One of the important distinctions of receiving treatment at Cellular Healing is the way your diagnosis and treatment plan are designed by a board certified and fellowship-trained orthopedic surgeon. This surgeon will be able to recognize specific signs and symptoms of your joint which may require one or more minimally invasive procedures to optimize your results.
Surgical procedures are only recommended when a patient has a condition with a torn, loose, or severely damaged bone and cartilage which cannot be corrected with more conservative measures such as physical therapy, medications, or bracing. Ignoring these symptoms of physical damage may prevent your joint from reaching the full potential of cell-based therapies, and as such, it is important that you are evaluated appropriately for these conditions by an orthopedic surgeon prior to receiving therapy.
The team at Cellular Healing sees patients every week who have received expensive stem cell therapies at decidedly less thorough clinics, with the outcome being sub-optimal results. This trend is disturbing because it causes patients to regard it as the failure of cell therapy, when it is really a failure to recognize the correct sequence of treatments. Cellular Healing is committed to provide you with the benefit of receiving a thorough evaluation by a board-certified specialist in bone and joint problems, giving you with a comprehensive plan with the correct sequencing of therapies.
Some patients may have pre-existing issues which cause catching, locking, or instability to the knee. If this is taking place at least two or more times per week, and your doctor can find a reproducible reason for this condition such as a meniscus tear, loose body, or a very tight knee cap, your doctor may recommend a minimally invasive and outpatient procedure to treat this condition in order to improve your overall outcome.
Normally, a MRI (Magnetic Resonance Imaging) of your knee is ordered to determine this condition, but it is not always needed - especially if the doctor can reproduce the symptoms upon exam. An MRI may also be ordered to look for a condition which may lie beneath the surface of your joint. This is known as a subchondral bone marrow lesion, abbreviated BML, where the bone marrow under your cartilage may react and become inflamed, causing a deep pain in the knee.
When a surgeon believes you may require a surgical procedure for your knee, they are normally looking for the following:
These are conditions which can be treated effectively with a minimally invasive procedure such as an arthroscopy. If you have had an MRI performed in the last 6 - 12 months, this may help the surgeon decide whether or not you require this procedure. If not, you may require an MRI to determine.
If an arthroscopic procedure is recommended, there are different types of procedures which can be done alone or in combination to help the outcome of your knee. Each one will be explained below. The exact risks, benefits, indications, contraindications, potential complications, expectations, and limitations of each procedure are discussed privately with the surgeon with ample time to ask questions.
In a healthy human body, we have two cartilage rings in our knees called menisci. These C-shaped rings help stabilize the knee during normal range of motion and activities. Sometimes, these tear or degrade over time. The tearing or degrading may occur without the inducement of trauma in many older or aging patients. When a tear occurs, this causes pain to the knee by catching and pulling on some sensitive tissue around the knee - think of this in terms of a hangnail. The meniscus itself, just like the finger nail, has little to no pain fibers. However, the sensitive tissue around the finger nail is just like the sensitive tissue around a meniscus: when this is pulled or pushed, it can cause some pain and even a feeling of instability.
However, not all tears require treatment. Sometimes, the tear does not pull or push on the sensitive tissue; in that case, the tear becomes asymptomatic, and there is no need to treat it apart from observing it closely.
When a tear is symptomatic and causing continual pain and a feeling of instability, the surgeon may decide to remove the portion causing the pain or repair the torn meniscus with a special suture. A majority of symptomatic tears in patients with arthritis are not repairable; many of the tears occurring in older adults are degenerative tears which appear like a shredded hem on a well-worn pair of jeans. In this case, trying to suture this type of tear will result in almost immediate failure. Only the portion of the meniscus causing the catching is removed, and every attempt is made to keep as much of the meniscus intact as possible.
In other cases, an MRI may show the meniscus to be bulging or extruded. This can also be symptomatic or asymptomatic. When this is symptomatic, the bulging portion of the meniscus may push on sensitive tissue, causing pain. Other times, it may simply bulge without any pain. When it is symptomatic, the portion bulging may need to be removed.
The surgery itself is a minimally invasive procedure: two small incisions are normally made on either side of the kneecap just at the joint line, and a small fiber optic camera is placed in one of these tiny incisions to see the inner portion of the knee. Instruments used to remove or sculpt the damaged knee are placed through the other incision. Typically, only the portions of the meniscus which are torn and causing the symptoms are removed using a specially designed micro instrument. A radiofrequency probe is also sometimes used to sculpt the remaining portion of the meniscus giving it a firm and smooth finish. The knee is inspected in all the other visible areas to ensure there are no other problems or conditions, and the knee is then washed out and the tiny incisions are closed with a simple single stitch.
Occasionally, a portion of the cartilage can come off the end of the bone and float around the knee; other times, your body can form calcified cartilage. These can become lodged and caught in and around your knee joint, causing locking, giving away, pain and swelling. In other cases, these can become attached to portions of your knee where they are out of harm's way and not cause any symptoms. If your knee has frequent episodes of instability, locking and/or swelling, you may require a surgery to remove these calcifications. This is done with a minimally invasive procedure called an arthroscopy, where two small incisions are made on either side of the knee cap. One is used for a small fiber optic camera and the other for a special tool used to grasp the loose body and remove this from your joint. In some cases, a third incision is required to remove larger or harder-to-reach loose bodies. At the end, the knee is inspected carefully to ensure that no other loose bodies or problems are occurring, and the knee is flushed out and closed with simple sutures.
This is a condition where the area underneath the cartilage becomes very inflamed, causing the bone supporting the cartilage to swell and sometimes begin to collapse. At times, this is reported as a fracture or break in the bone - but is not true with every patient. The cause of this intense response of your bone is still not fully understood; however, entering into this area with a special needle and stimulating new blood flow can help to correct the problem. Adding in natural growth factors, plasma proteins and even mesenchymal stem cells can aide in the healing process, and additional bone grafting material may be necessary in some rare cases.
This condition is called a bone marrow lesion, or BML, and is diagnosed mainly through a properly performed MRI. The exact location of these BML’s are mapped out for precise treatment, and a minimally invasive arthroscopy is performed to treat this condition. Two mini incisions are made on either side of the knee cap: one is used to place a small fiber optic camera into the knee joint, while the other is used to place a small probe or other instruments to feel the cartilage surface of the lesion. Sometimes, this will need to be cleaned up, and small portions of loose cartilage will be removed to prevent catching and locking.
Bone marrow is taken from the pelvis during the surgery while the patient is under an anesthetic, which is then processed into two distinct products. One product is the Bone Marrow Concentrate (BMC), which contains the mesenchymal stem cells along with some Platelet Rich Plasma (PRP) and other important Plasma Proteins (PP) used in the healing process. The other product is Platelet Poor Plasma or General Fluid Concentrate (GFC), which also contains even more important plasma proteins.
Once the integrity of the cartilage is determined and/or treated and all other treatable conditions of the knee are completed (such as meniscus tears), the decompression and treatment of the BML can happen.
A specially designed bone needle is directed into the BML using the pre-operative plan. Once the needle is within the BML, high pressure suction is used to stimulate a change in the marrow pressure and the stimulation of blood flow into the area. Once there is good blood flow, the BMC with the PRP, PP and GFC is slowly injected to fill in all the damaged area with healing cells. The needle is removed and the small incisions are closed normally with a single suture. Patients are usually asked to maintain limited weight bearing on this knee until their follow up appointment.
This treatment is used to help correct abnormal pressure across a knee cap, as well as helping to correct some alignment problems of the knee cap as it tracks along the front of the knee. During this procedure, a minimally invasive arthroscopy is performed, where two very small incisions are made on either side of the knee cap. In one incision, a small fiber optic camera is inserted; through the other incision, a small tool such as a radiofrequency probe is inserted. This probe is used to release tight scarred tissue on the outer edge of the knee cap. This tight tissue is called the lateral retinaculum, and releasing this should help to even out the pressure across the knee cap and correct alignment problems. The alignment is checked again after the release, and in some cases, the knee capsule on the inside portion of the knee cap will need to be tightened through another small incision. This part of the procedure is called a medial plication.
In some patients, the surgeon may decide to release the tight tissue through a small incision made on the lateral or outer portion of the knee cap. All of the incisions are closed with either one or two sutures. Most patients are allowed normal weight bearing, but they must strictly avoid squatting, kneeling, heavy lifting, and lunges for up to 6 - 8 weeks. This restriction of movement is done to protect the body and prevent the release from tearing up into the thigh.
Each of these procedures is designed to help heal mechanical problems of the joint or damaged bone near the joint, allowing the healing properties of the stem cells, platelet rich plasma, and plasma proteins to produce the greatest benefit.
Please note, these procedures do not guarantee a positive result; rather, they provide a logical solution to problematic joint. It is highly suggested and required that all prospective patients engage in a personal discussion with their surgeon regarding the risks, benefits, potential complications, expectations and limitations of these procedures so any questions and concerns can be answered completely before agreeing to the surgery.
If you are interested in a FREE CONSULTATION for your knee problems , just click away or maybe think about calling us at 810-299-8552 and speak with someone about your concerns.