilt). Her knee was slightly swolen, with some limitation in range of motion, and was significantly tender around the coronary ligament (supports the meniscus and joint), and laxity and pain was discovered in the medial collateral ligament (MCL). I did review her MRI, showing arthritis and a torn meniscus. While it may make sense to shave a torn meniscus on the surface, large medical studies have shown that arthroscopic surgery on an arthritic knee actually accelerates arthritis, and patients that have this surgery are more likely to need knee replacement than those that have not had the surgery.
We needed to decide on a treatment plan for this patient, of how to not only eliminate her pain, but also reduce the chances of needing a knee replacement in the coming years.
I used prolotherapy to correct the leg length discrepancy (pelvic tilt), which immediately corrected and her gait improved and limp was eliminated. We will use prolotherapy to rebuild the arch of her foot to reduce the excess pronation, and also treat the damage to the medial collateral ligament (which by the way did not show on MRI but was clearly found on examination). PRP will be used to treat the outside of the meniscus and the coronary ligament, as in my opinion works better in this area, as meniscal tissue has very little blood flow whatsoever. This patient will also be best served by a stem cell procedure, using the patient’s own fat to derive stem cells, which will be injected into the knee with PRP. I believe this will enhance the ability to regrow cartilage, and also reverse some of the arthritic changes in the knee, and reducing the risk of needing knee replacement in the future.
I hope this illustrates how we use a combination of therapies to treat an ailing joint problem that has failed traditional options. It is up to both an educated patient and a skilled physician to obtain the best results for the patient, and also prevent a surgery that may do harm.