S219 S290
Poster 275:
Comprehensive Regenerative Therapies with Bone
Marrow Stem Cell, PRP and Dextrose Prolotherapy to
Treat Severe Degree of Osteoarthritis: A Case Report
Yibing Li (Center for Pain and Rehab, Peoria, IL, USA),
Katherine Cazilas, PA-C, MPAS, Jeffrey Xue, BS, student, Leah Tabor,
BS, Christina Luncsford, MA
Disclosures:
Yibing Li: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
Ligament laxity and cartilage degenera-
tion are root causes of osteoarthritis. Dextrose prolotherapy (prolo),
platelet rich plasma (PRP) and autologous stem cell injections into the
joints and surrounding weak tendons and ligaments are effective
treatments for severe osteoarthritic conditions. Mesenchymal stem
cells (MSCs) from bone marrow aspirate with PRP and prolo were used
for 10 patients diagnosed with severe osteoarthritis, degenerative
joint disease (DJD), ligament laxity and tendinopathy by X-ray and
ultrasound or MRI, designed as alternative treatments to total joint
replacements. 7 knees, 2 wrists, 1 ankle and 2 hips were injected with
this protocol. Outcomes measured: subjective pain, function, ultra-
sound/MRI and radiographs.
Setting:
Outpatient clinic.
Results:
2 months after 1 bone marrow stem cell/PRP/prolotherapy
treatment, 3 patients reported 75-100% pain relief with improved
function, 3 patients between 50-75%, 1 patient between 25-50%, 1
patient
<
25% and 2 patients results pending. Imaging compared with
initial diagnostic scans all showed new tissue growth after 8 weeks. 1
patient with radiographic evidence of severe hip osteoarthritis prior to
injections was negative for DJD on follow up.
Discussion:
Comprehensive regenerative therapies are cutting-edge
alternatives to invasive orthopedic surgeries after failing traditional
non-surgical options. It is safe, cost-effective and low-risk for patients
who have severe DJD without the risks and downtime of surgery.
Severity of arthritis, previous surgeries, baseline health, and age
affect which patients will likely benefit from this protocol. Further
research with larger patient populations are needed to predict
outcomes.
Conclusions:
Future follow-up investigations will be completed,
addressing additional causes of pain and functional limitations. No
patients experienced any adverse reactions during or after injections.
All were able to return to work the next day.
Level of Evidence:
Level V
Poster 276:
Biologic Augmentation of a Surgically Repaired
Meniscus in an Elite High School Athlete: A Case
Report
Altamash Raja, DO (Lincoln Memorial University, Darby, Pennsylvania,
United States), Gerard A. Malanga, MD
Disclosures:
Altamash Raja: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 17-year-old high school football player
suffered a contact injury during a game. He immediately felt lateral
sided knee pain and weakness. Initial evaluation was consistent with a
lateral meniscus tear. MRI confirmed the diagnosis. He underwent a
lateral meniscus repair for a full-thickness, high-grade radial split
lateral meniscal tear of the posterior horn and body junction. He
presented to us 4 days later for adjunctive treatment to enhance re-
covery. We implemented a treatment course of Platelet-Rich Plasma
(PRP) followed by adipose-derived mesenchymal stem cells (MSCs) one
week later.
Setting:
Outpatient Medical Office.
Results:
At 5-weeks post treatment, pain significantly improved and
range of motion increased. By week 11, the patient reported no pain or
swelling. He was full weight-bearing, physical exam was benign. Week
13 post treatment, he reported no mechanical symptoms or swelling.
However, new complaint of mild soreness in the posterior knee,
around the lateral head of gastrocnemius. Per the surgeon, this was
likely related to suture attachment. Second look arthroscopy revealed
complete healing of the peripheral rim and body of the meniscus with
the exception of the central free edge. The free edge was trimmed
and the meniscal suture removed to decrease irritation. One week
later, the patient reported complete resolution of soreness.
Discussion:
Meniscal preservation may be a route to prevent early
arthritic changes associated with meniscal resection. In this compet-
itive athlete, PRP and adipose-derived MSCs injections were used to
enhance an arthroscopically repaired meniscus. Within 15 weeks, a
complex radial tear in a hypovascular region healed almost in its en-
tirety and allowed for return to sport.
Conclusions:
Presently, meniscal repair surgeries are infrequently
performed due to the poor intrinsic healing capabilities of these
structures. However, autologous stem cells may help increase this
healing potential. This case illustrates the potential for biologic
augmentation of current surgical procedures.
Level of Evidence:
Level V
Poster 277:
Recurrent Knee Pain in an Athlete Diagnosed by Ultrasound,
and Subsequently Treated with Combination of Percutaneous
Tenotomy, Platelet Rich Plasma (PRP), and Hydrodissection:
A Case Report
Chris Cherian, MD (Rutgers NJMS/Kessler Institute for Rehabilitation,
Newark, New Jersey, United States), Gerard A. Malanga, MD
Disclosures:
Chris Cherian: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
This is a case of a 15-year-old female
athlete with recurrent right knee pain, who originally developed the
discomfort 3 months prior while playing basketball. She was evaluated
by a primary care physician and pediatric orthopedist, who ordered
diagnostic imaging. The x-rays were unremarkable and MRI noted a
fluid signal on the proximal patellar tendon. She underwent rest,
bracing, and physical therapy (PT). She was cleared to play, but
developed recurrent knee pain, and was referred to our office.
Setting:
Outpatient Clinic.
Results:
The physical examination revealed minimal focal patellar
swelling, without erythema, or malalignment of the right knee. The
examination was otherwise normal except for asymmetric popliteal
angles
e
10 degrees on the left, 30 degrees on the right, and focal
tenderness at the inferior pole and proximal patella tendon. Ultra-
sound revealed patellar tendinopathy, a partial tear, and a 0.80 cm
linear calcification at the inferior pole of patella tendon, with no in-
crease in power Doppler flow. The patient underwent percutaneous
tenotomy to remove the calcification, followed by PRP to assist with
healing. Post-procedure, she underwent PT and gained complete
recovery of function and relief of pain. A day prior to follow up, she
re-aggravated her injury. Repeat ultrasound revealed significant
reduction in calcification, with a small hypoechoic area representing
residual tendinosis. A significant, increased power Doppler flow in the
inferior pole of the patella tendon both within the tendon and deep to
the tendon was noted, consistent with neovessels. Hydrodissection of
the neovessels enabled the patient to return to sport participation in 2
weeks.
Discussion:
To our knowledge, this is the first reported case of missed
patella calcification diagnosed by ultrasound, and treated with com-
bination of percutaneous tenotomy, PRP, and subsequent
hydrodissection.
Conclusions:
Ultrasound is an important tool that can identify pa-
thology missed with conventional imaging, and assist with therapeutic
interventions.
Level of Evidence:
Level V
S219
Abstracts / PM R 9 (2017) S131-S290