Joint Preservation Blog

December 23, 2008

How to save a knee…

Filed under: knee — Tags: , , , , , , , — D @ 2:14 pm

This is a case of a 72 yo male who makes fangs.  Yep, he is a professional dental prothesis maker for everyone from Hollywood actors to Goth kids who just want to add a little Dracula look to their black attire.  His knee is for all intents and purposes trashed (what we would call grade 4 Kellgren osteoarthritis).  How did we make his knee functional again, what were the steps?

First, he had significant problems with myofascial trigger points in his muscles and loose collateral ligaments (the duct tape that holds a joint together).   Before we could do anything else, we needed to solve these issues.  IMS therapy helped get rid of these muscle knots and prolotherapy injections helped tighten his knee ligaments.  The big difference here was that he felt like his knee was more stable and not “moving around” all the time while he made his fangs.  However, he still had significant pain especially with standing for a long-time.  So the next step was to look at his cartilage on an MRI.  His knee was a mess, with severe cartilage loss and meniscus loss.  While there is no way to “grow” him a new knee, we could use his own adult stem cells to help rebuild some cartilage and improve the health of what is still left.  As a result, we collected his stem cells, sent them to the lab for culture expansion (to grow to bigger numbers) and then injected those into the knee.  His pain with standing went from about a 7/10 to a 4/10.  While this was significant, his MRI provided a clue to another issue.  Because he was unable to fully extend the knee (due to his severe arthritis related bone destruction through the years), he was standing by stressing his quadiceps and patellar tendon (the tendon that holds the knee cap and attaches below the front of the knee).  This happens in some patients who have this lack of knee extension (can’t get their knee stright) because straightening the knee allows us to use no energy when we stand.  When you can’t “take the weight off” by fully extending the knee you hand on the quadiceps muscle and it’s patellar tendon.  As a result, his patellar tendon was constantly getting overstressed.  To help this we injected this area to attract stem cells to help beef up the tendon.  This finally helped the rest of his pain and allowed him to stand longer while making his fangs.

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