Putting in a Thumbtack with a Sledgehammer
A new Regenexx-C procedure patient illustrates a major problem in our medical care system. This is a 47 year old triathlete who has had 7 years of back and knee pain. She was diagnosed with patellar tendinitis on the right greater than left side. Her MRI showed significant cartilage loss on the medial side of the patello-femoral joint and significant medial soft-tissue and tendon swelling. Since there was a patellar tendon issue, the Quadriceps muscle should have been looked at as a cause of this problem. However, instead, a surgeon opened the area above the tendon and “scored” these swollen areas with a scalpel. This has now caused new scar tissue which restricts the lateral travel of the knee cap, thus more severely overloading the medial side (the side that had the problem before the surgery). Her pain has gotten worse and since her whole social life revolves around triathlons, this has affected more than her ability to exercise.
First, if the tissue needed to be tightened, there are many ways to do this that don’t involve open surgery. This could be accomplished via needle with prolotherapy or even procedures similar to thermal capsulorraphy. Why would someone take this “putting a tack in with a sledgehammer approach”? This type of musculoskeletal realignment surgery (such as lateral knee fascial releases) originated with very valuable surgeries on children with severe spasticity. These kids are generally unable to walk and cutting a structure here or tightening something there can really allow them to become more functional. In those kids, it doesn’t matter if the healing of the area is “spot on”. Their little bodies are generally so misaligned that even if the surgery heals with a precision of a 1/2″ (cm), no big deal. However, in a finely tuned athlete like this one, a few millimeters (1/16-1/32 of an inch) makes a huge difference. In these cases healing with an accuracy of 1/2″ is a big problem.
How can we help at this point? Good question. While we can likely help the cartilage on the medial side of the patello-femoral joint by injecting her own culture expanded stem cells, the issue is now the much greater force on that side created by the surgery. I’ve asked her to have a physical therapist try to regain the lost lateral travel of the patella so she can return to normal patello-femoral travel.
In summary, while knee realignment surgery can make a dramatic positive impact in kids with CP and other diseases where tight muscles cause severe functional problems, relying on big surgical procedures to realign the knees of athletes is fraught with difficulties. In other words, putting in thumbtacks with sledgehammers is generally ill advised.
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