The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advanced ankle and foot conditions without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function. Potentially avoiding recurrent episodes of pain, disability and further surgical interventions.

By repairing the cartilage and adjacent structures, further recurrent episodes of pain, osteoarthritis, disability and further surgical interventions may be avoided. For more information see Bio-Cellular Regenerative Therapies.

Ankle Arthritis

What is Ankle Arthritis?

Osteoarthritis or OA of the ankle is the most common form of arthritis and is related excessive wear and tear of the joints, ultimately damaging the joint the cartilage (which is the smooth, firm material which covers the ends of the bones in the hip joint). It can be associated with aging, overuse or trauma. With time, the cartilage become stiff, less effective in absorbing loads and damage ensures, causing inflammation. The tendons and ligaments around the joints begin to stretch and the pain worsens. Ultimately the cartilage wears out and the bones start to rub against each other, creating spurs and deformity in the joints.

 

Ankle OA, frequently affects patients over 50 years of age, female, commonly associated with smoking, obesity, poor nutrition, multiple sprains, previous surgery or trauma, meniscal tears, occupational factors, repetitive motions (sports) and genetic predisposition. Other causes of ankle arthritis are: rheumatoid arthritis, septic arthritis and gout.

 

What are the symptoms of Ankle OA?

Patients with ankle OA usually complain of pain associated with prolonged walking , worse at the end of the day. Stiffness, swelling and instability may also be present.

 

How is Ankle OA diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to confirm the diagnosis. MRI can yield more specific information about the degree of cartilage loss and other pathologic conditions usually associated with ankle OA .

 

How is ankle OA treated?

At our institute, we believe that conservative therapies should be utilized in every patient prior to more advanced regenerative interventions or surgical options. Most patients can be successfully treated with this approach. However, by the time patients are referred to our practice, they have usually finished a program of conservative therapies.

 

Conservative Interventions

  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Weight Reduction
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy
  • Braces
  • Lifestyle changes

 

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advance ankle arthritis without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function.

 

By repairing the cartilage and adjacent structures, further recurrent episodes of pain, osteoarthritis, disability and further surgical interventions may be avoided.

 

For more information see Bio-Cellular Regenerative Therapies.

Achilles Tendinitis

What is a tendon?

A tendon is a fibrous structure that connects a muscle to the bone. The Achilles Tendon is part of your calf muscles (gastrocnemius and soleus muscles) and attaches these muscles to your heel bone (the calcaneus). The main function of the Achilles tendon is to bend your foot and ankle towards the ground.

 

Tendinitis is a condition that occurs when the tendon and membrane develops micro tears and is unable to repair itself. It is usually an overuse injury, however it is more common as you get older. The tendon swells, because of abnormal new tissue is produced by a faulty healing process. This condition can also be exacerbated by poor conditioning, flatten arch of your foot and sudden increase in training intensity and trauma.

 

What are the symptoms of Achilles Tendinitis ?

Symptoms usually develop gradually unless is associated with an acute injury. There is usually tenderness over the tendon, stiffness which gets better as you warm up, mild swelling, a bump in the distal tendon and pain during the push off phase of walking.

 

How is Achilles Tendinitis diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to confirm the diagnosis. MRI can yield more specific information about the degree of tendon damage and other pathologic conditions. Ultrasound is a useful tool for assessing the swelling and inflammation.

 

How is Achilles Tendinitis treated?

Conservative Interventions

  •  Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Eccentric Achilles loading and incline
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy,
  • Orthotics, Boots

 

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advanced ankle tendinitis, without the need for surgical interventions. Our ultrasound guided BRI offer the same success rate of open surgical procedures by allowing us to visualize accurately the damaged tendon, without the need for an open surgical procedure.

 

What are the different types of Bio-Cellular Regenerative Interventions (BRI) for Achilles Tendinosis?

 

B.E.T.R. Bio-Tendon

B.E.T.R. stands for Biologic Enhancement of Tissue Repair and is a specific technique in which Biologic Stimulants are injected inside and around the tendon under ultrasound guidance.

 

  • Biologic Stimulants Therapies (BST)Is a type of therapy in which mostly natural substances are injected into the tendon in order to enhance the natural healing capabilities of damage or degenerative tissues. These treatments do not contain stem cells, but are highly effective. They can be use alone and more frequently in combination with other bio-cellular therapies.
  • Prolotherapy (Creates cellular proliferation)
  • Ozone (Increases tissue oxygenation)
  • Traumeel (Homeopathic anti-inflammatory)
  • Viscous Supplementation (Increases joint lubrication)
  • Peptide Therapy (stimulates production of cartilage cells)
  • Hormone Therapy (accelerate protein synthesis)

B.E.T.R. Stem-Tendon

Is the most advanced therapy for patients with moderate to advanced degenerative changes or injuries, which have failed conservative or Biologic Stimulant Therapies. It consists of intra-articular injections of a combination Bio-Cellular grafts (growth factors, scaffolds and mesenchymal stem cells) into the injured or degenerative tendon. This is designed to decrease inflammation, stimulate the growth of new cartilage, strengthen surrounding tissues and restore function.

  • Bio-Cellular Grafts Therapies
  • PRP (Growth Factors obtained from your own blood)
  • BMAC (Bone Marrow Aspirate Concentrate with Stem Cells)
  • ADSC (Adipose Derived Stromal Stem Cells)
  • AATG (Allogeneic Amniotic Tissue Graft)
  • Scaffolds (is a three dimensional biologic tissue or material)

 

In refractory cases we utilized a combination of BRI and an ultrasound guided percutaneous debridement of the tendon with a special ultrasonic device called Tenex Tenotomy.

 

For more information see Bio-Cellular Regenerative Interventions.

Chronic Ankle Sprains

What Is Chronic Ankle Instability?

 

Ankle instability is a term use to describe weakness or laxness in the ligaments that surround the ankle joint. It is a fairly common condition, especially in people who play high impact sports (basketball, football). Usually, ankle instability is a result of sprains injuring the ligaments.

Ligaments are fibrous tissue bands that connect bones to bones, giving joints mobility and stability. Due to its poor blood supply they are prone to non healing conditions from repetitive injuries.

Sprains can also damage other structures in the foot, and these secondary injuries can also contribute to symptoms of instability, pain and stiffness.

There are two main ligament complex in the ankle joint: The outer or lateral ligaments (anterior and posterior talo-fibular, calcaneo-fibular) and the inner or medial (deltoid).

 

What are the symptoms of Ankle Instability (Ligament sprain)?

The symptoms vary from difficulty walking on uneven surfaces, a feeling of weakness and instability, decrease perception of ankle position and chronic ankle pain. Other associated conditions can be present such as arthritis , tendinosis and cartilage defects which may presents with different symptoms.

 

How is Ankle Instability diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to assess for other changes. MRI and Sonography can yield more specific information about the degree of the tears and other pathologic conditions in the ligaments, which can be present.

 

How is Ankle Instability treated?

At the RSJI we believe that conservative therapies should be utilized in every patient prior to more advanced regenerative interventions or surgical options. Most patients with chronic ankle instability due to ligament tears can be successfully treated with this approach.

Conservative Interventions

  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Eccentric Achilles loading and incline
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy,
  • Lifestyle changes

 

The Regenerative Spine and Joint Institute Approach

With the advent of new bio-cellular regenerative interventions (BRI), we are able to successfully treat patients with mild to advanced partial ligament tears without the need for surgical interventions. \r\nOur ultrasound guided BRI offers a non-surgical alternatives with excellent success, by allowing us to visualize accurately the damaged ligaments, without the need for an open surgical procedure.

 

What are the different types of Bio-Cellular Regenerative Interventions (BRI) utilized in the treatment of Ankle Instability?

 

B.E.T.R. Bio-Ligament

Stands for biologic enhancement of tissue repair and is a specific technique in which Biologic Stimulant Therapies are injected inside the ligament.

 

Biologic Stimulants Therapies (BST)

Is a type of therapy in which mostly natural substances are injected into the ligament under ultrasound guidance, in order to enhance the natural healing capabilities of damage or degenerative tissue. These treatments do not contain stem cells, but are highly effective. They can be use alone and more frequently in combination with other bio-cellular therapies.

 

  • Prolotherapy (Creates cellular proliferation)
  • Ozone (Increases tissue oxygenation)
  • Traumeel (Homeopathic anti-inflammatory)
  • Viscous Supplementation (Increases joint lubrication)
  • Peptide Therapy (stimulates production of cartilage cells)
  • Hormone Therapy (accelerate protein synthesis)

 

B.E.T.R. Stem-Ligament

Most preferred method of treatment for patients who do not respond to the above interventions or have moderate to advanced degenerative changes or injuries. It consists injecting a combination of growth factors, scaffolds and mesenchymal stem cells into damaged or injured ligaments.

 

    • PRP (Growth Factors obtained from your own blood)
    • BMAC (Bone Marrow Aspirate Concentrate with Stem Cells)
    • ADSC (Adipose Derived Stromal Stem Cells)
    • AATG (Allogeneic Amniotic Tissue Graft)
    • Scaffolds (is a three dimensional biologic tissue or material)

 

For more information see Bio-Cellular Regenerative Therapies.

Osteo-chondral Defect (OCD)

What is OCD?

Is a term used to described a condition in which the bone cartilage and the underlying bone (sub-chondral) develops cracks due to poor blood supply. This can ultimately lead to bone death and partial bone collapse. Occasional fragmentation of a lesion can dislodge and create significant pain and further damage.

Twisting movements combined with direct impact like can occur with soccer, skiing, basketball, football are usually associated with OCD. Other cases are mainly due to degenerative wear and tear, genetic predisposition and other medical conditions.

 

What are the symptoms of OCD?

Ankle pain is the main symptom and is usually associated with weight bearing activities, mainly relieved by rest. Patients may experience a sense of instability, mild locking or clicking, dull ache and sometimes swelling of the joints.

 

How is OCD diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to assess for other changes. MRI can yield more specific information about the degree and magnitude of the defect and other pathologic conditions which can be present.

 

How is OCD treated?

At the RSJI we believe that conservative therapies should be utilized in every patient prior to more advanced regenerative interventions or surgical options. The treatment of OCD is dependent on the stage and severity of the lesion.

Conservative Interventions

  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Correction of muscle imbalance, stretching, Laser therapy,
  • Lifestyle changes

 

The Regenerative Spine and Joint Institute Approach

With the advent of new Bio-cellular Regenerative Interventions (BRI), we are able to successfully treat patients with mild to advanced osteo-chondral defects without the need for surgical interventions. The treatment depends on the type and size of the lesion.

 

Our ultrasound and fluoroscopically guided BRI, accurately pinpoint the precise location of the cartilage defect. This allows the treatment to be performed through a percutaneous approach, without the need for an open surgical intervention.

 

B.E.T.R. Stem-Cartilage

Most preferred method of treatment for patients who do not respond to conservatives interventions or have moderate to advanced ostechondral defects. It consists injecting a combination of growth factors, scaffolds and mesenchymal stem cells into damaged or injured ligaments.

 

  • PRP (Growth Factors obtained from your own blood)
  • BMAC (Bone Marrow Aspirate Concentrate with Stem Cells)
  • ADSC (Adipose Derived Stromal Stem Cells)
  • AATG (Allogeneic Amniotic Tissue Graft)
  • Scaffolds (is a three dimensional biologic tissue or material)

 

The above interventions are frequently performed in combination with a needle micro-fenestration of the osteo-chondral defect, in order to improve the effectiveness of the interventions.

 

For more information see Bio-Cellular Regenerative Interventions.

Osteonecrosis of the Ankle or ABN (Avascular Bone Necrosis)

What is Ankle ABN?

Osteonecrosis is a disease caused by reduced blood flow to bones in the ankle joints. With too little blood, the bone starts to die and may break down.

 

What are the symptoms of Ankle ABN ?

When osteonecrosis first begins, you may not have any symptoms. You may start to feel pain when you put weight on a joint with osteonecrosis. As the disease gets worse, you may have more pain and the joint may hurt even when you rest. Pain may be mild or severe.

If the bone and joint start to break down, you may have severe pain and not be able to weight bear on the ankle. The time from the start of symptoms to losing use of the joint can range from months to more than a year.

 

How Is Ankle ABN diagnosed?

After a comprehensive history and physical examination, usually X rays are obtained to confirm the diagnosis. MRI can yield more specific information about the degree of bone loss. Sometimes Computed Tomography and Bone Scans are necessary.

 

How is Ankle ABN treated?

Treatments depend on the patient’s age, stage of the disease and osteonecrosis and related causative factors. The goal is to stop or reverse the actual damage, improve the use of the joint and protect the joints and bone.

Conservative

  • Rest in the acute stages
  • Activity modification with avoidance of triggering factors
  • Physical Therapy, Bio-mechanical training
  • Nutritional supplements
  • Medications: NSAIDS (non-steroidal anti inflammatory drugs)
  • Range of motion exercises
  • Electrical Stimulation
  • Weight reduction

Minimally Invasive Core Decompression with Bio-Cellular Therapy

In patient with failed conservative therapy or early non-collapse joints with osteonecrosis, the most effective intervention is a combination of stem cell therapy with core decompression.

Core Decompression consists of inserting a bone marrow needle into the damage bone decreasing the pressure. Afterwards, either BMAC or ADSC are injected into the damage or necrotic bone.

BMAC stands for Bone Marrow Aspirate Concentrate and it is obtained by aspiration of bone marrow blood. It contains multiple types of stem cells and other important cells that produce red cells, platelets, antibodies and others. More importantly, it contains a type of stem cell called mesenchymal stem cells (MSC). These cells are responsible for secreting growth factors that can significantly enhance the tissues ability to heal and regenerate. These are the cells with the greatest capability to repair bone, cartilage and muscle. The total number of mesenchymal stem cells present in BMAC is usually .1% of the total cell population.

ADSC stands for Adipose Derived Stromal Cells. It contains a mixture of different types of stem cells and non-stem cells, which are obtained from your own adipose tissues . More importantly, it contains a type of stem cell called mesenchymal stem cells (MSC). These cells are responsible for secreting growth factors that can significantly enhance the tissues ability to heal and regenerate. The number of mesenchymal stem cells (MSC) can be up to 500-800% more than in BMAC and they have greater anti-inflammatory and regenerative capabilities. The total population of MSC present in ADSC is roughly 5-8% of the cell population.

Surgical Options:

In patients with advance Ankle ABN that do not respond to the above interventions or have significant joint collapse, a total joint arthroplasty is usually necessary.

Plantar Fasciitis

What is the Plantar Fascia?

It is a fibrous tissue or sheath that connects your heel bone to the toes and provides support to your foot.

 

What is Plantar Fasciitis?

Plantar fasciitis is the most common cause of heel pain. It is caused by repeated strain on the plantar fascia, ultimately creating tissue micro-tears and swelling. This can lead to foot weakness, inflammation, swelling and ultimately significant disabling pain. Plantar fasciitis is common in overweight patients, athletes, flat feet or high arches, prolonged standing, inadequate shoe support and other anatomical knee and hip problems.

Symptoms include pain upon waking and pain while walking and climbing stairs. Treatment includes resting the feet, doing calf stretches and towel stretches several times daily, and wearing shoes with good arch support and a cushioned sole.

 

What are the symptoms of Plantar Fasciitis?

The symptoms usually start with walking up in the morning with significant pain and a burning sensation in the heel when you first stand up. Pain is also present while walking, climbing stairs, running or other performing other sports.

 

How is Plantar Fasciitis treated?

Conservative

  • Activity modification (rest your feet often)
  • Avoid walking on hard surfaces
  • Orthotics (shoe forms)
  • Morning calf stretches and foot stretches
  • Over the counter NSAIDS( non steroidal anti-inflammatory drugs)
  • Weight reduction, proper nutrition, smoke cessation
  • New shoes with good arch support and cushioned sole.
  • Low level laser therapy, Ice

What are the different types of Bio-Cellular Regenerative Interventions (BRI) utilized in the treatment of Ankle Instability?

 

B.E.T.R. Bio-Fascia

Stands for biologic enhancement of tissue repair and is a specific technique in which Biologic Stimulants are injected inside the plantar fascia.

 

Biologic Stimulants Therapies (BST) Is a type of therapy in which mostly natural substances are injected into the ligament under ultrasound guidance, in order to enhance the natural healing capabilities of damage or degenerative tissue. These treatments do not contain stem cells, but are highly effective. They can be use alone and more frequently in combination with other bio-cellular therapies.

  • Prolotherapy (Creates cellular proliferation)
  • Ozone (Increases tissue oxygenation)
  • Traumeel (Homeopathic anti-inflammatory)
  • Viscous Supplementation (Increases joint lubrication)
  • Peptide Therapy (stimulates production of cartilage cells)
  • Hormone Therapy (accelerate protein synthesis)

B.E.T.R. Stem-Fascia

Most preferred method of treatment for patients who do not respond to the above interventions or have moderate to advanced degenerative changes or injuries. It consists injecting a combination of growth factors, scaffolds and mesenchymal stem cells into damaged or injured ligaments.

  • PRP (Growth Factors obtained from your own blood)
  • BMAC (Bone Marrow Aspirate Concentrate with Stem Cells)
  • ADSC (Adipose Derived Stromal Stem Cells)
  • AATG (Allogeneic Amniotic Tissue Graft)
  • Scaffolds (is a three dimensional biologic tissue or material)

Tenex Tenotomy is a procedure frequently performed in combination with the above therapies. It is designed to remove or debride the swollen and damaged plantar fascia. This allows for enhancement of tissue healing.

For more information see Bio-Cellular Regenerative Interventions.