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 knee 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.

Knee Osteo-Arthritis (OA)

  • What is Knee OA?

    Osteoarthritis or OA of the knee 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.

    Knee OA, frequently affects patients over 50 years of age, female, commonly associated with smoking, obesity, poor nutrition, previous surgery (meniscectomy) or trauma, meniscal tears, occupational factors, repetitive motions (sports) and genetic predisposition.

    What are the symptoms of Knee OA?

    Patients with knee OA usually complain of pain associated with prolonged walking, climbing or going down stairs, painful kneeling or squatting. Inability to sit for a prolonged period of with the knees bend is a frequent complaint.

    How is Knee 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 knee OA such as meniscal and ligament tears, bursitis and cartilage defects. Occasionally fluid is drained in order to analyzed for possible infection or gout.

    How is Knee OA 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 can be successfully treated with this approach.

    • 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
    • Patients who do not respond to non-operative care or Bio-cellular
    • Regenerative Interventions, are usually considered surgical candidates.

    The Regenerative Spine and Joint Institute Approach

    In patients with Knee OA we use a personalized, precise, regenerative medicine approach based on the proportionality of the conditions. We created an advanced proprietary tissue engineering system for joints repair and regeneration called, B.E.T.R Bio-Stem Joint.

    • What are the different types of Bio-Cellular Regenerative Interventions (BRI) used to treat Knee OA?

    • B.E.T.R Bio JointIs the preferred intervention in patients with painful and arthritic knee joints who are having mild to moderate symptoms and have minimal degenerative changes. It consists of injecting a combination of substances called Biologic Stimulants. Although it contains powerful growth factors and anti-inflammatories, this system does not contain mesenchymal stem cells. However it can be highly successful in early symptomatic joint arthritis.
    • B.E.T.R Stem JointThis system was designed for patients who have failed the above interventions or have moderate to advanced joint arthritis. It consists of using a proprietary method for injecting the arthritic or damaged joints with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with painful arthritic joints.

    See Bio-Cellular Regenerative Therapies

Patellar Chondromalacia

Patellar Chondromalacia (Patellofemoral Syndrome) is a term used to describe a condition where the articular cartilage behind the patella is either damaged or worn out. The cartilage is a tissue that lines the bones in a joint and provides shock absorption and stability. It can be associated with the normal wear and tear and certain sports such as running or jumping. Overuse, poor muscle control and previous knee trauma a common associated factors.

How is PC 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 chondromalacia such as meniscal and ligament tears, bursitis and cartilage defects.

How is PC treated?

  • Conservative
  • 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 advanced patellar chondromalacia without the need for surgical interventions. Our interventions are designed to repair, regenerate, restore tissue to its normal health and function.

In patients with Knee OA we use a personalized, precise, regenerative medicine approach based on the proportionality of the conditions. We created an advanced proprietary tissue engineering system for joints repair and regeneration called, B.E.T.R Bio-Stem Joint.

    • What are the different types of Bio-Cellular Regenerative Interventions (BRI) used to treat Knee OA?

    • B.E.T.R Bio Joint

      Is the preferred intervention in patients with painful and arthritic patellar joints who are having mild to moderate symptoms and have minimal degenerative changes. It consists of injecting a combination of substances called Biologic Stimulants. Although it contains powerful growth factors and anti-inflammatories, this system does not contain mesenchymal stem cells. However it can be highly successful in early symptomatic joint arthritis.

    • B.E.T.R Stem Joint

    • This system was designed for patients who have failed the above interventions or have moderate to advanced joint arthritis. It consists of using a proprietary method for injecting the arthritic or damaged joints with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with painful arthritic joints.

See Bio-Cellular Regenerative Therapies

Patellar Tendinosis (PT)

  • The patellar tendon connects the kneecap (patella) to the shin bone (tibia). It plays an important role in the way you use your legs. It helps your thigh muscles (quadriceps) straighten your knee. Patellar tendonitis is a condition that occurs when the tendon and membrane develops micro tears and is unable to repair itself.t is usually an overuse injury, commonly associated with jumping activities. Which is why it is often called “jumper’s knee”. It is most common in athletes whose sports involve frequent jumping, for example, basketball and volleyball players. However, anyone can suffer from patellar tendinitis.
    It is also seen in conditions associated with repetitive motions, tight thigh muscles, anatomical abnormality of the patella and being overweight.

    What are the symptoms of PT?

    Patients with patellar tendinopathy usually complain of anterior knee pain, around the lower patellar area. In the early stages, the pain is worse after exercise, during later stages it will happen during and athletic participation. In advanced cases athlete or patient is unable to participate in any significant athletic program

    How is PT 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.

    How is PT 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 can be successfully treated with this approach.

    • Conservative
    • Rest in the acute stages
    • Activity modification with avoidance of triggering factors
    • Eccentric patellar 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 patellar chondromalacia without the need for surgical interventions.

    In patients with symptomatic Patellar Tendinosis we use a personalized, precise, regenerative medicine approach based on the proportionality of the conditions. We created an advanced proprietary tissue engineering system for tendon repair named, B.E.T.R Bio-Stem Tendon.B.E.T.R. stands for biologic enhancement of tissue repair.

      • What are the different types of Bio-Cellular Regenerative Interventions (BRI) used to treat Patellar Tendinosis?

      • B.E.T.R Bio Tendon

        Used initially to treat patients with patellar tendo]inosis who are having mild to moderate symptoms and have minimal degenerative changes. It consists of injecting a combination of substances called Biologic Stimulants. Even though it is devoid of stem cells, it contains powerful growth factors and anti-inflammatories, which are capable of achieving great success.

      • B.E.T.R Stem Tendon

      • This system was designed for patients who have failed the above interventions or have moderate to advanced tendon damage. It consists of using a proprietary method for injecting the damaged tendon with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with painful damaged tendons.
      • TENEX TENOTOMY

    Is a new device designed to remove the damaged tissue in the tendons that are swollen and have a significant amount of abnormal tissues. The device is based on ultrasonic technology and is inserted into the tendon through a very small incision. The Tenex Device, cleans and removes damage or injured tissue and creates a healing response. Bio-Cellular Therapies are frequently performed in the tendon, following the Tenex procedure. In our experience, this combination therapy provides the best results.

    We use the Tenex Tenotomy, only in patients with Tendinopathy that have not responded to conservative therapy or Bio-Cellular Therapies.

    See Bio-Cellular Regenerative Therapies

Partial Ligament Tears (Medial and Lateral Collateral)

    • What is ligament tear?

      Ligaments are fibrous bands that connect bones to bones, giving the knee functional and anatomical stability. There are 4 main ligaments in the knee: Medial and Lateral Collateral (side stability) and Anterior and Posterior Cruciate (forward and backward stability). These ligaments a frequently injured in athletic activities (repetitive motions or trauma) or during normal wear and tear. It is not uncommon to have more than one ligament tear at a time. Ligament tears are classified according to the severity of symptoms and damage.

      What are the symptoms knee Ligament Tears?

      Patients with partial ligament tears usually complain of pain associated with certain motions, localized pain over the injured area, swelling , stiff need, feeling of instability, buckling and others.

      How is knee Ligament Tears 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 tear s and other pathologic conditions which can be present.

      How are knee Ligament Tears 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 partial knee ligament tears can be successfully treated with this approach.

      • Conservative
      • Rest in the acute stages
      • Activity modification with avoidance of triggering factors
      • Eccentric patellar 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.
      Our ultrasound guided BRI offer the same success rate of open surgical procedures by allowing us to visualize accurately the damaged lgaments, without the need for arthroscopy.

      • What are the different types of Bio-Cellular Regenerative Interventions (BRI) are used to treat knee Ligament Tears?

      • B.E.T.R Bio Ligament

        Used initially to treat patients with collateral ligament problems who are having mild to moderate symptoms and have minimal degenerative changes. It consists of injecting a combination of substances called Biologic Stimulants. Even though it is devoid of stem cells, it contains powerful growth factors and anti-inflammatories, which are capable of achieving great success.

    • B.E.T.R Stem Tendon

    • This system was designed for patients who have failed the above interventions or have moderate to advanced ligament partial tears. It consists of using a proprietary method for injecting the damaged tendon with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with moderate partial tears or injuries.

See Bio-Cellular Regenerative Therapies

Surgical Options

Patients not responding to above interventions or patients with complete ligament tears, a more comprehensive open surgical procedure is necessary.

Meniscal Tears

  • What is a Meniscal Tear?

    The meniscus is a structure made up of cartilage that is located in your knee joint. In each knee, there are two C-shaped menisci. They have the important function of acting as shock absorbers and lubricants in your knee. Due to the lack of significant blood supply in the inner 1/3 of the meniscus, tears occurs very frequently. The mechanism of injury is usually wear and tear in older adults, and traumatic or twisting motions in sports related activities.

    What are the symptoms of Meniscal Tears?

    Patients with meniscal tears usually complains of pain while moving in a certain direction, a feeling of instability, clicking or locking, stiffness and swelling.

    How are Meniscal Tears 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 which can be present.

    How are Meniscal Tears 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 meniscal tears can be successfully treated with this approach.

    • Conservative I
    • Rest in the acute stages
    • Activity modification with avoidance of triggering factors
    • Eccentric patellar 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 meniscal tears 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 arthroscopy.

    In patients with Knee OA we use a personalized, precise, regenerative medicine approach based on the proportionality of the conditions. We created an advanced proprietary tissue engineering system for joints repair and regeneration called, B.E.T.R Bio-Stem Joint.

      • What are the different types of Bio-Cellular Regenerative Interventions (BRI) used to treat Meniscal Tears?

      • B.E.T.R Stem Cartilage

        This system was designed for patients who have failed the above interventions or have moderate to advanced meniscal tears. It consists of using a proprietary method for injecting the degenerative or torn meniscus with a combination of Bio-Cellular Grafts (growth factors, biologic scaffolds and mesenchymal stem cells obtained from your own bone marrow or adipose tissue). It is considered the most advanced regenerative treatment available for patients with painful meniscal tears.

    See Bio-Cellular Regenerative Therapies

    • Surgical Interventions

      Patients who do not respond to non-operative care or Bio-cellular Regenerative Interventions, and have significant pain are considered surgical candidates.

Knee Osteochondral Defect (OCD)

    • What is as 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 Knee OCD?

      Knee 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 are Knee 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 that can be present.

      How are Knee 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
      • Rest in the acute stages
      • Activity modification with avoidance of triggering factors
      • Eccentric patellar 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 osteo-chondral defects without the need for surgical interventions. The treatment depends on the type and seize of the lesion.

      Our ultrasound and fluoroscopically guided BRI accurately pinpoint the precise location of the cartilage defect and direct our treatment percutaneously , without the need for arthroscopy.

        • B.E.T.R. Stem-Cartilage

      Most preferred method of treatment for patients who do not respond to conservative interventions or have moderate to advanced osteo-chondral 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 Therapies

Osteonecrosis of the Knee or ABN (Avascular Bone Necrosis)

  • What is Knee ABN?

    Osteonecrosis is a disease caused by reduced blood flow to the bones in the knee joints. With too little blood, the bone starts to die, slowly collapsing, causing cartilage damage and ultimately leading to significant joint arthritis and collapse .

    What are the symptoms of Knee 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 knee. The time from the start of symptoms to losing use of the joint can range from months to more than a year.

    How Is Knee 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 Knee 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

    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 moderated (pre joint collapse stage) osteo-necrosis without the need for more aggressive surgical interventions. The treatment depends on the type, size of the lesion and presence of joint collapse.

    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.

    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, Bio-Cellular Grafts with mesenchymal stem cells are injected into the area containing the dead bone.

    For more information see Bio-Cellular Regenerative Therapies

    Surgical Options:

    In patients with advanced Knee ABN that do not respond to the above interventions or have significant joint collapse, a Total Joint Arthroplasty is usually necessary.