The knee joint consists of, on one hand, the 4 bones that support the leg: the femur (long bone of the thigh), the tibia (the shin bone), the patella (kneecap), and the fibula (the thin bone found on the outside of the lower leg).
The bones are separated by cartilage, a soft tissue that serves as cushioning and also as a source of joint fluid (synovial fluid). The joint fluid allows smooth gliding of the bones on each other during movement.
Now, the bones of the knee joint are stabilized during motion by six ligamentous structures. The medial and lateral collateral ligaments (MCL and LCL) stabilize the knee joint during lateral motion. The anterior and posterior cruciate ligaments (ACL and PCL) stabilize the joint during both front-back motion and lateral motion. Finally, the medial and lateral meniscus are discoid soft tissues situated between the femur and the tibia for extra cushioning of motion in all planes.
The bones of the knee joint, stabilized by the six ligaments, are moved by the muscles spanning the knee joint. The quadriceps, hamstring, and calf muscles not only move the joint but also offer extra stability to the knee.
In degenerative knee conditions such as osteoarthritis of the knee, the cartilage wears out. With the loss of cushioning, the bones come in contact. The extra force (weight) on the bone surfaces creates extra pressure, according to the formula:
P(pressure) = F(force)/S(surface area)
The bone seeks to keep the pressure constant, so with increased force, it will need to increase its surface area. These are the so-called “bone spurs”, which are another sign of osteoarthritis (OA). Other signs of OA are decreased joint space and degenerative cysts under the articular surfaces (subchondral cysts).
Degenerative knee OA is a consequence of aging, but also of knee instability. Knee instability is a consequence of muscle weakness and imbalances and usually leads to injury of one or more of the six stabilizing ligaments.
To resume, muscle weakness or asymmetry leads to altered stride and gait motion, which leads to ligament injury, which leads to knee joint instability, which leads to cartilage loss and osteoarthritis.
Why is this important and how does it relate to stem cell treatment?
Successful knee pain treatment starts with a thorough evaluation of the structural support, of the stabilizing structures, and of the muscles that activate the knee joint. We call this anthropometric analysis, and it is a combination of physical examination and radiological (usually MRI), information.
When the history and anthropometric analysis are appropriate for regenerative treatment of knee pain, the next important decision to be made is what type of regenerative treatment is the best for each individual patient? In this respect, we at Precision Medicine offer a full range of therapies, from dextrose and ozone prolotherapy, platelet rich plasma, bone marrow and adipose derived stem cells, to amniotic fluid, umbilical cord blood, Wharton’s jelly, placental tissues and exosomes. The extent of injury will determine the choice of treatment.
Another important consideration is how and where to deliver the appropriate regenerative cells or growth factors. We use a combination of ultrasound and fluoroscopic imaging for guidance. The anthropometric analysis will also guide our delivery into the knee. For example, if what we treat primarily is cartilage loss due to OA, we will have to deliver stem cells inside the bone articular surfaces, as well as inside the joints themselves, since cartilage grows from inside the bone and that’s where the stem cells will have their greatest efficacy. If what we treat primarily is a meniscus tear, we will deliver the cells precisely in the torn meniscus.
Finally, regenerative treatment of the knee is a comprehensive program that addresses several aspects of patient’s health (in conjunction with the actual injections of stem cells):
Let’s have a conversation about regenerative treatment for knee pain. You deserve an honest opinion!