Marc Darrow MD,JD

The hip joint, the shoulder joint, the knee joint, the big toe joints, they all have one thing in common. When they are in the process of wear and tear degenerative joint disease, they become unstable, painful, and they start forming bone spurs and bony overgrowths. Sometimes the person suffering from degenerative joint disease will let this condition of joint instability go on for too long. This will cause the bone spurs to become too large and they will freeze up the joint, making it stiff and unmoveable, and, necessitating a need for surgery to shave down the bones. In the big toe, this bone spur or overgrowth is commonly referred to as a bunion.

In this article I will discuss with you the two main type of patients we see with big toe pain. The patient who has big toe joint instability that can be helped with PRP and stem cell therapy injections and the patient with a large bunion and what we may be able to do for them.

The big toe has two joints

• metatarsophalangeal joint (the bunion joint)
• interphalangeal joint (the joint under the toenail)

The metatarsophalangeal joint is where we will concentrate this article.
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Marc Darrow MD,JD

The application of blood platelets for hair restoration is sometimes difficult to understand in the context of the many hair restoration products available. At our Institute we like to present the science to show you theoretically how this works at the cellular and molecular level. This science comes from leading research institutes and publications. This article is a 2021 research update.

At the Darrow Stem Cell Institute we utilize Platelet Rich Plasma (PRP) not only to accelerate repair of damaged joints, but also for the regeneration of hair.

• PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected into an area of thinning hair on the scalp. These treatments can then stimulate hair regeneration in many people. The treatment is aptly named Platelet Rich Plasma therapy as it is blood plasma that is rich is platelets. Now let’s find out how they work.

A June 2018 study in the Journal of cosmetic dermatology (1) reported these findings about PRP for hair loss and how it worked.

“The clinical application of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors that are released from (the) alpha-granule (simply the container within the blood that holds growth factors) of the concentrated platelets and in the secretion of proteins which are able to capitalize on the healing process at the cellular level. It has been invented to restore the natural beauty by starting the natural rejuvenation process of the skin and aiming to make it function as a younger one and to keep the skin youthful and maintain it. Besides that, it is also emerged to include hairs as a new injectable procedure to enable stimulating hair growth locally and topically; preventing its fall; improving hair shaft, hair stem, and its caliber; increasing its shine, vitality, and pliability; and declining hair splitting and breakage. Thus, youth is in your blood as it has a magical power imposed in the platelet factors.”

Now we do not like to use the word “magical” to describe any medical procedure because we want our patients to know their realistic options before treatment, but here is the word “magical” being used in a peer-reviewed and well esteemed medical journal. So there may be something to this PRP treatment for hair restoration.

Why another hair loss treatment when there are so many to choose from?

This is what doctors at university medical centers in Greece published their review of PRP’s effect on androgenetic alopecia and alopecia areata seem to suggest At the beginning of their paper, the Greek doctors answered the question posed above: why another hair loss treatment when there are so many to choose from?

Here is their answer:

“Despite available therapeutic options, the search for new, more effective hair restoration treatment is constant. Platelet-rich plasma could be the more effective treatment. . . Growth factors in platelets’ granules of PRP bind in the bulge area of hair follicle, promoting hair growth making PRP a potential useful therapeutic tool for alopecias, without major adverse effects.” (2)

The Greek doctors answered the question. Why PRP as a hair loss treatment? It works.

Here Dr. Darrow is injecting PRP into a patient’s scalp to regrow hair! Platelet-rich plasma (PRP) therapy stimulates hair growth through the promotion of vascularization and angiogenesis (the creation of new blood vessels that brings new blood circulation to the scalp), as well as encourages hair follicles to enter and extend the duration of the anagen phase (the most active growth portion of the hair growth cycle).

Platelet-rich plasma “safe and effective alternative procedure” when compared to Minoxidil ®, Finasteride ®

An April 2020 study published in the International journal of molecular science (3) compared Platelet-Rich Plasma use in Androgenetic Alopecia  with Minoxidil®, and Finasteride®.

Here are some of their learning points:

• 12 clinical trials were analyzed for the effectiveness of Platelet Rich Plasma in the treatment of Androgenetic Alopecia.
• In total, 84% of the studies (10 of 12) reported a positive effect of PRP for Androgenetic Alopecia treatment.
• The information analyzed highlights the positive effects of PRP on Androgenetic Alopecia, without major side effects and thus it be may considered as a safe and effective alternative procedure to treat hair loss compared with Minoxidil® and Finasteride®.

Another April 2020 study, this one published in the journal Expert opinion on pharmacotherapy.(4) offered similar observations:

• “Androgenetic alopecia progresses over time and although the current available medical treatments like finasteride and minoxidil are effective in arresting the progression of the disease, they allow only partial regrowth of hair at its best. Early treatment achieves a more optimal outcome. Non-pharmacologic treatments like PRP can be considered in patients refractory to medical treatment.”

PRP VS. Minoxidil ® 5% and PLACEBO

More on Mixoxidil comparisons: Doctors at university medical centers in Egypt compared topical minoxidil 5% and platelet rich plasma treatments for alopecia areata, a disease that results in one or more areas of coin-sized hairless patches.

• Patients treated with minoxidil 5% and platelets rich plasma both have significant hair growth than placebo.
• Patients treated with platelets rich plasma had an earlier response in the form of hair regrowth, reduction in short vellus hair and dystrophic hair unlike patients treated with minoxidil and control.

With these findings the Egyptian doctors were able to conclude that platelets rich plasma is more effective in the treatment of alopecia areata than topical minoxidil 5%.(5)

Doctors at the University of Rome reported their results of a randomized, placebo-controlled, half-head group study to compare the hair regrowth with PRP versus placebo.

• In this study of three treatment cycles, the patients presented clinical improvement in the mean number of hairs, with a mean increase of 33.6 hairs in the target area and a mean increase in total hair density of 45.9 hairs per square centimeter compared with baseline values.
• No side effects were noted during treatment. The data clearly highlight the positive effects of PRP injections on male pattern hair loss and absence of major side effects.(6)

Creating greater hair density and thickness

A study in the journal Facial plastic surgery clinics of North America, November 2018 also found PRP to be an effective treatment in creating greater hair density and thickness:

• “(In numerous studies) Overall positive clinical response to the use of PRP in androgenetic and alopecia areata patients is observed. The effects on hair density, count, and thickness were demonstrated through multiple clinical trials. . . “(7)

At the University of Connecticut, doctors found that PRP showed a benefit on patients with androgenic alopecia, including increased hair density and quality.(8)

Here are the summary learning points of this study:

• After (PRP) therapy, mean hair density/diameter increased and terminal/vellus hair ratio was also improved.
• Patients presented epidermal thickness, perifollicular neoangiogenesis (new blood vessels to fee new hair), cell proliferation, and terminal/miniaturized hair ratio (less pattern hair loss) improvement. Plasma rich in growth factors seemed to reduce the perivascular inflammatory infiltrate (inflammation of the blood vessels that has been linked to hair loss), promote the remodeling of dermo-epidermal tissue, and increase bulge stem cell niches. (Hair follicles have a niche for mature stem cells—hair follicular stem cells (HFSCs)—a so-called “bulge” in the attachment region of arrector pili muscles, (the small muscles attached to hair follicles). (Note: There are stem cells in your hair. They are just not active, PRP can make them active.)
• Patients declared an overall positive satisfaction, and a high clinical improvement score was achieved.

PRP INDUCES THE PROLIFERATION OF DERMAL PAPILLA CELL (HAIR FOLLICLES)

Doctors at the Santosh Medical College in India documented similar findings, in their study in the Asian Journal of Transfusion Science, (9) doctors conducted a study of 10 patients with hair loss. In the introduction of the study the doctors acknowledged that Platelet-rich plasma (PRP) has shown remarkable beneficial effects without any major adverse reactions in the treatment of androgenic alopecia, as did the Greek doctors.

Here is what the Indian doctors found: The growth factors in autologous (your blood) PRP induces the proliferation of dermal papilla cell (Hair follicles). Ten patients were given PRP injections prepared from their own blood on the affected area of alopecia over a period of 3 months at interval of 2-3 weeks and results were assessed. Three months after the treatment, the patients presented clinical improvement in the hair counts, hair thickness, hair root strength, and overall alopecia. They concluded that PRP appears to be a cheap, effective, and promising therapy for androgenic alopecia with no major adverse effects.

In another study from Greek researchers lead by the Democritus University of Thrace, 20 patients, 18 males and 2 females, with androgenetic alopecia had three PRP treatment sessions performed every 21 days and a booster session at 6 months following the onset of therapy.At 6 months and at 1 year, hair volume was significantly increased.(10) Images from this study:

PRP PROMOTES HAIR GROWTH AND INCREASE THE NUMBER OF HAIR FOLLICLES IS BY INDUCING ANGIOGENESIS

In an October 2017 research study published in the European journal of medical research, doctors confirmed earlier research that suggests one of the ways PRP promotes hair growth and increase the number of hair follicles is by inducing angiogenesis. The formation of new blood vessels that brings growth factors to the scalp.(11)

This agrees with earlier research from the journal Dermatologic surgery suggesting Platelet-rich plasma therapy stimulates hair growth through the promotion of vascularization and angiogenesis (the creation of new blood vessels that brings new blood circulation to the scalp), as well as encourages hair follicles to enter and extend the duration of the anagen phase (the most active growth portion of the hair growth cycle).(12)

In the Journal of cosmetic dermatology, Elghblawi Ebtisam MD, a Libyan Amazagh researcher, published her findings in support of PRP for reversing skin aging and hair restoration. Here is what she wrote in this September 2017 study:

The clinical application of platelet-rich plasma (PRP) is based on the increase in the concentration of growth factors that are released from alpha-granule of the concentrated platelets (the small particles that house a lot of healing growth factors include those that stimulate hair growth), and in the secretion of proteins which make the healing process go and the cellular level. (So in general, you have growth factors released from the platelet particles and directed by protein messages.)

“(PRP treatments) restores natural beauty by starting the natural rejuvenation process of the skin and aiming to make it function as a younger one and to keep the skin youthful and maintain it.

Besides that, it is also emerged to include hairs as a new injectable procedure to enable stimulating hair growth locally and topically; preventing its fall; improving hair shaft, hair stem, and its caliber; increasing its shine, vitality, and pliability; and declining hair splitting and breakage.

PRP proved to promote wound healing and aid in facelift, volumetric skin, skin rejuvenation, regeneration, and reconstruction; improve wrinkling; stimulate hair growth; increase hair follicle viability and its survival rate; prevent apoptosis; increase and prolong the anagen hair growth stage; and delay the progression to catagen hair cycle stage with increased density in hair loss and hair transplantation.”(13)

Dr. Ebtisam’s findings were based on a comprehensive review of the current medical literature.I would like to also point out that was Dr. Ebtisam who was the researcher in the above study calling PRP, “magical”.

In August 2016, a team of researchers from Patna Medical College and Hospital in India also published in the Journal of cosmetic dermatology that Platelet-rich plasma has shown beneficial effects in the treatment of androgenic alopecia with its growth factor properties in accelerating the dermal papilla. In this study the technique of micro-needling was added.

Note: PRP injections followed by micro needling stimulates new hair growth by re-activating dormant follicles and heals the follicle at a cellular level.  This results in healthier thicker hair.

In this research from India, patients with mild to moderate androgenic alopecia, aged 18-45 years in the study group were given autologous platelet-rich plasma injections with microneedling over a period of 3 months at 3 weekly interval.

Hair growth started after the first session. Patients’ satisfaction was more than 75% on patients’ subjective hair growth assessment scale.(14)

AFTER SIX PRP SESSIONS

Doctors and researchers from the Department of Dermatology, Hospital Clínic, University of Barcelona, Barcelona, Spain published their clinical findings of six years experience utilizing PRP for androgenetic alopecia.

Utilizing a standard treatment protocol that they had developed, the University of Barcelona doctors reported that after six PRP sessions, they were able to achieve these results:

• In MEN with androgenetic alopecia
  • successful outcome in 71.4%
  • stayed them same 21.4%
  • worsening hair loss problems 7.1%
• In WOMEN with androgenetic alopecia
  • successful outcome in 73.4%
  • stayed them same 16.3%
  • worsening hair loss problems 10.2%

The researchers concluded: “PRP together with a periodical application protocol can be considered effective as a coadjuvant therapy in patients who no longer respond to pharmacological treatments.”(15)

One year later, after PRP, mean hair density/diameter increased and terminal/vellus hair ratio was also improved

Another Spanish university study from May 2017 (16)  published new findings suggesting that platelet rich plasma injections played an important role in hair follicle restoration.

In their research, the doctors gave 5 PRP injections to 19 patients with androgenetic alopecia. One year later, after PRP, mean hair density/diameter increased and terminal/vellus hair ratio was also improved. Terminal and Vellus are the two types of hair that grow on the scalp of men with male pattern baldness. Terminal hair is darker, thicker, longer.

In addition patients showed:

• epidermal thickness,
• perifollicular neoangiogenesis (new blood vessel formation in the scalp),
• cell proliferation, and terminal/miniaturized hair ratio improvement. (Miniaturized hair is hair that shrinks over time).

Plasma rich in growth factors seemed to reduce the perivascular inflammatory infiltrate (inflammatory conditions which can lead to hair loss as in androgenetic alopecia ), promote the remodeling of dermo-epidermal tissue, and increase bulge stem cell niches (Hair undergoes a regenerative and rest stage managed by stem cells in a region of the skin known as the “bulge.”) Patients declared an overall positive satisfaction, and a high clinical improvement score was achieved.

Female pattern hair loss

There has been a lot of research suggesting the benefit of PRP in male pattern hair loss. Part of the reasoning is that some research suggest that PRP works so much better for men. But it also works for women.

A study published in February 2019 in the Journal of cosmetic dermatology (17) investigated the efficacy, tolerability, and clinical improvement of PRP for the treatment of female Androgenetic alopecia.

Research summary:

PRP for patients not responding to and minoxidil.

• A total of 10 female patients affected by Androgenetic alopecia and not responding to treatment with minoxidil and/or oral antiandrogens were enrolled and treated with PRP.
• After 12 weeks, the medium hair diameter in frontal area showed a significant increase  and after 24 weeks  the vellus relative change instead showed a decrease, especially in the front and the central area, while for the vertex, the decrease was mainly visible at the end. (The vellus hair are the short, thin hair that comes in to try to replace the hair that has fallen out. More vellus hair, more hair loss).
• Platelet-rich plasma injections have a positive therapeutic effect on hair density and hair diameter improvement.

Another study in the Journal of cosmetic dermatology (18) found PRP to be an effective therapeutic tool for hair loss in women. Thirty female patients with female pattern hair loss were randomly assigned to receive PRP injections into a selected area, and another area of hair loss and was injected with normal saline as a placebo. Sessions were performed weekly for a maximum total of four sessions. Patients were followed up 6 months after the end of last session.There was a statistical significant difference between PRP and placebo areas regarding both hair density and hair thickness as measured by a folliscope. Platelet-rich plasma injections can be regarded as an alternative for the treatment of female pattern hair loss with minimal side-effects and a low cost-to-benefit ratio.

Summary

A January 2021 (19) study offers us an up to date overview of PRP therapy for hair loss and restoration in cases of alopecia.

• “PRP is a safe and easy method for treating hair loss and has limited adverse effects. Optimization of this method depends on dosage, number of sessions and their intervals, and injection techniques. According to the results, the use of PRP due to its relatively high efficiency, low and tolerable side effects, and low recurrence rate can be a good method for the treatment of alopecia and hair loss.”

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 Elghblawi E. Platelet‐rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering. Journal of cosmetic dermatology. 2018 Jun;17(3):423-30. [Google]
2. Maria-Angeliki G, Alexandros-Efstratios K, Dimitris R2, Konstantinos K. Platelet-rich Plasma as a Potential Treatment for Noncicatricial Alopecias. Int J Trichology. 2015 Apr-Jun;7(2):54-63. doi: 10.4103/0974-7753.160098.
3 Gentile P, Garcovich S. Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil^®, Finasteride^®, and Adult Stem Cell-Based Therapy. Int J Mol Sci. 2020;21(8):2702. Published 2020 Apr 13. doi:10.3390/ijms21082702
4 York K, Meah N, Bhoyrul B, Sinclair R. A review of the treatment of male pattern hair loss. Expert Opin Pharmacother. 2020;21(5):603-612. doi:10.1080/14656566.2020.1721463
5 El Taieb MA, Ibrahim H, Nada EA, Seif Al-Din M. Platelets rich plasma versus minoxidil 5% in treatment of alopecia areata: A trichoscopic evaluation. Dermatol Ther. 2017 Jan;30(1). doi: 10.1111/dth.12437. Epub 2016 Oct 28.
6 Gentile P, Garcovich S, Bielli A, Scioli MG, Orlandi A, Cervelli V. The Effect of Platelet-Rich Plasma in Hair Regrowth: A Randomized Placebo-Controlled Trial. Stem Cells Transl Med. 2015 Nov;4(11):1317-23. doi: 10.5966/sctm.2015-0107. Epub 2015 Sep 23. PMID: 26400925; PMCID: PMC4622412.
7 Badran KW, Sand JP. Platelet-Rich Plasma for Hair Loss: Review of Methods and Results. Facial Plastic Surgery Clinics. 2018 Nov 1;26(4):469-85.
8  Anitua E, Pino A, Martinez N, Orive G, Berridi D. The Effect of Plasma Rich in Growth Factors on Pattern Hair Loss: A Pilot Study. Dermatol Surg. 2017 May;43(5):658-670. Dermatol Surg. 2017 May;43(5):658-670.
9 Singhal P, Agarwal S, Dhot PS, Sayal SK. Efficacy of platelet-rich plasma in treatment of androgenic alopecia. Asian J Transfus Sci. 2015 Jul-Dec;9(2):159-62. doi: 10.4103/0973-6247.162713.
10 Gkini MA, Kouskoukis AE, Tripsianis G, Rigopoulos D, Kouskoukis K. Study of platelet-rich plasma injections in the treatment of androgenetic alopecia through an one-year period. J Cutan Aesthet Surg. 2014 Oct-Dec;7(4):213-9. doi: 10.4103/0974-2077.150743.
11 Cheng H, Zhang J, Li J, Jia M, Wang Y, Shen H. Platelet-rich plasma stimulates angiogenesis in mice which may promote hair growth. European Journal of Medical Research. 2017 Oct 11;22(1):39.
12 Gupta AK, Carviel J. A Mechanistic Model of Platelet-Rich Plasma Treatment for Androgenetic Alopecia. Dermatol Surg. 2016 Dec;42(12):1335-1339.
13 Elghblawi E. Plasma‐rich plasma, the ultimate secret for youthful skin elixir and hair growth triggering. Journal of Cosmetic Dermatology. 2017 Sep 8.
14 Jha AK, Udayan UK, Roy PK, Amar AK, Chaudhary RK. Platelet‐rich plasma with microneedling in androgenetic alopecia along with dermoscopic pre‐and post‐treatment evaluation. Journal of Cosmetic Dermatology. 2017 Aug 3.
15 Ferrando J, García-García SC, González-de-Cossío AC, Bou L, Navarra E. A proposal of an effective platelet-rich plasma protocol for the treatment of androgenetic alopecia. International journal of trichology. 2017 Oct;9(4):165.
16 Ferneini EM, Beauvais D, Castiglione C, Ferneini MV. Platelet-Rich Plasma in Androgenic Alopecia: Indications, Technique, and Potential Benefits. J Oral Maxillofac Surg. 2017 Apr;75(4):788-795. doi: 10.1016/j.joms.2016.10.040. Epub 2016 Nov 15.
17 Starace M, Alessandrini A, D’Acunto C, et al. Platelet-rich plasma on female androgenetic alopecia: Tested on 10 patients. J Cosmet Dermatol. 2019;18(1):59-64. doi:10.1111/jocd.12550
18  Tawfik AA, Osman MAR.Tawfik AA, Osman MA. The effect of autologous activated platelet‐rich plasma injection on female pattern hair loss: A randomized placebo‐controlled study. Journal of cosmetic dermatology. 2018 Feb 1;17(1):47-53.
19 Roohaninasab M, Goodarzi A, Ghassemi M, Sadeghzadeh‐Bazargan A, Behrangi E, Najar Nobari N. SYSTEMATIC REVIEW OF PLATELET‐RICH PLASMA (PRP) IN TREATING ALOPECIA: FOCUSING ON EFFICACY, SAFETY AND THERAPEUTIC DURABILITY. Dermatologic Therapy.:e14768. — 3461

Marc Darrow MD,JD

I receive many emails about accelerating the healing of a surgically repaired tendon with stem cell therapy. These emails come from athletes or people who need to get back to work much faster than their surgical rehabilitation is allowing them to. Generally speaking stem cell therapy can be very successful in augmentation repair of a surgery. Of course each patient is unique and a consultation would be required to come up with a realistic healing program for that patient’s specific goals.

Preferably we would like to see the patient before the surgery to see if stem cell therapy and Platelet Rich Plasma injections can repair the Achilles tendon without the need for surgery. If the patient can avoid a surgery, then the patient can avoid the recovery that surgery requires.

A brief description of our treatments

• PRP treatments involve collecting a small amount of your blood and spinning it in a centrifuge to separate the platelets from the red cells. The collected platelets are then injected back into the injured area to stimulate healing and regeneration. Learn more about PRP treatments.
• Stem Cell Therapy is the injection of a damaged area of the body with stem cells that have been drawn from the patient’s own bone marrow. Stem cells are “de-differentiated pluripotent” cells, which means that they continue to divide to create more stem cells; these eventually “morph” into the tissue needing repair — for our purposes, collagen, bone, and cartilage.

These treatments may be effective in partial Achilles tendon tears or strengthening the other structures of the ankle / foot complex.

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Marc Darrow MD,JD

As with other joint problems, I will often get emails that are simply an MRI report. The MRI tells me that the person has a disc herniation at L1 or L2 or L4 or L5. Then the report will describe varying degrees of degenerative disc disease. The email will end with “can you help?” That answer would be easier if there was some more information included in that email.

At no point in the email did the person say how bad their pain was, what type of limitations they had, or how their back problem was affecting their ability to work or be active. Information as simple as knowing how someone’s back feels today is good information to have when trying to determine if our treatments can help.

It is not the emailers fault for excluding this information. For some people, they have been trained that the MRI has captured the image of what is causing their pain and this image can be used as a roadmap or baseline to help doctors plot out a surgical path now or in the near future. I get the MRI report because these people are exploring ways to avoid that surgery.

Research: some surgeries and MRIs are “unjustified and wasteful healthcare expenditures.”

The problem of over reliance on MRI is that they can send you to a surgery you may not need. A study that appeared in the medical journal Radiologia (Radiology) (1) examined the traditional recommendations of sending a patient to get an MRI and then offering a surgery based on what the MRI indicated. The researchers had concerns about the enthusiasm some surgeons had for surgery that was likely inappropriate.
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Marc Darrow MD,JD

This is a Darrow Stem Cell Institute research article published in the Biomedical Journal of Scientific & Technical Research (BJSTR), July 2018. This article presents highlighted portions of that research. For the full article please visit this link.
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Marc Darrow MD,JD

The problems of ACL reconstruction surgery are many. So much so that surgeons are now exploring new surgical options. In the medical journal Knee, August 2017, doctors discuss the resurgence of interest in primary anterior cruciate ligament (ACL) repair.(1) This is a surgery that will attempt to fix the remnant or remaining ACL with what is left behind. This of course as opposed to using transplanted material to reconstruct the ligament. The first benefit of the primary ACL repair is that this procedure is less invasive than ACL reconstruction. An ACL that can be repaired usually does not need tunnels drilled in bone to thread the ACL graft and screws to hold them down. However, one must remember that the reason transplant became popular was because the primary repair really did not work that well.

So to take this idea one step further, how do you make the surgery more successful? in December 2019, a study from the Mayo Clinic (2) suggested that stem cell therapy may offer a viable enhancement to post-surgical ACL reconstruction repair. They write, “improved outcomes spanning from higher patient-reported outcome scores to magnetic resonance imaging evidence of ligament healing in the setting of anterior cruciate ligament tears.”
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Marc Darrow MD,JD

As with other joint problems, I will often get emails that are simply an MRI report. The MRI tells me that the person has a disc herniation at L1 or L2 or L4 or L5. Then the report will describe varying degrees of degenerative disc disease. The email will end with “can you help?” That answer would be easier if there was some more information included in that email.

At no point in the email did the person say how bad their pain was, what type of limitations they had, or how their back problem was affecting their ability to work or be active. Information as simple as knowing how someone’s back feels today is good information to have when trying to determine if our treatments can help.

It is not the emailers fault for excluding this information. For some people, they have been trained that the MRI has captured the image of what is causing their pain and this image can be used as a roadmap or baseline to help doctors plot out a surgical path now or in the near future. I get the MRI report because these people are exploring ways to avoid that surgery.
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Marc Darrow MD,JD

I want to begin this article with two case studies we recently published research in the Biomedical Journal of Scientific & Technical Research.(1)

• The patient was a 77 year-old female with a 20-year history of lower back pain, which had progressed with age.
• The patient wore a back brace to attempt to reduce the stiffness and pain when standing or sitting for extended periods of time.
• Radiographic assessment of her lumbar spine showed mild dextroscoliosis (a sideways curve) and
• a mild narrowing of L1-L2, L3-L4 and moderately severe narrowing of L5-S1.
• Her baseline resting and active pain prior to treatment was:
  • 1/10 (resting) and 5/10 (active), and a 33/40 functionality score.

After physical assessment of her lower back, we determined her pain was generated from a lumbosacral sprain. Not the narrowing of the L1-L5,S1

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Marc Darrow MD,JD

We have seen many patients over the years who were looking for options to an arthroscopic wrist surgery for their unresolved wrist pain. They, like you perhaps, had a wrist pain that an MRI could not explain and their doctors felt that exploratory arthroscopic surgery may help find this pain. While the surgeons explored, the hope is that they may come upon something that they could repair. Whether or not that was the cause of the patient’s wrist pain, could not be confirmed until after the recovery period.

This type of surgical option is also one that many parents are trying to avoid for their young athlete. You may imagine that an athlete, with a small time table to return to sport would not want to chance a surgery and recovery where the outcome may be in doubt.

We offer non-surgical options to unresolved wrist pain. Stem cell therapy and Platelet Rich Plasma Therapy. In this article I want to present our research findings on the effects of Platelet Rich Plasma Therapy on unresolved chronic wrist pain published in the journal Orthopedic & Muscular System: Current Research (March 2019).
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Marc Darrow MD,JD

Everyday we get many emails. Some of these emails concern neck pain. In many of these emails the person asking a question sends me their cervical neck MRI findings. That is all they send: A cut and paste of their MRI report. They never say what their pain is like, how this neck pain is affecting their day to day quality of life, or any other glimpses into how this chronic neck pain is hurting them. The email that they send me is all about their neck MRI. Our own clinical findings and that of researchers is that maybe your neck pain should not be all about your MRI.It should be about you.

As many of you are already aware, MRI interpretations can be a long, hard to understand, somewhat frustrating thing for a patient to see and read. The MRI may also seemingly describes a lot of problems with a lot of terminology that can be considered frightening. This may, for many, cause unneeded anxiety and fear. I have been doing regenerative medicine for more than 20 years. Over the years we have been blessed to have helped many people with their neck pain. I have seen patients with varying degrees of degenerative cervical spine disease trying to avoid surgery, I have also seen patients after a cervical neck surgery with more challenges than before the surgery who, unfortunately, may have had a surgery that they did not need. The one thing many of these people had in common was a cervical neck MRI that suggested a lot more problems than the patient was actually having.
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