Avascular necrosis (AVN) has been treated with stem cells for some time, just under different names and applications. Knee AVN is only followed by the hip in leg frequency of AVN occurrence.
Stem cell treatments for avascular necrosis (AVN) are being seen more frequently, including for knee avascular necrosis.
Avascular necrosis (AVN) occurs when the loss of blood to a region of bone results in ischemia and the bone cells die. This is much like a heart attack, only it occurs to the bone cells. The amount of blood supply affected determines the size of the infarcted or necrotic area of bone.
The initial area of avascular necrosis can only be the start of problems, which is a troubling feature of AVN. The necrotic bone may collapse, and a rapid arthritis than occurs due to accelerated degeneration.
Idiopathic or spontaneous (Unknown)
High Alcohol intake
Sickle Cell Disease
Caisson’s Disease (decompression sickness)
Coagulopathies (blood clotting disorders)
Autoimmune Diseases (Lupus and Rheumatoid Arthritis)
Since not all cases of AVN are alike, stem cell treatment is based on each patient. The size of the necrotic area, the underlying cause of AVN, and inter-patient differences all can affect treatment.
This is important to provide significant information so a skilled Regenerative Medicine specialist can assess the treatment options.
Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. Dr. Lox has expertise in the treatment of avascular necrosis with Stem Cell Therapy.
Stem cells are master builder and control cells for the body. Tissues which must turn over rapidly, such as the skin or gastrointestinal tract have an abundant supply of stem cells to allow replacing new cells. To replace a cell, you need a stem cell to turn into a new cell.
This is simplistic but true. There are precursor cells called progenitor cells, but the stem cell is needed to form these cells. Without a stem cell no new cells can be formed. In blood cells the stem cell necessary to form new blood product is the hematopoietic stem cell. In cartilage, muscle and bone repair the stem cell is the mesenchymal stem cell.
Mesenchymal stem cells, mesenchymal stromal cells, and medicinal stem cells all may be all abbreviated with MSC. The MSC is the building block for repair and regeneration as well as control inflammatory responses which directly break down cartilage leading to osteoarthritis or degenerative arthritis.
Knowledge of stem cell functioning is helpful to understand how stem cells may be beneficial in a variety of knee problems, including arthritis of the knee and traumatic injuries to the knee.
Surgery in these cases can alleviate symptoms at times, yet over time the surgery accelerates knee degenerative arthritis. All of these factors become increasingly important when understanding progressive knee arthritis and factors which may prevent knee joint replacement surgery. This is a chapter all to its self, and explained in greater detail in another section.
Baseball like so many other sports, is difficult to excel at when knee pain hampers sports performance. Stem cells have been used in most major sports including the professional ranks.
Baseball has had many famous athletes with knee problems.
Surgery is often frequently prescribed when early conservative measures do not allow return to baseball. The injured knee in baseball may involve the meniscus, medial or lateral collateral ligaments or the anterior cruciate ligament (ACL).
Surgery that is successful invariably will accelerate the rate of arthritis progression. Trauma perpetuates arthritis, and surgery further aggravates this degeneration over time. This may shorten the athletes career. Baseball injuries in high school may impact college, which may impact a professional career. This domino effect of arthritis progression becomes significantly important the younger the age of injury.
Treatments strategies that may influence this degenerative pathway or cascade have led to the emergence of Regenerative Medicine in sports. Platelet Rich Plasma (PRP) and Stem Cell Therapy are not unique to professional baseball or any sport. In fact these Regenerative Medicine procedures have been seen in most every sport. The knee being a common thread.
Professional football and baseball player Bo Jackson was injured while playing professional football. He injured his hip and developed avascular necrosis (AVN). Jackson later underwent hip replacement surgery, ending his football career, and he subsequently played only one more season of professional baseball. Another Major League Baseball pitcher was diagnosed with hip avascular necrosis (AVN) on a routine physical. His multimillion dollar contract was cancelled and he was resigned for significantly less salary. AVN can also occur in the knee following trauma. Dr. Dennis Lox has treated numerous athletes with avascular necrosis, returning some to their sport.
Stem cells may be considered as a viable treatment option for athletic injuries including the knee in certain cases.
Dr. Dennis Lox has successfully treated a professional baseball player who failed to respond to multiple knee surgeries, with knee stem cell therapy. The player later resigned with a new team.
Dr. Lox is an expert in Sports and Regenerative Medicine. Not all cases are simple, and whether it is simple or complex, the needs of each patient should be evaluated, as no two patients are alike, and treatment should be individualized for each patient.
Skiers commonly injure their knees. Thank changes in boot design and bindings for sparing the previously devastated ankle, with imparting the force of injury to the knee.
That aside, modern skiers enjoy much more stability at speed.
Knee ailments in skiers is readily apparent as the ski patrol transports injured skiers down the mountain. The effect is better appreciated at après ski venues, where knee immobilizers and crutches are tell tale signs.
Stem cells have found their way into all avenues of sports. Skiers injure many knee sites, including the common meniscal tear, ACL tear, MCL and LCL sprain and tears.
Knee surgery is not uncommon in skiers. Trauma has been shown to accelerate arthritis. Surgery is a form of trauma. This illustrates a close examination that trauma and surgery, will indeed accelerate knee degenerative arthritis.
Ask any skier 15 years after knee surgery and a common thread occurs, knee arthritis is more likely than not. Most avid skiers wish to continue skiing. This leads to another dilemma. More trauma will further propagate the degeneration.
Dr. Dennis Lox a Sports and Regenerative Medicine expert, offers simply advice to the older skier with knee problems: don’t fall.
This advice sounds to simple. However, after discussing trauma and surgery, this advice is meant to reiterate a point. It is applicable to the young as well as the older skier from a scientific standpoint. Yet from a skier’s perspective it is not always obtainable with ice, changing snow conditions, and the moguls that may abound on your favorite runs.
The advice is meant to explain simplistically to lessen stressors on the knee and try and limit further trauma.
Stem cells may have a role in skiers much as they do in other sports that affect the knee. The rationale is to lessen the rate of arthritis progression. Halting this process or reversing it with some knee cartilage regrowth is ideal.
Many athletes wish to continue to enjoy their sport even with advancing age. The trick is to try and outsmart the arthritis as much as possible while maintaining quality of life.
Being smarter is becoming more educated. An experienced Sports and Regenerative Specialist such as Dr. Lox can be invaluable in this process.
Football is fraught with injuries. The knee is frequently involved. Knee surgery is a well known situation in football, this results in ending some elite professional players careers. Some athletes may go on to stellar careers after surgery, and some athletes are able to avoid knee surgery.
We now know athletes are being treated with stem cells for knee problems, including after knee surgery. Some professional football players have made remarkable fast recoveries from what were lengthy post surgical recoveries. For some football players and other elite athletes the difference has been the addition of stem cells.
Football players are notorious for meniscus tears, medial and lateral collateral ligament strains and tears. The dreaded anterior cruciate ligament tear (ACL) has derailed many football careers at all ranks from high school to the professional football player.
Many famous and very talented football players especially running backs are never the same after knee injuries and surgeries. While others continue on with football. Joe Namath is a famous example of a professional quarterback, who despite winning a super bowl, was stricken with rapid degenerative arthritis after knee surgeries. Namath later in life had both knees replaced.
There are those professional athletes that do not respond to knee surgery and their careers are stalled, or the team cuts them when the do not progress in a timely fashion.
Dr. Dennis Lox has treated some of these failed knee surgery athletes with stem cell therapy, and they have later gone on to be resigned with new teams. This includes professional football. The viability of stem cell applications for athletes has led to new insights to knee injury, recovery and treatment.
Injury and arthritis are chief among these potential sources of knee pain.
The location of the pain and what brought on the knee pain may provide clues to what is going on.
Knowing how the knee functions and local anatomy are important to help identify the root cause and understand how to help alleviate symptoms in some cases.
Anatomy of the Knee
Patella (knee cap)
The Knee Joint
Synovium: the lining of the knee joint.
The synovium allows nutrients to diffuse into the knee joint, as well as acts as a active tissue secreting both inflammatory and anti-inflammatory signals.
There are two discoid menisci. The lateral meniscus is the outer meniscus.
The medial meniscus is on the inside of the knee. The meniscus functions to allow gliding of the femur on the tibia, provide joint stabilization, and acts as a shock absorber.
Both the femur and tibia are covered with a cartilage layer to separate the bones, this allows frictionless motion across the menisci during motion. In abnormal conditions of trauma or arthritis, defects in the cartilage covering the femur and tibia occur. These are known as osteochondral defects.
Tears in the meniscus or meniscal degeneration also impair normal knee joint functioning.
Medial and Lateral collateral ligaments: connect the femur and tibia as well as the meniscus.
Anterior cruciate ligament (ACL) : connects the femur and tibia in the middle of the knee joint. The ACL functions to stabilize the knee against primarily anterior translation motion.
Posterior cruciate ligament (PCL) : connects the femur and tibia in the middle of the knee joint in an opposing direction to the ACL forming a cross pattern. The PCL functions to stabilize the knee primarily against posterior translational motion.
Primarily the large quadriceps in the front and the hamstrings in the back.
Additional muscle groups include the adductor muscles insertion on the inner aspect of the knee. The outer aspect also includes the tensor fascia lata (TFL).
The gastrocsoleus or calf muscles insert behind the knee joint.
Smaller muscles that lie deeper to these muscles include the plantaris and popliteus.
Pes Anserine: is located on the inside of the knee
Popliteal fossa: behind the knee
Suprapatellar: above the knee cap
Infrapatellar: below the knee cap
Arthritis may occur in the synovium, cartilage, meniscus, and the underlying bone may be affected with advancing arthritis.
Knee arthritis or osteoarthritis (OA) is a progressive disorder. The hallmark is the underlying degeneration of joint cartilage. Stem cells have been used for a variety of musculoskeletal conditions. Knee Stem Cell Therapy is gaining popularity as a treatment alternative for degenerative osteoarthritis.
Knee Osteoarthritis (OA) the Underlying Problem
Knee OA is characterized by many underlying factors. It is not just a wear and tear disorder, but a complex interaction of many factors at play.
Knee OA Associated Factors:
Biomechanical abnormalities (Joint laxity or leg length differences)
Prior knee surgery
Other arthritic joints
Local inflammatory mediators (cytokine dysregulation)
Knee OA Progression
Over time repeat x-Rays at 3 and 5 year intervals have shown great variability. Some individuals will show rapid degeneration during this time, while others are slowly progressive. Some patients have silent arthritis. They changes are occurring, yet symptoms may be absent.
Some patients develop symptoms late in life, yet when they present for evaluation their x-rays show severe degeneration.
Stem Cell Treatment
Studies have shown prescription arthritis medications (NSAIDS’s) do not alter the course of degenerative osteoarthritis, nor does cortisone injections, or debridement of the meniscus with arthroscopic surgery.
Stem cells may exert an effect on degenerative osteoarthritis by regulating the function of chemical mediators of joint breakdown, the catabolic cytokines.
Stem cells may also exert a reparative effect by promoting anabolic cytokine signaling which acts to build new cartilage. This reparative effect can also be regenerative through the direct actions of stem cells to form new cartilage cells, or the recruitment of progenitor cells which are precursor cells to cartilage cells.
The many effects of stem cells have the ability to halt the progression of degenerative arthritis, or in some cases to restore balance to normal cell functioning. Stem cells may create repair, which can be seen as reversing the degeneration of knee osteoarthritis.
Knee Stem Cells: Know Your Doctors Credentials
Patients are advised to do their homework on the exciting field of Regenerative Medicine.
Why do your homework?
As with all areas of medicine an educated patient can be better prepared to make informed educated decisions. This is not just common sense it is good medicine as well.
Stem cells are not new. There are just newer applications. The knee has seen many applications for stem cell treatments. These include post-operative planning as well as alternatives to knee surgery.
Knee replacement alternatives have included Stem Cell Therapy in some cases.
Knee osteoarthritis is a common condition that has profound effects on the patient.
Understanding stem cells and arthritis can be helpful in decision making.
Selecting the right Regenerative Medicine specialist is important for successful Knee Stem Cell Therapy. Not all patients are created equal. This really means there are many factors that may influence successful knee stem cell treatment.
Experience is important to understand the different needs of different patients.
Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. Dr. Lox lectures nationally and internationally on stem cell treatments. Dr. Lox has treated a multitude of different types of knee injuries and disorders, including professional athletes.
For further information contact Dennis M. Lox, M.D., on how to arrange a consultation.
Knee Stem Cells and Tennis
Some sports are more grueling on the knee than others. Tennis is hard on many joints the knee is one of them. Stem cell therapy has made its way into the treatment of many knee problems. Tennis and Stem Cell Therapy will most likely remain on friendly terms. Many professional athletes from a variety of sports have discussed their treatment with Platelet Rich Plasma (PRP). These include elite athletes from all major sports including tennis star Rafael Nadal. Most recently Nadal’s camp has stated he will undergo back stem cell treatments and has previously undergone knee stem cell treatments. Tennis fans know of Rafael Nadal’s struggles with knee problems and his frequent return to championship form following his chronic knee problems.
Trauma perpetuates knee arthritis. Repetitive trauma only aggravates this phenomenon. Early arthritis has ended many sports careers. Surgery also accelerates knee joint arthritis. Arthritis medications and cortisone injections do not halt this progression.
Though long term studies are not yet available for 20-30 year outcomes with stem cell therapy in knee arthritis, the pathophysiology of how degeneration of the knee joint is better understood now from a cellular level. The role that stem cells exert on influencing the inflammatory process is also now better understood.
Tennis will exert repetitive stress to the knee joint. This may never completely halt the degenerative cascade with repetitive micro trauma in some athletes. However, methods to aid in repair are desirable in those who wish to continue in their chosen sport. Stem Cells may exert anti-inflammatory as well as regenerative effects. The regenerative effects can occur by the formation of knee cartilage cells. This is one mechanism by which stem cells may exert positive effects in sports medicine applications.
Some athletes are blessed with good fortune and genes, and will play tennis as seniors. Others may need help.
Stem Cell Therapy may be a viable option for chronic knee problems associated with tennis.
Stem cells are part of the emerging field of Regenerative Medicine. Biologics and Platelet Rich Plasma (PRP) are also regenerative medicine procedures. Platelet Rich Plasma (PRP) gained popularity after numerous elite professional athletes in a variety of sports began surfacing in the news media. That is old news, and stem cells much as they did in race horses are taking the notoriety in professional athletes away from PRP.
Regenerative Medicine deals with the field of regeneration and tissue engineering. Helping the body heal itself is a cornerstone. Growth factors in Platelet Rich Plasma (PRP) assist tissues to heal by direct actions and by influences cell signaling responsible for tissue breakdown.
Stem cells are much more effective at this healing response than PRP alone.
That is because stem cells are master control cells. They have been referred to as medicinal cells by one prominent stem cell researcher for their ability to heal and control the immune system and anti-inflammatory properties.
Stem cells also are capable of differentiating into new cells in the knee most importantly is cartilage cells or chondrocytes. This process can be referred to as regeneration. The degree of regeneration may be dependent upon many factors. Regeneration may not always occur. Another property of stem cells is their ability to affect inflammation.
At times stem cells may exert their healing effect by controlling cell signaling which promote tissue breakdown or catabolism. By inhibiting catabolism or cartilage breakdown arthritis does not progress.
If repair is allowed to occur by regeneration than new cartilage growth can actually demonstrate reversal to some degree of the degenerative arthritis cascade. No other form of treatment is capable of doing this.
If knee breakdown is halted than no net cartilage loss occurs over a period of time which in itself is positive as well. Studies have shown that knee arthritis can progress significantly over a 3-5 year period on serial x-rays. Therefore measures showing no net loss are actually positive in a known progressive degenerative or arthritic situation.
Stem cells exert many more complicated effects by direct and indirect signaling with other cells and tissues. These multiple effects can be so complex that all possible interaction patterns for every situation, and each person own unique cell signaling responses may vary by multiple other factors further augmenting or confusing the issue.
Needles to say there are some patients who will always respond better than others. No different than younger healthier patients typically respond better to any procedure. Many of the reasons apply equally to stem cell effectiveness.
Stem cells still have some hidden mysteries, as do our own brains. Yet the therapeutic potential and applications of stem cells continue to expand in many areas of medicine.