Hypertension and coronary artery disease often are seen together. As our understanding of underlying causes of hypertension and coronary artery disease increase, key associated factors are integral to stem cell treatment.
Inflammation is a common denominator in joint arthritis, hypertension and coronary artery disease. Inflammation has been associated with obesity and the rise of inflammatory markers common in many diseases including diabetes and heart disease.
These inflammatory markers are also involved in Rheumatoid arthritis and degenerative osteoarthritis. Inflammation causes changes in blood vessels leading to plaque formation and atherosclerosis. This leads to less flexibility of blood vessels and high blood pressure ensues. These changes also lead to narrowing of the blood vessels to the heart resulting in coronary artery disease (CAD).
Stem cells may function in multiple ways, including regulating the inflammatory process. Studies are underway to use stem cells to treat heart attacks. However, this is after the fact. Prevention is still the obvious answer. Diet and obesity can all contribute to the progression of inflammation in blood vessels. These factors are important treatment as well as preventative measures.
Stem cells placed into patients who are obese or suffer from multiple systemic inflammatory disease processes, are always thrust into a harsher inflammatory environment than stem cells placed in your healthy patients.
This does not mean it is hopeless. In fact this is exactly why a highly skilled Regenerative Medicine physician is needed to deal with more complicated patients.
Treating knees with stem cells should not be a one size fits all patients practice.
Many factors control the fate and success of stem cells placed into a knee joint.
A key factor is the knowledge and experience of the physician treating your knee.
Dr. Dennis Lox is an expert in Sports and Regenerative Medicine. Dr. Lox understands the complexity of different patients and the need for individualized care. This approach ensures the best possible outcome.
Dr. Lox lectures on the National and International level on various Stem Cell related issues.
Avascular Necrosis (AVN) may occur from a variety of sources. Trauma is the leading cause of avascular necrosis (AVN). Spontaneous or insidious onset AVN is another common factor.
When more than one joint is diagnosed as having spontaneous avascular necrosis, an exhaustive search for other potential causes should be undertaken. Some patients may be a candidate for Stem Cell Therapy of more than one joint. If a proper evaluation suggests they may be a good candidate for several joint stem cell treatments, a proper understanding of whether the AVN is truly insidious or not is important.
CAUSES OF AVN
Excessive corticosteroids (cortisone)
Caisson’s disease (decompression sickness)
Sickle cell disease
Spontaneous Avascular Necrosis
This term should be used when no other risk factor is present that may readily explain the condition. A times, remote corticosteroids during childhood for asthma, may be forgotten if the history is not very carefully structured.
Multiple trauma induced AVN, may also be diagnosed much later.
The effects of chemotherapy and radiation therapy may have many side effects as well, often confusing early diagnosis. With many possible risk associated factors, Spontaneous AVN should be used hesitantly in AVN occurring in multiple sites without exhausting other potential causes.
Treatment of AVN with Stem Cell Therapy
The treatment of avascular necrosis with Stem Cell Therapy should be with a Regenerative Medicine physician who has experience treating AVN. The complexities of treating AVN, as well as the issues of patient specific goals, needs, or sports participation is highly important for the patient, and in arriving at a treatment plan.
Factors which may progress Knee Osteoarthritis faster:
Prior knee surgery
Other diseases (Inflammatory related)
Coronary artery disease
Joint Mechanical problems (instability and ligamentous laxity)
Knock knees and bowlegs
Leg length differences
Abnormalities of adjacent joints hip, the other knee, or foot
These factors should be addressed if possible.
The effect of weight is significant. For each 10 pounds gained there is a 30-50 pound load increase on the knee. Women traditionally have smaller knee joints thus the available surface area to absorb these additional weigh related forces is reduced, there by accentuating the weight gain effects on the knee in women.
Inflammatory effects have not been shown to be altered long term with arthritis medications (NSAID’s) or cortisone injections.
Surgery and continued trauma accelerates the knee arthritis.
Inflammation may be modified by stem cells. The knee undergoes cartilage degeneration in osteoarthritis. This is a progressive disease state. Some progress at faster rates than others.
Stem cells may exert a positive anti-inflammatory effect on the knee cartilage resulting,in slower rates of degeneration, cessation of degeneration for a period of time (stopping Father Time) or may repair and regrow cartilage which reverses the degenerative effect of arthritis. Again this sets time back (like turning the clock back), however time will eventually begin ticking again but turning it back may add years of forestalling knee joint replacement, if stem cells are done early enough in the treatment of knee arthritis combined with modifying other risk factors like obesity and trauma, substantial changes may occur as a strategy to avoid knee replacement surgery.
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.