In our practice, Regenexx at New Regeneration Orthopedics, the whole gambit of patients and severity of cases walks through the door. We see everything from professional athletes who need to be able to get back on the field as soon as possible to the super-grandma who wants to be able to get up and down off the floor with her grandkids. There is no success story that doesn’t remind us why we do what we do every day to help patients in Orlando, Tampa Bay, St. Petersburg and Sarasota. We love what we do, and the stories we get to be a part of are too good not to share.
Knee pain from arthritis is one of the leading types of orthopedic pain—it is debilitating and limiting. One patient in particular, John, came in reporting severe pain in his knee. He was referred to Regenexx at New Regeneration Orthopedics by a local Physical Therapist we have a great relationship with, Jim Godin, PT, DPT at EXOS Fishhawk. Jim sent John in because he found his pain to be recalcitrant to conservative therapy.
He described his knee pain as 7 out of 10, with the pain on the inner side of the knee. His arthritis was so severe, he had fissures and cracks in his cartilage, other lesions in his cartilage, and those lesions extended so deeply into the bone that it caused painful changes in the bone marrow as well. He was diagnosed with mild arthritis in 2017 and was getting cortisone injections in addition to high-molecular weight hyaluronic injections, also known as viscosupplementation.
He was not getting lasting relief. In fact, his pain was getting worse and he was becoming more limited in his function. This worsening pain led him to seek out MRI imaging.
Based on how this looked on MRI, and his pain level, the first orthopedic surgeon he visited told him his “knee was essentially dying within the bone,” (see below) and recommended he undergo a knee replacement or high tibial osteotomy.
Now, here’s a little bit to know about John: He is 45. He was a Navy Seal. He is a lifelong athlete to the tune of snowboarding, weightlifting, biking, swimming, skydiving, and hiking. So, knowing that John is a tough, active guy when his family said he was in too much pain to even get around in everyday tasks, we knew this was something that had to be corrected.
I performed a thorough physical orthopedic exam, reviewed John’s MRI, and also looked at the knee under diagnostic ultrasound. This examination revealed intense pain in passive bending of his knee, and that this pain originated from the middle condyle, or end of the femur (upper leg bone) as it met the knee joint. I also found tenderness on palpation of the middle joint line of the knee. On ultrasound, I was able to visualize deterioration of the outer margins of the middle meniscus, inflammation of the joint line, and some irregularities in the cartilage. All of these findings were then compared to the MRI images because a phrase I commonly say is: “I treat the patient, not the MRI.”
In this case, there was a huge congruence in the MRI findings, physical exam findings, and ultrasound findings, so my recommendation was that John get treated with Bone Marrow Concentrate (BMAC). This BMAC treatment would be interosseous (IO), meaning “directly injected into the diseased bone.” The current literature on the impact of interventional orthopedics on knee arthritis strongly suggests that IO injections and/or IO with intraarticular (or into the joint) are the superior choice over intraarticular injections (AI) alone.
John was optimistic about this treatment option because he was really focused on avoiding surgery. Getting a knee replacement at 45 could lead to multiple subsequent surgeries, revisions, and even a replacement to the knee replacement. John opted to do the BMAC procedure as we discussed.
During the procedure, I did a combined treatment, interosseous medial condyle of the upper leg bone (or the femur) and intraarticular injections. I also injected the ligaments and tendons that stabilize the knee joint. When I injected into the joint (IA), it was directly onto the site of the cartilage fissures to support healing in that area. When I injected directly into the bone (IO), it was directly into the bone marrow lesion in the femur bone.
The procedure went perfectly.
John continued with his physical therapist, starting with basic, post-procedural exercises to help manage pain and inflammation. He quickly progressed to more functional movements to help him load the joint safely so that he could start preparing to return to his favorite activities.
At his six-week follow-up, John reported less pain. At 10 weeks post-procedure, he went snowboarding and had no pain. John has continued his physical therapy and continues to improve.
These types of cases are what we specialize in and love to do at Regenexx at New Regeneration Orthopedics. Knee replacements are sometimes necessary, but oftentimes, they are avoidable with the proper exam, diagnosis and non-operative treatment.
At the end of the day, even heroes like John realize their joints aren’t invincible, and they need something better than surgery to get back in the game.