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K. Dean Reeves, M.D. Clinical Associate Professor Physical Medicine and Rehabilitation
Emphasis on Research in Use of Prolotherapy (Also called Regenerative Injection Therapy) ReevesOffice @ gmail.com Office Email DeanReevesMD @ gmail.com Personal email
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| Stem Cell Use in Osteoarthritis of the Knee. A Case Report on Potential Use in Cartilage Growth Stimulation
200 ml of blood was drawn from a sngle patient and spun down to provide platelet rich plasma to support the bone marrow cultures. --> 10 ml of L post sup iliac spine (PSIS) marrow was obtained and 10 ml of R PSIS marrow in an operating room. --> 5 passages (culture method with 5 periods of growth to allow enough stem cells to be obtained) were taken to separate and concentrate the MSCs (mesenchymal stem cells or cells that can become ligament, tendon and cartilage cells). --> Bone marrow aspiration is performed again to obtain 1 ml of fresh nucleated cells, and blood is drawn for a fresh platelet rich plasma component with the latter diluted to 10% platelet solution. --> The cultured and grown MSCs are injected along with the 1 ml of nucleated cells and 1 ml of platelets into the knee . --> 1 ml of dilute (10%) platelets were then injected in the knee one week after stem cell injection--> 1 ml of dilute (10%) platelets were then injected in the knee two weeks after stem cell injection Therefore, in summary the interventions taken included 3 bone marrow aspirations, 4 blood draws for platelet rich plasma, and 3 knee injections. In addition there was a time lag for culture prep and passages of MSCs. This is a lot of interventions and expense of course. Nevertheless this is an excellent study in that it explains the process with the best of current technology and this was a 6 month followup. Notice that the patient in this study appeared to have some cartilage left. Here is that abstract and the PDF is available on line for a fee from the company. ABSTRACT: BACKGROUND: The ability to repair tissue via percutaneous means may allow interventional pain physicians to manage a wide variety of diseases including peripheral joint injuries and osteoarthritis. This review will highlight the developments in cellular medicine that may soon permit interventional pain management physicians to treat a much wider variety of clinical conditions and highlight an interventional case study using these technologies OBJECTIVE: To determine if isolated and expanded human autologous mesenchymal stem cells could effectively regenerate cartilage and meniscal tissue when percutaneously injected into knees. DESIGN: Case Study SETTING: Private Interventional Pain Management practice. METHODS: An IRB approved study with a consenting volunteer in which mesenchymal stem cells were isolated and cultured ex-vivo from bone marrow aspiration of the iliac crest. The mesenchymal stem cells were then percutaneously injected into the subject's knee with MRI proven degenerative joint disease. Pre- and post-treatment subjective visual analog pain scores, physical therapy assessments, and MRIs measured clinical and radiographic changes. RESULTS: At 24 weeks post-injection, the patient had statistically significant cartilage and meniscus growth on MRI, as well as increased range of motion and decreased modified VAS pain scores. CONCLUSION: The described process of autologous mesenchymal stem cell culture and percutaneous injection into a knee with symptomatic and radiographic degenerative joint disease resulted in significant cartilage growth, decreased pain and increased joint mobility in this patient. This has significant future implications for minimally invasive treatment of osteoarthritis and meniscal injury.
Dextrose + Sodium Morrhuate: Centeno
2008: Injection to ABSTRACT BACKGROUND: Baker's cysts are commonly encountered in pain management practices. OBJECTIVE: To ascertain if sclerotherapy treatment of a Baker's cyst could produce objectively verifiable MRI imaging changes. DESIGN: Case report. METHODS: A 52-year-old white male with a posterior horn of the medial meniscus tear and a large Baker's cyst who had failed conservative care and drainage was imaged before treatment with sclerosing. Three injections of 12.5% dextrose and anesthetic with sodium morrhuate were injected intraarticular into the right knee after drainage. RESULTS: The Baker's cyst resolved on both postoperative imaging after the completion of care as well as on physical examination. CONCLUSIONS: Prolotherapy in this case study seemed to be an effective treatment for Baker's cyst in this patient. AUTHOR'S ADDRESS: The Centeno-Schultz Clinic Westminster, CO, USA. centenooffice@centenoclinic.com.
Fullerton BD 2007 Healing of a
medial meniscus ABSTRACT: High-resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability, low cost, ability to visualize tissue in real-time motion, and superior resolution of highly organized tissue such as a tendon. Prolotherapy, defined as the injection of growth factors or growth factor production stimulants to grow normal cells or tissue, has been a controversial procedure for decades; it is currently gaining in popularity among physiatrists and other musculoskeletal physicians. This report describes imaging of tendons, ligaments, and medial meniscus disease (from trauma or degeneration). Although these tissues have been poorly responsive to nonsurgical treatment, it is proposed that tissue growth and repair after prolotherapy in these structures can be documented with ultrasound and confirmed with magnetic resonance imaging. Directions for future research application are discussed.
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To contact us: General questions --> reevesoffice@gmail.com
Billing related questions --> reevesbilling@gmail.com
Research related questions --> DeanReevesMD@gmail.com
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Centeno
CJ, Busse D, Kisiday J, Keohan C, Freeman M, Karli D. Increased knee cartilage
volume in degenerative joint disease using percutaneously implanted, autologous
mesenchymal stem cells. Pain Physician (United States), May-Jun 2008, 11(3)
p343-53
Shrink a Baker's Cyst WIth X-Ray Confirmation
Centeno et al demonstrated a case of MRI use to
demonstrate shrinking of a Baker's cyst by simply injecting the knee, since the
knee lining is connected with the Baker's cyst. This suggests a favorable
change in the joint to stop overproduction of joint fluid which allows the cyst
to shrink since it is connected with the knee joint. Simple intra articular
injection of 12.5% dextrose and sodium morrhuate on 3 occasions in a patient who
failed conservative care and drainage was described. In the present
and near future both MRI and ultrasound scans can be used to objectively
document in this way. Anticipate more such studies.
Centeno CJ; Schultz J; Freeman M. Sclerotherapy of Baker's cyst with imaging
confirmation of resolution. Pain Physician (United States), Mar-Apr 2008, 11(2)
p257-61 
tear. The
medial meniscus of the knee is non linear structure. Dr. Fullerton
published examples of regeneration from dextrose injection, including an example
of repair of a tear in the medial meniscus.. Image B was actually
taken after one injection and Image D after 3 injections, with the obvious tear
closing in favor of meniscus tissue with normal appearance. The patient stopped
having symptoms, the McMurray test became negative and the meniscus also healed
according to pre and post MRI scans. Fullerton
BD. High-Resolution Ultrasound and Magnetic Resonance Imaging to Document Tissue
Repair After Prolotherapy Arch PM&R 2008. 89(2):377-385