Marc Darrow MD,JD

We are getting many emails from people who are waiting for a hip arthroscopic surgery or trying to find other solutions. Now a leading surgical center, the Hospital for Special Surgery says this: “The percentage of patients with hip arthritis who had a hip replacement within two years of hip arthroscopy was unacceptably high at 68%, according to a new study of more than 2,600 patients by investigators at Hospital for Special Surgery (HSS). Prior hip arthroscopy was also associated with significantly worse outcomes after hip replacement.”

This was from a May 18, 2020 Press statement

“Arthroscopic hip surgery should not be performed in patients with a diagnosis of osteoarthritis”

This conclusion warning that people with hip osteoarthritis should not have arthroscopic surgery comes from Hospital of Special Surgery research published in the journal Hip International.(1) Here is the concluding remarks of that research:
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Marc Darrow MD,JD

When a joint is in degenerative disease, a multifactorial system is in play that breaks down bone, cartilage, and soft tissue. It all happens simultaneously and spontaneously. This multifactorial breakdown system is so complete that it turns the protective synovial fluid into a toxic pool of inflammatory factors manifest as the chronic, harmful swelling that most are plagued with.

According to researchers, this is what is happening in your joints during this breakdown process.

• Runaway oxidative stress (free radical and unchecked oxidative damage, antioxidant deficiency leading to breakdown of the entire joint structure).
• Overproduction of reactive oxygen species (ROS) simply the process that creates a toxic inflammation in your joints. ROS regulates intracellular signaling processes (sends signals to create more inflammation), chondrocyte senescence (stops the development and growth of cartilage) and apoptosis (instructs immune system to kill cartilage cells), along with synovial inflammation and dysfunction of the subchondral bone.

Research: Start targeting the complex oxidative stress signaling pathways

• As suggested by an April 2016 study, (1) “disease-modifying drugs for osteoarthritis are rare, targeting the complex oxidative stress signaling pathways would offer a valuable perspective for exploration of potential therapeutic strategies in the treatment of this devastating disease.”

As we will see in the below research, vitamin C may be an answer in targeting excessive oxidant damage in joints where osteoarthritis has taken hold. How? By helping to reverse the damaging signals the oxidants are sending out.

“There is no denying that vitamin C benefits everybody, whether they have arthritis or not”

This is from a June 2019 paper in the journal Medical archives.(2)

“There is no denying that vitamin C benefits everybody, whether they have arthritis or not. Therefore, it is a good idea to maintain a healthy balance of vitamin C. Without a doubt, vitamin C benefits most people with early osteoarthritis.”

It is unlikely that anyone would question the benefits of vitamin C in supporting immune function, recently however, researchers have looked at what vitamin C can do for inflammatory arthritis and osteoarthritis.

In an August 2019 study from Loma Linda University (3), researchers examined how vitamin C worked on arthritis:

“Vitamin C (ascorbic acid) is a well-known regulator of bone and cartilage metabolism, they write, “However, the mechanisms of Vitamin C’s action in these tissues are only partly understood.” So we know it helps, but how? In this study, the research team confirmed their findings that Vitamin C (ascorbic acid) contributes to bone and cartilage metabolism by (preventing) articular cartilage and trabecular bone (porous bone such as that found in the femur or thigh bone) breakdown by way of helping to create more chondrocyte (cartilage cells) and osteoblasts (bone cells). How, by disrupting gene modification pathways and preventing cell mutation in osteoarthritis.

A 2017 study in the International journal of molecular sciences (4) found that Vitamin C can prevent against anti-apoptosis (prevents cell death and breakdown of cartilage and bone), work as an anti-inflammatory while effectively turning into a pro-inflammatory (signalling for the good inflammation that creates healing.)

Vitamin C’s benefit on stem cells in a damaged joint

There is a lot of research concerning the role of vitamin support stem cells and their many functions throughout the body. In regard to joint problems:

• A 2017 study in the journal Stem Cells International (5) suggests: “Vitamin C regulates extracellular matrix/collagen homeostasis (the building of cartilage through collagen production) and plays a key role in the differentiation of mesenchymal stem cells towards osteoblasts (bone cells), chondrocytes (cartilage cells), and tendons.“

Vitamin C supplementation can help many people with joint pain. How much can it help? That is the debate within the medical community and a discussion for you and your doctor.

Do you have questions? Ask Dr. Darrow about your joint pain

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References

1 Lepetsos P, Papavassiliou AG. ROS/oxidative stress signaling in osteoarthritis. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2016 Apr 1;1862(4):576-91.
2 Ripani U, Manzarbeitia-Arroba P, Guijarro-Leo S, Urrutia-Graña J, De Masi-De Luca A. Vitamin C May Help to Reduce the Knee’s Arthritic Symptoms. Outcomes Assessment of Nutriceutical Therapy. Med Arch. 2019 Jun;73(3):173-177. doi: 10.5455/medarh.2019.73.173-177. PMID: 31404121; PMCID: PMC6643354.
3. Lindsey RC, Cheng S, Mohan S. Vitamin C effects on 5-hydroxymethylcytosine and gene expression in osteoblasts and chondrocytes: Potential involvement of PHD2. PLoS One. 2019 Aug 7;14(8):e0220653. doi: 10.1371/journal.pone.0220653. PMID: 31390373; PMCID: PMC6685624.
4 Chiu PR, Hu YC, Huang TC, Hsieh BS, Yeh JP, Cheng HL, Huang LW, Chang KL. Vitamin C Protects Chondrocytes against Monosodium Iodoacetate-Induced Osteoarthritis by Multiple Pathways. Int J Mol Sci. 2016 Dec 27;18(1):38. doi: 10.3390/ijms18010038. PMID: 28035982; PMCID: PMC5297673.
5. D’Aniello C, Cermola F, Patriarca EJ, Minchiotti G. Vitamin C in Stem Cell Biology: Impact on Extracellular Matrix Homeostasis and Epigenetics. Stem Cells Int. 2017;2017:8936156. doi: 10.1155/2017/8936156. Epub 2017 Apr 20. PMID: 28512473; PMCID: PMC5415867. — 930

Marc Darrow MD,JD

Research: Realistically 9 to 30% of patients do not return to work after knee replacement

Before I begin, let me state that some people get great benefits from total or partial knee replacement. But not everyone is convinced it will be of great benefit to them or realizes the expectation they had going into knee replacement that they would come out with a pain-free knee with increased mobility. Some people are willing to wait months for their knee replacement, some people try to avoid the knee replacement because they have a lot of concerns about lengthy rehabilitation, down time, ability to return to work or some type of sport and the possibility that something can go wrong. Some people get the knee replacement because they think everything will go right.

“Not what I expected”

In January 2020,(1) doctors in Sweden produced an ambitious study to try to understand why a patient was not happy with their knee replacement when there were no obvious reasons that they should be. Especially when the surgery went without complication and was considered successful.

Here are some of the problems the patient reported and how it hindered them in their daily routine or trying to get back to work. Read More

Marc Darrow MD,JD

We get a lot of emails from people looking at their rotator cuff options. The emails we get center around the possibilities that a surgery can be avoided with regenerative medicine injection options such as stem cell therapy or Platelet Rich Plasma therapy or PRP. There is some new research I will explore with you here on these options.

We know that some people, like someone with a physically demanding job or an athlete, will make their decision as to how to treat their rotator cuff problems based on what treatment they believe will get them back to their job or sport the quickest. This is the great appeal of surgery to some. These people believe that surgery is the fastest way back and they have a lot of confidence that the surgery will make them whole again.

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Marc Darrow MD,JD

In our practice we often see patients who are in severe back pain. These people have an MRI, X-ray and/or scan that may show an inaccurate picture of what is causing their pain. What do I mean by inaccurate picture?

• The MRI cannot show muscle spasms from a simple back strain which can cause excruciating pain.
• Conversely, the MRI can show a large herniated disc which may be completely asymptomatic.

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Marc Darrow MD,JD

Getting a shoulder replacement or rotator cuff surgery may require you being on a waiting list. For over 20 years we have been offering regenerative medicine injections including the use of stem cell therapy. Often we will get an email that asks, “is there any research?”

The Darrow Stem Cell Institute has published research on the treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow derived stem cells.The research appears in the peer-reviewed journal Cogent Medicine. The study can be found here in its entirety: Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections with a June 20, 2019 publication date.

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections
Marc Darrow, Brent Shaw, Nicholas Schmidt, Gabrielle Boeger & Saskia Budgett | Udo Schumacher (Reviewing editor)
Article: 1628883 | Received 02 Jan 2019, Accepted 30 May 2019, Accepted author version posted online: 18 Jun 2019, Published online: 20 Jun 2019

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Marc Darrow MD,JD

As many people contemplate waiting for a shoulder replacement and they have the time to review the research, they see that they have three main options to manage their shoulder pain.

Replace the ball and socket of the shoulder joint. The reason a shoulder replacement can be tricky is that the joint is more a golf ball and tee than a ball and a socket like the hip. This, as we will see from the research, can make shoulder replacement a technically challenging surgery.

Manage the shoulder with “conservative non-surgical treatments,” such as painkillers, anti-inflammatories, cortisone, physical therapy, and other remedies for as long as you can until the pain or loss of function becomes unbearable.

Try regenerative medicine such as stem cell therapy and platelet rich plasma therapy.

When someone comes into our institute it is usually after the “conservative treatments,” have failed and that a surgery is being strongly recommended. What people, perhaps one day like yourself, who come into our office want is a realistic plan to get them to a pain-free range of motion in a functioning shoulder. Many times we can get people to this goal, many times we come close to getting people to this goal with significant improvement to their quality of life. There are times when we can only help a little. There are times we cannot help at all. People we cannot help would be significantly advanced cases of degenerative shoulder disease. Perhaps 10 to 20% of patients who seek regenerative medicine will not be good candidates. This is why I invite people to email me to discuss before they make an appointment. You can do so as well by using the form below. Read More

Marc Darrow MD,JD

Epidural steroid injections do not heal a bad back. Some researchers consider epidural steroid injections to be, at best, a very short-term painkiller that sometimes prevents a patient from getting the proper treatment for his/her back pain.

The one thing that surgeons and regenerative medicine specialists agree on is the question being raised in the medical literature asking whether patients have been informed of the poor likelihood of long-term epidural injection treatments success for disability. The same question is also being raised about spinal surgery.

In the research below from some of the leading medical universities in the world, we see that the goal of epidurals and surgery is to provide pain relief. Unfortunately improving disability and function may not be an attainable goal with these treatments.
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Marc Darrow MD,JD

Many people today are exploring meniscus surgery alternatives. One reason is that they may be on a waiting list to get the surgery. Another is that they have been doing research and are not absolutely convinced that meniscus surgery will help them anyway.

Meniscus repair surgery, opinion as of 2020: “in the knees without the meniscus, the impact and load are three times higher.”

A 2020 study in The archives of bone and joint surgery (1) offers an updated opinion on meniscus surgery. Here are some points brought up by the surgeon researchers.

The knee needs its meniscus:

• “The menisci (meniscus) perform many essential biomechanical functions. These functions include load transmission, shock absorption, stability, nutrition, joint lubrication, and proprioception (the sense of knee in 3D space). They also serve to decrease contact stress and increase contact area and joint congruency. The knee would be deprived of all these functions if the meniscus removed. Therefore, in the knees without the meniscus, the impact and load are three times higher.”

Surgical repair? Patients should be warned the return to sport should be delayed for up to 6 months

• “Rehabilitation after meniscal repair is slower and different from rehabilitation after meniscectomy. The physiotherapist and surgeon should respect the slow process of biological healing of the meniscus and therefore they need to be careful with the rehabilitation program especially in active flexion. The return to sport should be delayed for up to 6 months; however, 86 to 91% of patients could back to play. It is also crucial for the patient to know there is 8 to 20% risk of failure and re-operation, however, the long term outcome of meniscal repair is better than partial meniscectomy because of chondroprotective action of meniscus.”

Meniscus repair is not a small surgery without complication.

• “Meniscus repair is not a small surgery without complication. It is technically challenging and has a steep learning curve. General complications of arthroscopy such as venous thromboembolism, infection and vascular injury could occur. Specific complication including nerve injuries, ligamentous injury, iatrogenic cartilage lesions, and poor suture techniques can happen during meniscal repair. The surgeon should depict and accept the eventual complications and address them as rapidly as possible. It is also important to form patients about potential complications.”

Failure of meniscal repair occur in up to 25 % of patients

• “Failure of meniscal repair occur in up to 25 % of patients. Failures in the first six months of surgery are usually related to technical issues during repair, while failures between 6 and 24 months are indicating poor healing process. Failure later than 2 years of repair show retear or degenerative processes in the meniscus. . . Secondary meniscectomy is a treatment for failed meniscal repair. The amount of meniscal resection is less in 35% of cases, which shows partial healing of the meniscus. Revision of meniscal repair is another option and two small series reported 25 to 33% failure rate for the procedure.”.

Meniscus transplant surgery – “Meniscal allograft transplantation for symptomatic knees after meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus”

Sometimes I will get an email or phone call asking me about meniscus transplants. The person who asks me has been told that they have a bone on bone situation in their knee. What I find interesting is that many of these people are active people. They maybe having a little trouble running or jogging but they can ride their bicycles without issue, they are even skiing, and they can walk okay. So this is a knee that is functioning and moving. But, the person who contacts me says that they have be recommended to a meniscus transplant because they have “bone on bone and the meniscus transplant will bring back some cushion.”

Meniscal transplant is a very major surgery as far as I’m concerned. I have personally never seen one work out with the patients who come in to see me. There are a lot of people who had this surgery successfully. The people who are coming to see me are the ones for whom this surgery has failed. That is why I never see the successful surgery patients.

In December 2020, there was an editorial in the medical journal Arthroscopy (2). It gives a good reality of the meniscus transplant outcome.

“Meniscal allograft transplantation for symptomatic knees after meniscectomy decreases pain and often improves function, but it does not replicate a normal meniscus. The ability of to delay arthritic changes is an ongoing area of study, and it is known that outcomes and graft survivorship deteriorate with longer follow-up. Recommended indications are symptomatic patients after meniscectomy with mild (or at most moderate) degenerative changes and absence of (or surgically corrected) associated malalignment or ligament deficiency. When these indications are followed, 80% of patients improve, with survivorship of 83% at 10 years and 56.2% at 20 years.

Can stem cell therapy regenerate meniscus tissue?

For many people, the long rehabilitation, possible need for secondary surgery, and other post-surgical factors weigh heavily in their decision making process as to how to proceed to fix their meniscus tear. For many people, regenerative medicine in the form of stem cell therapy may be something to be explored.

• New research into the healing world of the knee meniscus is fascinating. Despite decades of traditional medical beliefs that because of its poor or even absent network of blood vessels and blood supply, parts of the knee meniscus cannot heal. Researchers are discovering the meniscus is in fact, always trying to heal itself.
• HOWEVER, the expectation that stem cell therapy can regrow a meniscus from nothing or regenerate extensive amounts of meniscus tissue removed in meniscectomy must be tempered with a realistic expectation of what these treatments can and cannot do.
• Stem cell therapy for meniscus tears can help repair deficits in the existing meniscus.
• Stem cell therapy when administered as a multi-injection treatment as opposed to a single one-time shot, can also help support, rebuild, and stabilize the knee capsule and help restore a more normal knee function. A more normal knee function can remove stress from the meniscus and other supportive knee tissue such as ligaments and tendons.
• What your realistic expectation of what stem cell therapy can do for your meniscus tear must be discussed with a doctor knowledgeable and experienced in the treatment.

White Zone,” and “Red Zone,” meniscus tears.

Let’s look at an October 2020 study (3) that made some interesting observations. What the research team wanted to do was assess Bone marrow-derived mesenchymal stem cells’s potential to engineer meniscus-like tissue. The researchers pointed out that “Bone marrow-derived mesenchymal stem cells have the potential to form the mechanically responsive matrices of joint tissues, including the menisci of the knee joint.” So to test how good these stem cells were at re-engineering meniscus tissue, they compared the bone marrow stem cells taken from the iliac crest versus the meniscus fibrochondrocytes cells (cartilage cells) isolated from castoffs of partial meniscectomy from non-osteoarthritic knees.

To simulate conditions that may occur in the human body after cell transplantation, the bone marrow-derived mesenchymal stem cells were cultured in type I collagen (the stuff that cartilage is made of) scaffolds. What they found was that the bone marrow-derived mesenchymal stem cells produced functional replacement meniscus tissue better than meniscus tissue did.

This study is not definitive in the way bone marrow derived stem cells may heal and regenerate meniscus tissue. What it does show however, that it is possible.

The Meniscus is always trying to make more meniscus

A study in the Journal of orthopaedic research (4) lead by the Department of Orthopaedics and Rehabilitation, University of Iowa discusses how a meniscus regenerates and heals.

The researchers of this study hypothesized that the meniscus contains a population of regenerative cells, (cells that stimulate stem cell activity) and that these cells migrate to the site of meniscal injury.

“White Zone,” and “Red Zone,”

If you had a meniscus tear you are familiar with “White Zone,” and “Red Zone,” meniscus tears. The “Red Zone,” part of the meniscus, the outer edges, receives a steady stream of healing cells from its well organized blood vessel network. For those of you with a meniscus injury that is being recommended to surgery, you may have had your doctor explain to you that you have a “White Zone,” tear. The “White Zone,” lies in the center of the meniscus. It does not have a well organized blood network. It is these meniscal injuries that send patients to surgery.

This is what these researchers said: “studies revealed that migrating cells were mainly confined to the red zone in normal menisci: (This is the area where the meniscus has good blood flow and healing elements are abundant). However, these cells were capable of repopulating defects made in the white zone, (the area without circulation). When the meniscus was injured, migrating cell numbers increased dramatically. Stem cells in the knee increased in number to combat the injury.These findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor cell population with strong reparative potential, even into the white zone area.

The short of it? The meniscus figures out how to heal itself if it can. Even in the areas that are typically believed unhealable because of lack of blood flow to that area.

The meniscus is mobilizing the stem cells already in the knee to the site of the its injury.

Stem cell numbers? What could be considered even more fascinating is that the meniscus signals for more stem cells from the knee capsule to come to the injured area. For those people asking about stem cell numbers that are harvested for treatment, the meniscus is mobilizing the stem cells already in the knee to the site of the its injury.

Research from September 2020: Stem cells live in all the zones of the meniscus

A study published in the journal Arthroscopy (5) wanted to know what type of stem cell populations lived in the meniscus’s red-red (RR), red-white (RW) and white-white (WW) zones and what type of blood flow went into these areas. To find out they performed a study on human cadaver menisci. So, what did they find?

• There were no significant differences in the clonogenicity (the ability to clone itself to start healing repair) of isolated cells between the three zones.
• Progenitors (cells like stem cells that differentiate into different types of cells, chondrocytes for example that make cartilage) from all zones were found to be potent to differentiate to mesenchymal lineages.
• Additionally, results demonstrate the presence of vascularization in the WW zone. The white-white is typically considered unrepairable because it is believed that no blood flow is present.

The meniscus and cartilage are always trying to heal each other

An October 2020 paper titled: “The menisci and articular cartilage: a life-long fascination,” (6) explains that the “menisci and articular cartilage of the knee have a close embryological, anatomical and functional relationship, which explains why often a pathology of one also affects the other.”

Simply, if you have a meniscus tear, eventually this will damage the protective cartilage of the thigh and shin bones which sandwich the meniscus. But Nature is pretty clever. Nature does not rely on surgical outcomes because as noted, meniscus surgeries lead to accelerated osteoarthritis, how? By accelerating stress and damage on the articular cartilage. So Nature designed the meniscus and the cartilage to look out for each other.

In the Journal of orthopaedic research (7) doctors examined the process of meniscal regeneration and cartilage degeneration following meniscus surgical removal in mice. They found that there is a healing environment that the meniscus and cartilage create independently of each other spurred on by native stem cells, that later melds together, suggestive of a balance between meniscal regeneration and cartilage homeostasis. The meniscus and cartilage are trying to regenerate each other.

This special relationship between cartilage, meniscus and stem cells is discussed in research from the University of Iowa. The Iowa findings demonstrate that, much as in articular cartilage, injuries to the meniscus mobilize an intrinsic progenitor (stem cell) population with strong reparative potential.(8) The problem for patients is that despite the desire to heal and regenerate, as pointed out by the Iowa researchers, “Serious meniscus injuries seldom heal and increase the risk for knee osteoarthritis; thus, there is a need to develop new reparative therapies. In that regard, stimulating tissue regeneration by autologous stem/progenitor cells has emerged as a promising new strategy.”

In past articles I have written extensively about how stem cells change the environment of diseased joints to healing. Research like that above confirms that when one part of the knee is repairing, the entire knee is repairing. This change of environment is something a surgery is not expected to offer.

What are realistic expectations that stem cell therapy can help your meniscus related knee problems?

Researchers at the Osaka University Graduate School of Medicine in Japan teamed with the Mayo Clinic to release a January 2020 (9) paper outlining the current research on stem cell therapy for meniscus repair. In this study they wrote:

“Clinical studies evaluating the effects of MSC (stem cell) injections in the knee joint are limited, but early clinical data suggests encouraging results. Currently, there have not been any reported safety concerns or side-effects in the clinical use of MSC injections.

There is only one randomized double-blind controlled study to date studying the effects of MSC injections into the knee post medial meniscectomy [10]. The study contained 55 subjects in 3 groups who underwent a percutaneous injection of allogeneic MSCs with one group receiving 50 × 106 cells another 150 × 106 cells and control receiving only hyaluronic acid. At 12 months follow up, MRI scan findings reported a significant increase in meniscal volume in 24% of patients receiving 50 × 106 cells and 6% receiving 150 × 106 cells. None of the control group patients demonstrated an increase in meniscal volume. The study is limited to MRI scan being the only objective outcome measure, but the study methodology is rigorous in that it has the advantage of being blinded and randomized.”

As you have seen in this article, the meniscus has an ability to heal itself. When someone comes into our office with knee problems we start with a conversation so we can learn about the patient’s lifestyle and what are his/her goals of the treatment. Is it to get back to marathon training or is it to get up and down a staircase without his/her knee locking up? Then we will do a detailed physical examination looking for those signs that will tell us how helpful stem cell therapy may be.

Do you have questions? Ask Dr. Darrow

A leading provider of stem cell therapy, platelet rich plasma and prolotherapy
11645 WILSHIRE BOULEVARD SUITE 120, LOS ANGELES, CA 90025

PHONE: (800) 300-9300 or 310-231-7000

Stem cell and PRP injections for musculoskeletal conditions are not FDA approved. We do not treat disease. We do not offer IV treatments. There are no guarantees that this treatment will help you. Prior to our treatment, seek advice from your medical physician. Neither Dr. Darrow, nor any associate, offer medical advice from this transmission. This information is offered for educational purposes only. The transmission of this information does not create a physician-patient relationship between you and Dr. Darrow or any associate. We do not guarantee the accuracy, completeness, usefulness or adequacy of any resource, information, product, or process available from this transmission. We cannot be responsible for the receipt of your email since spam filters and servers often block their receipt. If you have a medical issue, please call our office. If you have a medical emergency, please call 911.

References:

1 Razi M, Mortazavi SMJ. Save the Meniscus, A good Strategy to Preserve the Knee. Arch Bone Jt Surg. 2020 Jan;8(1):1-4. doi: 10.22038/abjs.2019.45438.2242. PMID: 32090138; PMCID: PMC7007719.
2 Carter T. Editorial Commentary: Medial and Lateral Meniscus Allografts Using Bone Plug Fixation in Patients Without Advanced Arthritis Have 80% Positive Outcomes at 10 Years.
3 Elkhenany HA, Szojka ARA, Mulet-Sierra A, Liang Y, Kunze M, Lan X, Sommerfeldt M, Jomha NM, Adesida AB. Bone Marrow Mesenchymal Stem Cell-Derived Tissues are Mechanically Superior to Meniscus Cells. Tissue Eng Part A. 2020 Oct 30..
4 Seol D, Zhou C, Brouillette MJ, Song I, Yu Y, Choe HH, Lehman AD, Jang KW, Fredericks DC, Laughlin BJ, Martin JA. Characteristics of meniscus progenitor cells migrated from injured meniscus. Journal of Orthopaedic Research. 2016 Nov 1.
5 Chahla J, Papalamprou A, Chan V, Arabi Y, Salehi K, Nelson TJ, Limpisvasti O, Mandelbaum BR, Tawackoli W, Metzger MF, Sheyn D. Assessing the Resident Progenitor Cell Population and the Vascularity of the Adult Human Meniscus. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020 Sep 23.
6 Kopf S, Sava MP, Stärke C, Becker R. The menisci and articular cartilage: a life-long fascination. EFORT Open Reviews. 2020 Oct;5(10):652-62.
7 Hiyama K, Muneta T, Koga H, Sekiya I, Tsuji K. Meniscal regeneration after resection of the anterior half of the medial meniscus in mice. J Orthop Res. 2016 Nov 2. doi: 10.1002/jor.23470. [Epub ahead of print]
8 Seol D et al. Characteristics of meniscus progenitor cells migrated from injured meniscus. J Orthop Res. 2016 Nov 3. doi: 10.1002/jor.23472.
9 Jacob G, Shimomura K, Krych AJ, Nakamura N. The Meniscus Tear: A Review of Stem Cell Therapies. Cells. 2019 Dec 30;9(1):92. doi: 10.3390/cells9010092. PMID: 31905968; PMCID: PMC7016630.
10 Vangsness Jr CT, Jack Farr II, Boyd J, Dellaero DT, Mills CR, LeRoux-Williams M. Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial meniscectomy: a randomized, double-blind, controlled study. JBJS. 2014 Jan 15;96(2):90-8.

Marc Darrow MD,JD

Many people have successful spinal surgery. Some do not. There are many reasons why someone will have a failed spinal surgery. One reason among the many causes can be the muscle damage caused by the fusion surgery itself.

In a situation like this we would examine the spine and look for tenderness and weakness in the muscle attachments / tendons and the spinal ligaments. If these structures are damaged, we would treat with regenerative injections including platelet rich plasma therapy and/or stem cell therapy. Read More