CN is a late 30’s Army officer who was seen in 2008 for knee pain due to patello-femoral chondromalcia. This means that the cartilage on the back of the knee cap was wearing away. He had failed physical therapy and his only other option was a surgical lateral release (please see Orthopedics 2.0 for a discussion of our take on lateral release surgery). The problem with a lateral release surgery is that it involves cutting important fascial structures that stabilize the knee cap. It also permanently alters the bio-mechanics of the knee in an attempt to allow the patella to move more smoothly in it’s groove. The other downside is that while the body is tuned to millimeter precision, surgical healing is not that exact, so we’ve seen many patients through the years who were worse off after the lateral release. Also the surgery is a one way street-there’s no going back and undoing the surgical changes (at least not easily). When CN was first seen for this problem in 2008, he was having such difficulty running that we had to write a letter to his Army command to take him off this kind of physical activity. He received several Regenexx-C procedures in 2008 and 2009, which involved precision injections of his own stem cells. He reported success and he continued to be followed in our tracking database. In addition, I have previously blogged on the increases seen in the thickness of his knee cartilage observed on ultra-high filed MRI scans (noted as patient Ch Na). However, I had otherwise lost track of CN as a patient, since he hasn’t been in the clinic recently. How is the knee holding up years later? The e-mail he just sent us this week is a testimony to how his knee is performing:
“Hi there! I hope you are well. I am trying to get the Army to …remove my running restrictions. Funny thing is I ran two half and one full marathon last year on my “new” knee and am doing just fine. Can I have Dr. Centeno draft a letter…stating that I am medically released from running restrictions…”
In the end CN avoided a lateral release surgery with the big downtime from running associated with that surgery. He also avoided permanent changes to the bio-mechanics of his knee. Instead, he had a few injections into his knee and is now running Marathons. We thank CN for his service to our country and wish him many more half and full marathons! In addition, realize that all patients don’t get the results experienced by CN.