Watch a Meniscus Treatment Using Precise Interventional Orthopedics

by Chris Centeno, MD /

In order to understand what a Regenexx interventional orthopedic treatment involves, there’s nothing quite like joining us in a procedure suite to watch it for yourself. Today, I invite you in to observe a meniscus treatment as Dr. Pitts performs advanced precise image-guided injections into both the meniscus and the patella tendon. The patient is a young athlete with a meniscus tear as well as defects in his patella and hamstrings tendons due to a history of two prior surgeries that utilized these tendons to reconstruct the ACL.

Terminology Used During the Meniscus Treatment

As Dr. Pitts narrates and guides you through each step of the treatments he is performing (see the video above), there are some medical terms that you will want to be familiar with if you aren’t already.  I have highlighted these below in the order mentioned in the video:

Meniscus: The meniscus is a rim of tissue that rests between the between the upper- and lower-leg bones and serves as a shock absorber for the knee joint and cushions the cartilage. The medial meniscus sits between the two bones on the inner side of the knee, while the lateral meniscus sits between the two bones on the outer side of the knee. The meniscus can tear due to normal wear and tear as we age or due to trauma, such as a sports injury.

MCL: The medial collateral ligament (MCL) is a band of tissue that stretches vertically from the lower end of the femur (upper leg bone) to the upper end of the tibia (lower leg bone) on the inner side of the knee. It protects against excessive sideways movement or opening of the femur on the tibia.

Ropivacaine, Marcaine, Lidocaine: These are all potential anesthetics that can be used to block the nerves in the area where a procedure is being performed. Dr. Pitts uses ropivacaine because Marcaine, lidocaine, and other anesthetics have been shown to be toxic to the healing stem cells.

Coronary Ligament: The coronary ligament is a small stabilizing ligament that attaches both the medial and lateral meniscus to the leg bones. When the coronary ligament is damaged or lax, the meniscus can shift into unnatural positions and cause problems.

Fluoroscopy: Live X-ray that allows Dr. Pitts to precisely guide his needle while visualizing it in real time.

Contrast: The orthobiologics being injected are invisible on X-ray, so small amounts of a contrast dye, which can be seen on X-ray, is injected to ensure the targeted location is being reached. You will see this process on the video when Dr. Pitts visualizes on fluoroscopy the contrast flowing along the meniscus.

Bone Marrow Concentrate: To obtain bone marrow concentrate (BMC), first, bone marrow is drawn from the patient, and this is called bone marrow aspirate (BMA). The BMA is then centrifuged to isolate and concentrate the stem cells. Once concentrated, this is bone marrow concentrate (BMC).

Adipose Tissue: Adipose tissue is fat tissue, which Dr. Pitts utilizes during this procedure as it contains some factors that contribute to repair and provide some structural support.

Patella Tendon: The patella is commonly known as the kneecap. Attaching the front of the tibia bone in the lower leg to the patella is a strong tendon called the patella tendon. To address the defect left in the patella tendon during the patient’s previous ACL reconstruction, Dr. Pitts injects this tendon to strengthen the weakened tissue.

Interventional Orthopedics Is Very Different from Surgical Orthopedics

In this video, Dr. Pitts demonstrates why Regenexx is very different. Keep in mind, that your orthopedic surgeon, who focuses on invasive surgeries on the musculoskeletal system, is not trained to perform nonsurgical interventional orthopedics procedures. The new field of interventional orthopedics is now providing less-invasive same-day treatments for all but the most extreme musculoskeletal conditions, much like interventional cardiology did for cardiovascular conditions when it came on the scene a few decades ago and provided less-invasive solutions for operations such as open heart surgery. So before you pull the trigger on a joint replacement or an ACL reconstruction, or any other orthopedic surgery, check out your interventional orthopedics options first.

Your Doctor Needs to Be Trained and Certified in Interventional Orthopedics

As discussed, interventional orthopedics (IO) is new. You can clearly see that it involves much more than just shoving a needle into the joint and blindly injecting something. There is a certification program for IO provided through the Interventional Orthopedics Foundation (IOF). This is the only coursework out there that rigorously defines a curriculum of 90+ different precise, image-guided procedures that your doctor must learn and master. It also provides hands-on training and then testing to ensure competence. Hence, if the doctor who is offering to inject your meniscus with PRP or stem cells isn’t IOF certified, then find one who has those credentials.

The upshot? As you can clearly see, there’s quite a bit to injecting a damaged meniscus. It’s an advanced skill that few physicians on earth have mastered. Hence, if someone wants to treat your meniscus tear, make sure they’re trained and certified to know what they’re doing!

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8 thoughts on “Watch a Meniscus Treatment Using Precise Interventional Orthopedics

  1. Richard Watkins

    Is lidocaine also toxic to the stem cells when used in harvesting bone marrow and andipose fat?

    1. Chris Centeno Post author

      Yes, but only if it comes in contact with the cells. So for bone marrow aspiration, it’s easy to keep them apart. Not so for liposuction, where the lidocaine has been shown to hurt cells.

  2. Gary Momenee

    I had a meniscus flap tear “repaired” with surgery, i.e., some (@19%) medial meniscus was removed. I assume your treatment will not help someone like me.

    1. Chris Centeno Post author

      If meniscus was removed, there was no repair. If you still have pain coming from a meniscus issue, then yes, this may help.

  3. Lori

    Is this procedure only for tears in the meniscus? 47 years ago I had a piece of my meniscus surgically removed due to a gymnastics accident. Can you replace/transplant or use stem cells to restore meniscus now? Thanks, Lori

    1. Chris Centeno Post author

      Lori, while we can see increased meniscus size with the culture expanded procedure we perform at the licensed Grand Cayman site, it’s not a reliable effect (meaning we have seen it intermittently which is c/w with what others have published).

  4. Geraldo

    I ’m 54 y.o, in a good shape, and I have a three compartiment arthrosis on my left knee. I have already underwent 6 surgical procedures on which I had the removal of the damage cartilage. Does interventional ortopedics could help me get back to physical activitie (especially playing soccer)

    1. Regenexx Team

      Geraldo,

      Glad to take a look, as we’d need to examine you.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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