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Eye-Opening Knee Stem Cell and PRP Journey

Jan 10, 2024 | Anti-Aging

The previous three sections described the state of the art in stem cell treatment in great detail, so much so it required 13,545 words. They say a picture is worth a thousand words. If so, we have many photos, plus another 1,400 words, to illuminate the brave new world of stem cell therapy. Feel free to share this bleeding-edge medical excursion on social media, it’s definitely one of a kind.

This Regenexx Same-Day Stem Cell Procedure took place on Wednesday, April 13, followed by a lumbar PRP procedure on Thursday, April 21, 2022, in Las Vegas, Nev. Here’s how Regenexx describes the treatment (please note that the Prolotherapy was skipped):

  • Bone Marrow Aspiration – The second day of the treatment is the stem cell injection. You will first be prepared for the bone marrow aspiration, which entails taking bone marrow from the back of your hips (iliac crest). The bone marrow aspiration process is often described by patients as being only mildly uncomfortable and well-tolerated. You will lie on your stomach on the procedure table, and an area at the back of your hip will be numbed. A special needle will be used to draw marrow blood out of this area. X-ray or ultrasound will be used to ensure the optimum location. This will be done on both sides of your hips.
  • Stem Cell Injection – A few hours later, you will receive your stem cell injections. The doctor will reinject your stem cells and natural growth factors from your blood platelets using advanced imaging guidance into the area in need of repair (real-time fluoroscopy or musculoskeletal ultrasound, using your MRI as a map for the injection). This allows the doctor to pinpoint the exact location of the injection and the dispersion of the cells into the tissue.
  • Super Concentrated Platelet (SCP) – The Regenexx Super Concentrated Platelet (SCP) and Platelet Lysate (PL) procedures use growth factors from your blood to promote damaged tissue repair. For most patients, the recommended SCP or PL protocol involves a blood draw and an injection on the same day.

Diagnosis

The patient is a male diagnosed with left knee osteoarthritis (OA) and mild degenerative bulging of the L3-L4 and the L4-L5 discs in the lumbar spine. The technical details of the diagnosis are as follows:

Knee

  • Meniscus – There is a truncation of the inner free edge of the body, anterior, and posterior horn of the medial meniscus over a 3.5 cm segment with small severely macerated remnant portion of the meniscus, suggesting prior arthroscopic partial medial meniscectomy.
  • MCL – There is mild edema along the MCL without rupture or laxity.
  • Patella – There is mild edema along the lower pole the patella and proximal patellar tendon.
  • Cartilage – Medial compartment articular cartilage shows severe full-thickness cartilage loss in the central weight-bearing region, the medial tibial plateau, and medial femoral condyle, with exposure of subchondral bone and moderate subchondral stress response. There are tricompartmental marginal osteophytes.

Lumbar

  • L3-L4 – 2 to 3 mm asymmetric disc bulge, greatest in the foraminal regions, resulting in mild-moderate bilateral neural foraminal narrowing and mild central canal narrowing. There is no facet arthropathy.
  • L4-L5 – 4 mm circumferential disc bulge resulting in mild central canal narrowing and mild bilateral neural foraminal narrowing.

Check In

In 1982, the blockbuster business book “In Search of Excellence: Lessons from America’s Best-Run Companies” listed this maxim as the epigraph of chapter five, “Eighty percent of success is showing up.” As with any medical procedure, the most important decision is to have one and show up. 😁

Regenexx door sign
09:41 am: The stem cell procedure will be performed at the Regenexx Las Vegas clinic of Dr. Joshua Goodwin.

Patient Coordinator Jenn
09:49 am: Checking in with Patient Coordinator Jenn Palpallatoc at the front desk.

Regenexx plaque
Regenexx is one of 60 clinics worldwide specializing in stem cell and PRP therapy. Regenexx Las Vegas has been in operation since 2016.

Blood Marrow Aspiration

After check-in, I was met by the friendly and proficient Radiologic Technologist Nina Runyan. She asked me a few questions and then pricked my hand for a small blood sample.

Patient being prepped in OR
10:13 am: The patient is prepped in OR. Notice the GE OEC 9800 Plus fluoroscopic x-ray machine with C arm.

GE OEC 9800 Plus control panel
The GE OEC 9800 Plus control panel allows the staff to change such parameters as collimation and contrast.

SonoSite ultrasound GE fluoroscopy
Bone marrow aspirate (BMA) is harvested from the posterior superior iliac crest region. Regenexx relies on both fluoroscopy X-ray and ultrasound. The SonoSite ultrasound image is on the left, and the GE fluoroscopy image is on the right.

Marked needle entry areas
10:16 am: Needle entry areas are marked on the lower back. Goodwin typically aspirates bone marrow from three sites on each side of the iliac crest, the largest of three bones that make up the pelvis. One skin puncture offers access to three sites on either side of the bone.

Bone marrow extraction needles
10:17 am: Bone marrow extraction needles are ready to be used. Using advanced imaging guidance, Dr. Goodwin deploys 18-gauge needles to aspirate bone marrow from the iliac crest.

Instant topical anesthetic
Gebauer Spray & Stretch, an instant topical anesthetic and skin refrigerant, is applied to numb the skin and make it feel cool. The injection area is then prepped with EcoVue, a water-soluble ultrasound gel that wipes off easily and acts as a conductor between skin and the ultrasound transducer.

Naropin and Heparin bottles
On the left is Naropin (ropivacaine), a local anesthetic, The Heparin bottles on the right are used to prevent the aspirate from coagulating. Prior to aspiration, 1 ml of heparin is added to each syringe to avoid clot formation.

Injection closeup
10:19 am: A closeup of the injection area and needle shows the EcoVue gel and ultrasound probe used to provide imaging guidance. Read more about ultrasound devices in Why Have a Stem Cell Treatment?

SonoSite ultrasound needle guidance
10:36 am: Using the SonoSite ultrasound image, Dr. Goodwin is able to monitor the bone marrow aspiration process in realtime. The needle is clearly visible on the display, allowing for precise placement of the extraction needle.

Arrow OnControl Powered Driver
Once the optimum iliac crest entry point has been located, Goodwin uses a battery-powered drill, an Arrow OnControl Powered Driver from Athlone, Ireland-based Teleflex, to drill the trochar and cannula (see definitions below) into the medullary cavity of the posterior iliac crest.

Cannula
A tube that is inserted into the body to drain or inject fluid.

Trochar
A pointed, hollow cylindrical device that is used to make small incisions and surgically insert cannulas into body cavities, or to aspirate fluids.
 

Trochar
10:36 am: After the trochar is inserted into the iliac crest, a syringe pre-filled with 1 ml of heparin is attached to the trochar.

Bone marrow extraction
When bone marrow aspirate (BMA) is drawn from the iliac crest bone, the needle hits the bone. That felt mildly uncomfortable but strangely enough was less noticeable on the left side compared to the right. Even the drilling of bone was barely detectable.

BMA harvest
10:51 am: A total of four 30-ml syringes, about 120 ml in total, were harvested in this instance. Usually, approximately 60 ml of bone marrow is aspirated, requiring two 30-ml syringes.

Vials of blood growth factors
11:41 am: Nina Runyan performs a blood draw (called a phlebotomy) and extracts 12 vials of blood. After processing, these platelets are added to the BMAC injection performed that afternoon.

Regenexx lab
12:36 pm: After the bone marrow aspirate has been harvested, it’s processed in a centrifuge and turned into BMAC (bone marrow aspirate concentrate) in the lab and combined with the natural growth factors from drawn blood platelets.

Stem Cell Injection

The afternoon featured the main event: injecting BMAC plus a concentrated mix of the 12 vials of blood.

Propofol IV
01:16 pm: The knee stem cell injection will take place under an intravenous injection of propofol — an anesthetic and sedative.

Gel application
01:18 pm: Dr. Goodwin prepares the knee by cleaning it with a 60–70% alcohol-based solution (isopropyl alcohol or ethanol), followed by an application of Gebauer instant topical anesthetic.

Gelled knee
01:19 pm: A knee closeup after applying EcoVue ultrasound gel.

Propofol bottles
01:20 pm: There is enough Propofol here to knock out a horse. 😁

BMAC syringes
01:21 pm: Two syringes marked “bone” will be injected into the knee. The two syringes marked MCL are clearly the platelet-rich plasma (PRP) extracted earlier.

BMAC knee injection
01:23 pm: The BMAC syringes are injected first into the knee.

MCL knee injection angle 2
01:31 pm: Followed by two PRP injections, the syringes marked MCL.

Fluoroscopy MCL injection guidance
01:41 pm: Injecting the knee is challenging due to bone that interferes with ultrasound waves. That explains why fluoroscopy works better in the knee.

Bruised knee injection01:51 pm: By the end of the day that knee looks pretty bruised and swollen.

PRP Injections

April 21, 2022, was PRP (platelet-rich plasma) day, the final step in a Regenexx stem cell procedure that deals with two areas, the knee and lumbar spine.

MRI monitor
01:17 pm: Feb. 3, 2022 spine MRI is displayed on the monitor.

Goodwin and Runyan
01:21 pm: Nina Runyan points to the ultrasound display while Dr. Goodwin injects the knee with another syringe labeled “Knee” SCP, as Regenexx calls PRP. That was preceded by an injection of lidocaine to numb the area.

PRP instruments
01:22 pm: The syringes and medical instruments are ready. Blood was collected around 10:30 that morning and processed. Two syringes are labeled “PLM,” one is labeled “Contrast,” one “Lido” (lidocaine), two “Font” (?), one is illegible and another “Prolo,” although no prolotherapy is scheduled.

Fluoroscopy of spine
01:30 pm: The monitor shows a fluoroscopy image of the lumbar spine and what appears to be the needle, although it seems too large.

Spine lidocaine injection
The spine is being prepared with a shot of lidocaine.

Spine needle position 1
01:54 pm: To give you an idea of how deep that needle will go in…

Spine needle position 2
…see this photo with the needle deeply inserted.

Injection attachment
01:56 pm: What does this attachment do? Slow the flow?

Michael and Nina Runyan
02:47 pm: Procedure is done, and the patient is still alive and smiling, although his face shows face-cradle dimples, here with Nina Runyan. 😂

After this major undertaking, the question is, “Did it work?” Below is a recap that will be updated periodically. Some stem-cell providers say results may not appear for as many as nine months.

Date Condition - Knee Condition - Lumbar
May 25, 2022 Knee is sore from 1 mile walk Back condition unchanged
July 13, 2022 Made a bad move this morning and left knee reminded me that I’m still not 100% — or 50% for that matter. So, has the knee improved? Not materially. Did the PRP treatment of the spine help? Not really. Had three PT sessions at ATI with their largely disinterested staff. Cathryn Jakobson Ramin called them “PT Mills” in her book, “Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.”
Jun. 1, 2023 More than a year after procedure, knee is still sore, but I am able to bike two days in a row. It could well be that the stem-cell procedure staved off a total knee replacement for a few years. Back is still sore after long hours of sitting, or laying down working. Stem cells are clearly not able to reverse a decades old back injury.
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After a year and six weeks post-procedure, the jury is out on whether stem cells can reverse old knee and back injuries. It should be noted that due to the age of the author and the severity of his osteoarthritis, stem cell treatment was initially already deemed a debatable procedure. Younger patients or those suffering from a less advanced stage of OA may experience better results.

Michael Tchong

Michael Tchong

Founder, Author, Adjunct Professor, Futurist

Michael is the founder of Toolhacker LLC, an innovation speaker and adjunct professor at the University of San Francisco, futurist, and author of “Ubertrends — How Trends And Innovation Are Transforming Our Future.” He is also the founder of four ahead-of-the-wave startups, including MacWEEK, Atelier Systems, CyberAtlas, and ICONOCAST.