What the Heck is the Knee Coronary Ligament and What does that Have to do with Stem Cells?
Can an knee stem cell injection of her own stem cells help an unstable meniscus? What is an unstable meniscus and why should you care? LJ is a middle aged woman who loves yoga and running, but was diagnosed with a displaced medial meniscus tear in 2009. She underwent meniscus repair surgery and three months later she began to have knee swelling and catching and was diagnosed with a retear. In 2010 she had another arthroscopic knee surgery which gave her relief for 10 months. She then began to have return of pain on the inside of the knee and a new knee MRI showed a new meniscus tear. She was told that all of the knee meniscus would be removed in the next surgery. After she tried a cortisone shot that lasted for only a few weeks, she wanted to get off of this surgical Merry go Round, so she was referred by her treating provider to our clinic. She first wanted to try SynVisc injections, which helped only moderately for a few months. Based on those lack-luster results she opted for a Regenexx-AD procedure to buttress the medial meniscus and to inject bone marrow stem cells into to the meniscus. By a few months out from this knee stem cell procedure, she reported about 65% improvement, but Dr. Hanson noted issues with pain from the pes anserine and an unstable coronary ligament. For those that follow this blog, you know that the pes anserine is the tennis elbow of the knee. The knee coronary ligament is a new structure to this blog. It basically attaches the medial and lateral meniscus to the tibia. Think about it as the piece of duct tape that holds and stabilizes the meniscus to the bottom knee joint bone (tibia). As you can see from the diagram above, it’s the red line that attaches the meniscus to the bone. When it’s chronically injured and stretched, the meniscus can move into bad positions, leading to excessive trauma. In this patient, Dr. Hanson noted that the remaining medial meniscus was too mobile on ultrasound imaging (this is one of the advantages of ultrasound over MRI-you can see how things move). This explained why she continued to injure this same meniscus as she tried to get active again. To improve her outcomes after the initial stem cell procedure, Dr. Hanson injected the pes anserine area and the medial cornary ligament sprain using the Regenexx-SCP procedure. Sure enough, the patient now reports 80% relief and is back to running three days a week. The upshot? The patient is doing well at about 9 months after an injection of her own stem cells. However, to get her further down the road to an active recovery, we had to look at specific structures and target those with precision guidance. What’s interesting is that most physicians injecting stem cells wouldn’t know the name of this structure, let alone how to identify a chronic injury. Just goes to show you, Orthopedics 2.0 beats magic stem cells every time!