Marc Darrow MD,JD

I have already written about stem cell therapy as an alternative to meniscus surgery and Platelet Rich Plasma therapy as a meniscus tear alternative. In this article I want to offer research surrounding whether or not you even have a meniscus tear despite what your MRI may or may not say.

Do you even have a meniscus tear? “Understanding that this MRI finding does not represent a true meniscus tear may save patients from unnecessary arthroscopic surgery.”

The accuracy of MRIs, specifically the accuracy of MRIs in sending people to a knee surgery has always been questioned. A February 2021 study says (1) “MRI could be a diagnostic tool for meniscus tears, but has limited accuracy in their classification of the type and location.” Simply, it is not without its errors. Of course in this case you may get a surgery you did not need.

Also in February 2021, this editorial from Peter R Kurzweil, MD, Orthopedic surgeon, published in the journal Arthroscopy (2)

“The false-positive finding of anterior horn meniscus (pseudo) tear on magnetic resonance imaging (MRI) is an important finding of which to be aware. We have recently seen awareness similarly raised regarding root tears of the meniscus, which, if overlooked, could have detrimental consequences. Manifestations of the MRI finding of meniscus pseudotear arise from the variability of the insertion of the transverse geniculate ligament into the anterior horn of the lateral meniscus. Bearing in mind that anterior knee pain is a common reason that patients present for an orthopaedic and sports medicine evaluation, the understanding that this MRI finding does not represent a true meniscus tear may save patients from unnecessary arthroscopic surgery.”

“The negative role of MRI in promoting surgical expectations needs further consideration” – “A lack of evidence for the use of arthroscopy”

Also from February 2021, this paper in the journal Musculoskeletal science & practice (3). This is what a group of physical therapists wrote:

“Current clinical practice guidelines for degenerative meniscal tears recommend conservative management yet patients are frequently referred to the consultant orthopaedic surgeon despite a lack of evidence for the use of arthroscopy.”

What this study was about was that people went to their doctor fully expecting a meniscus surgery recommendation. The doctor told them that they may be better off with physical therapy. This seemed top upset some of the patients who conveyed their thoughts to the physical therapists in this way:

“Participants described beliefs, strongly influenced by magnetic resonance imaging (MRI) results, that damaged structures were causing their knee problems (“The meniscus is busted”), and expected their knee problems to inevitably worsen over time (“It’s only going to get worse”). Participants were hopeful the orthopaedic consultation would clarify their problem and lead to a subsequent definitive intervention (“Hopefully they will give me answers”). Most participants viewed surgery as “the quick and straightforward solution” necessary to repair faulty cartilage. Exercise was not seen as compatible with the recovery process by most (“Would I make it worse?”).

This is how the physical therapists concluded their paper: “How participants understand their knee problem contributes to surgical expectations and perceptions that it is not amenable to conservative management. Findings suggest a need to educate both patients and primary care clinicians about the safety and efficacy of exercise as first-line therapy for degenerative meniscal tears. The negative role of MRI in promoting surgical expectations needs further consideration.”

“There is a noticeable increase in the unnecessary ordering of Magnetic Resonance Imaging (MRI) of the knee in older patients.”

This is a study from November 2020. (4) “There is a noticeable increase in the unnecessary ordering of Magnetic Resonance Imaging (MRI) of the knee in older patients. This quality improvement study assessed the frequency of unnecessary pre-consultation knee MRIs and investigated the effect on the outcome of the patients’ consultation with the orthopedic surgeon.”

650 medical charts of patients aged 55 years or older referred to an orthopedic clinic with knee complaints were reviewed. Of the 650 patient charts reviewed, 225 patients presented with a pre-consultation MRI, 76% of which were not useful for the orthopedic surgeon.

The ordered knee MRI scans were considered not useful because they were requested for confirmed meniscal tear for patients more than 55 years, suspected degenerative disorder and ligament/tendon injury, or for patients with severe osteoarthritis without locking or extension. These MRI scans were done despite the absence of signs of effusion, tenderness, soft tissue swelling, decreased range of motion, or difficulty of weight-bearing, a lack of persistent knee joint pain at the time of assessment, or with no x-ray before ordering MRI.”

It was later noted: “patients with pre-consult (before being sent to the surgeon) MRI were less likely to be considered for total knee arthroplasty (TKA).”

Do you need an MRI before I come in?

In many emails that I get, people ask me if they should get an MRI. Usually an MRI is not necessary as outlined in the research above. I want to first do a physical examination. Other people email and some of them have had a recent MRI and a report of what the MRI recorded and what the radiologist interpreted. Some of these MRI reports are deep and comprehensive in their description of an unseemly insurmountable amount of damage to the person’s knees. The person who sends in the email will sometimes add something in the email to suggest that their MRI is one of the worst that their doctor has ever seen. The funny thing is when we ask, “well how does your knee feel today?” Sometimes we get the answer, “not bad.”

Meniscus tear treatment at the Darrow Stem Cell Institute

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.

Please see my articles

Stem Cell Therapy Alternative For Meniscus Surgery

Platelet Rich Plasma Therapy | Meniscus Tear Injections

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 Kim SH, Lee HJ, Jang YH, Chun KJ, Park YB. Diagnostic Accuracy of Magnetic Resonance Imaging in the Detection of Type and Location of Meniscus Tears: Comparison with Arthroscopic Findings. Journal of Clinical Medicine. 2021 Jan;10(4):606.
2 Kurzweil PR. Editorial Commentary: False-Positive Meniscus Pseudotear on Magnetic Resonance Imaging: A False Sign That Rings True.
3 O’Leary H, Ryan LG, Robinson K, Conroy EJ, McCreesh K. “You’d be better off to do the keyhole and make a good job of it” a qualitative study of the beliefs and treatment expectations of patients attending secondary care with degenerative meniscal tears. Musculoskeletal Science and Practice. 2021 Feb 1;51:102281.
4 Mohammed HT, Yoon S, Hupel T, Payson LA. Unnecessary ordering of magnetic resonance imaging of the knee: A retrospective chart review of referrals to orthopedic surgeons. Plos one. 2020 Nov 2;15(11):e0241645. —1315

Marc Darrow MD,JD

In Germany there is a medical procedure called Orthokine in which anti-inflammatory factors are removed from the patient’s blood, manipulated, and then re-injected into the painful areas. It is an anti-inflammatory treatment used to suppress back and joint pain. By admission of its proponents it is only an anti-inflammatory and not a healing remedy.

In the United States it is called Regenokine and is considered a variant of Orthokine because of significant legal and medical issues surrounding the simple fact  that the Orthokine process is not approved for use in the United States.* The US ban has to do with blood manipulation and blood storage.

Orthokine/Regenokine is often confused with Platelet Rich Plasma Therapy, some even confuse it with stem cell therapy. The confusion comes from the belief that all the therapies have something to do with blood being injected into a painful joint. Below I describe the differences in detail.

Almost every email or phone call to our office eventually will ask “where is the research on PRP or stem cell injections?”  We are happy and eager to answer these questions as there is a great collection of research available on both PRP and Stem Cells.Including those published by our institute:

Please see our research here:

• Stem cell therapy for knee osteoarthritis –
• Stem cell therapy as an alternative to hip replacement –
• Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections
• Treatment of Lower Back Pain with Bone Marrow Concentrate

Sometimes we are asked where is the research on Orthokine or Regenokine. That is not as easy to provide. 

Pubmed the government repository of medical papers lists over 8,600 medical papers on PRP. Nearly 10,000 on stem cell therapy.

Only 8 appear for Orthokine, 154 appear under “autologous conditioned serum,” a descriptive term for “heated” or condition blood plasma injections. Under Regenokine there are NONE.

• Obviously the research on Orthokine/Regenokine is not as robust.

Dr. Peter Wehling, the pioneer of Orthokine, invented the technique in the 1980s after noticing that some patients with terrible spinal MRIs had no pain from mechanical problems but patients with less damage on MRI had terrible pain. Dr. Wehling concluded the “wildcard” factor was inflammation.

• The body heals by inflammation, so if inflammation is present the body is trying to heal something, if you stop the inflammation process you stop healing. Inflammation is not the enemy of pain patients, not enough inflammation or not enough healing is.

Let’s go back to Dr. Wehlin: On July 10, 2012 the New York Times reported the following “(Wehling’s treatment Orthokine) might sound similar to another blood-spinning treatment, known as platelet-rich plasma, or PRP., that has gained popularity in the United States in recent years. In that procedure, the goal is to produce a high concentration of platelet cells, which are believed to speed the healing process.

Wehling said his treatment differed from PRP  because he heats the blood before it is spun to increase the concentration of anti-inflammatory proteins, rather than the platelets. The idea is not just to focus on mechanical problems in the joints or lower back but to treat inflammation as a cause of tissue damage as well as a symptom. So there are two things to note – the joint is not being treated – the inflammation is being suppressed. The blood is heated and that is why it cannot be practiced in the United States.”

PLATELET RICH PLASMA, OR REGENOKINE?

PRP injection is a treatment method in which high concentrations of endogenous (your own) platelets are delivered to a specific area of injury in order to stimulate your body’s natural healing response. During the procedure your blood is drawn and placed in a centrifuge to separate the platelet rich plasma from the rest of your blood. This plasma is then injected using ultrasound guidance.

Here lies a crucial difference in the treatment methods.

Both draw blood, but one draws the anti-inflammatory portion, one draws the pro-inflammatory portion. Clearly the two treatments can never be combined.

Regenokine attacks the interleukin-1 (IL-1) inflammation producing system. As a joint continues deeper into a degenerative state, the immune system produces more interleukin-1 to break down dead, dying, diseased tissue to clear the way for new tissue. However, in degenerative joint or disc disease, the immune system can be destroying more tissue that the body can create to replace it. The immune system is destroying cartilage your body needs.

By contrast PRP contains healing agents, or “growth factors.” Let’s look at some of the growth factors and what they do:

• Platelet-derived growth factor (PDGF) is a protein that helps control cell growth and division, especially blood vessels. When more blood (and the oxygen it carries) is delivered to the site of a wound, there is more healing.
• Transforming growth factor beta (or TGF-β) is a polypeptide and is important in tissue regeneration.
• Insulin-like growth factors are signaling agents. They help change the environment of the damaged joint from diseased to healing by “signaling” the immune system to start rebuilding tissue.
• Vascular endothelial growth factor (VEGF) is an important protein that brings healing oxygen to damaged tissue where blood circulation might be damaged or inadequate.
• Epidermal growth factor plays a key role in tissue repair mechanisms.

The PRP is also working to remove dead dying tissue and reduce an overactive immune system from breaking down too much cartilage. BUT, the PRP is also creating new tissue simultaneously.

Stem cell therapy also works in the capacity of removing dead tissue, shutting down an overactive immune breakdown system. It also works by bringing stem cells into a damaged area to facilitate a quicker and somewhat more powerful healing response.

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.

Published research in the medical literature from the Darrow Stem Cell Institute

Treatment of shoulder osteoarthritis and rotator cuff tears with bone marrow concentrate and whole bone marrow injections

The Darrow Stem Cell Institute has published new 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

Read More

Marc Darrow MD,JD

One of the most fascinating subjects in health is caloric restriction and fasting, since both have been shown to promote healing, health, and longevity.

• Short-term caloric restriction suppressed oxidative stress and improved cardiac function.(1)
• Caloric restriction increases the level of the hormone DHEA (short for dehydroepiandrosterone) in muscle and blood, suggesting that DHEA might partially mediate anti-aging, anti-obesity, and
  health-promoting effects.(2)
• Caloric restriction has been found to reverse the impairment caused by a high-fat diet with very high energy efficiency in a short period.(3) In the context of joint repair, caloric restriction becomes especiallyintriguing.
• Caloric restriction may be beneficial for wound healing efficiency in aging individuals.(4)

Fasting triggered stem cell-based regeneration

In 1985, doctors at the University of Southern California released research showing that fasting triggered stem cell-based regeneration. They found that cycles of prolonged fasting not only protect against immune system damage, but also induce immune system regeneration, shifting stem cells from a dormant state to a state of self-renewal.

Such findings have significant implications for healthier aging, as the decline in immune system function with aging contributes to increased susceptibility to disease. Calorie restriction with adequate nutrition is the only nongenetic intervention, and the most consistent nonpharmacological one, that both extends the lifespan and reduces inflammation.(5,6)

Inflammation and caloric restriction

Arthritis is related to inflammation in the joint tissue. Reducing inflammation through proper food choices and diet is something I recommend to all my patients. Then why do I use the  nflammation of regenerative medicine to heal the body? Consider the following precepts:

1. Musculoskeletal pain and arthritis is often caused by chronic inflammation that is uncontrolled.

2. Regenerative medicine causes a controlled, short burst of inflammation, which is needed to initiate the growth of new tissue.

3. The short burst of inflammation brings new healing cells to the injured or worn tissue, stimulating new tissue growth which stops the chronic inflammation.

Foods that may aggravate arthritis and should be minimized in the diet:

• Foods high in saturated fat (e.g., dairy, red meat, and baked goods)
• Coffee (because of the high acid content)
• Sugary foods
• Refined grains (e.g., refined pasta, white rice, and white breads)
• Refined or processed foods (if it’s in a box or a can, it’s processed)
• Alcohol

Foods that help lower inflammation in the body and should be mainstays of the diet:

Vegetables and certain fruits (create an alkaline environment)

• Whole grains, such as brown rice and bulgur wheat
• Sources of omega-3 fatty acids, such as fatty fish (e.g. salmon and mackerel), fish oil supplements, and walnuts
• Lean protein sources (e.g., chicken, turkey, or beans)
• Green tea

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.

1 Kobara M, Furumori-Yukiya A, Kitamura M, Matsumura M, Ohigashi M, Toba H, Nakata T. Short-term caloric restriction suppresses cardiac oxidative stress and hypertrophy from chronic pressure overload. J Card Fail. 2015 May 13. pii: S1071-9164(15)00127-X. doi: 10.1016/j.cardfail.2015.04.016. [Epub ahead of print.]
2. Yokokawa T, Sato K, Iwanaka N, Honda H, Higashida K, Iemitsu M, Hayashi T, Hashimoto T. Dehydroepiandrosterone activates AMP kinase and regulates GLUT4 and PGC-1α expression in C2C12 myotubes. Biochem Biophys Res Commun. 2015 May 15. pii: S0006-291X(15)00908-0. doi: 10.1016/j. bbrc.2015.05.013. [Epub ahead of print.]
3. Gong H, Han YW, Sun L. The effects of energy intake of four different feeding patterns in rats. Exp Biol Med (Maywood). 2015 May 12. pii: 1535370215584890. [Epub ahead of print.]
4.  Yanai H, Toren D, Vierlinger K, Hofner M, Nöhammer C, Chilosi M, Budovsky A, Fraifeld VE. Wound healing and longevity: lessons from long lived αMUPA mice. Aging (Albany, NY). 2015 Mar;7(3):167-76. [Erratum: Aging 2016.]
5. Wu S. Fasting triggers stem cell regeneration of damaged, old immune system. USC News. 2014 June 5. http://news.usc.edu/63669/fasting-triggersstem-cell-regeneration-of-damaged-old-immune-system
6. Testa G, Biasi F, Poli G, Chiarpotto E. Calorie restriction and dietary restriction mimetics: a strategy for improving healthy aging and longevity. Curr Pharm Des. 2013 Sep 26. [Epub ahead of print.]