Repair and Regrowth of cartilage, tissue and bone in the knee.

With over twenty years’ experience practicing musculoskeletal medicine; I’ve never been more excited about current and future advancements than I am today. In fact, three recent patient encounters prompted me to write my first blog. Today’s blog will focus on microfracture procedures and the question I’d pose to the surgeons: Does the procedure work?

The first patient is a middle aged gentleman with knee pain due to an OsteoChondral Defect (OCD). OCD is essentially a defect in the cartilage. I often describe it to patients as a “divot” or “pothole” in the cartilage and bone in advanced cases. He was initially seen by a local Orthopedic Surgeon who proposed surgical intervention with microfracture procedure. This procedure involves drilling holes in the bone inside of the cartilage lesion to release bone marrow stem cells in order to stimulate cartilage growth. After learning the theory behind the procedure, this patient asked, “what about stem cell injections?” The surgeon responded “that won’t work”. The patient questioned: why can stem cells grow cartilage after drilling, but not if injected? His search for the answer led him to Harbor View for a second opinion.

The second patient, also a middle-aged gentleman, had been advised by an Orthopedic Surgeon to avoid stem cell injections after recommending total joint replacement for his knee arthritis. In this surgeon’s opinion, injecting the joint with stem cells would be…“The equivalent of injecting coffee grounds.” His belief was that stem cell injections would be a waste of time and money.

Shortly after seeing these two patients, I had opportunity to see Abigail for her one year post procedure follow-up. Abigail’s knee was injected with bone marrow derived stem cells for OCD. This condition had sidelined her from all athletic participation. Prior to consulting with me at Regenexx Des Moines, she had seen an Orthopedic Surgeon who recommended microfracture procedure. As with my other two patients, the surgeons were adamant that stem cells would not work.

In Abigail’s case, based upon current medical evidence, microfracture procedure followed by a short course of “cookie cutter” physical therapy would have exposed her to long-term knee problems. As a 14 year old multi-sport athlete, she developed a muscle imbalance commonly seen in female athletes. Due to women having a wider pelvis than men they require good strength in their hip abductors (moving outward) to keep the knees from adducting (moving inward) when landing while running or jumping. For Abigail, this biomechanical imbalance resulted in repetitive trauma to the knee while running which ultimately wore out the cartilage and some of her bone.

The precise placement of Abigail’s own stem cells followed by physical therapy focusing on postural restoration has allowed her to return to competing pain free. As you’ll see in the accompanying video testimonial, which includes Before and After MRI images, she continues to regrow and self-repair cartilage and bone.

Pay close attention to the gait change revealed in the before and after video of her running. With correction of her muscle imbalance she no longer lands with her knees inward, thereby significantly reducing knee trauma. Combined with the precise injection of her stems cells Abigail was able to avoid surgery as well as months of recovery from an invasive procedure.

Based on Abigail’s results, it’s my opinion that microfracture surgery followed by therapy that fails to identify and correct biomechanical deficits is the equivalent of treating with coffee grounds!