Joint Preservation Blog

January 22, 2009

Does ibuprofen inhibit ligament repair?

As a doctor, I get asked allot, “Does ibruprofen inhibit ligament repair?“. In short, likely. We know from the medical research that Ibuprofen belongs to a drug class (NSAID’s) that inhibits the cyclo-oxengenase pathway of inflammation (COX) and that this can inhibit bone healing. We also know from animal models that injecting NSAID’s into a joint can cause arthritis. We also know that NSAID’s can negatively impact adult mesenchymal stem cells that are key in the ligament healing process. The upshot, Ibuprofen and NSAID drugs like Alleve, Motrin, Celebrex, and others likely impair healing of bones, ligaments, tendons, and other musculoskeletal tissues by impairing adult stem cells in their normal role of tissue repair. The upshot, based on the circumstantial evidence, taking NSAID’s after a ligament injury is likely a bad idea.

Advertisements

January 10, 2009

Ankle support in london?

As a physician, you might say that I have an American MD specializing in Regenerative Medicine and a “doctorate of hard knocks” in ankle braces.  When I came across people searching for “Ankle support in london” I had to throw in my two cents.  I don’t live in London, far from it, I’m in beautiful Boulder, Colorado.  If you’re looking for an ankle support brace, I can tell you first hand that I’ve tried them all.  The winner?  The Malleoloc.  However, my quest for the perfect ankle support didn’t end there, I then tried prolotherapy which allowed me to get rid of the ankle support brace.  This technique involves injecting substances into the ankle ligaments to kick off an inflammatory healing response.  This worked pretty well, even allowed me to take a run every once in a blue moon.  What would I do today instead of the ankle support?  I’d try this cutting edge procedure where they inject your won stem cells into the ankle ligaments to heal and repair the damage.  The video below shows a patient where this was done in the U.S.:

January 6, 2009

recooperation from shoulder surgery

Typical shoulder surgery recovery.

Typical shoulder surgery recovery.

As a doctor, recooperation from shoulder surgery can be tough. The problem is that the severe degree of immobilization that’s needed (that big blue pillow) makes that arm/hand useless. Is there a better way? Well, if you have a rotator cuff tear, newer and much less invasive methods of treatment may be the answer, as with less trauma from the procedure comes quicker recovery times (read no blue pillow). How can this be possible? Trade the scapel for a needle. Rather than trying to sew ligaments back together or sewing a torn rotator cuff tendon, get stem cells to repair the damge. The doctor simply places the cells in the damaged area with an injection. Little trauma, little recovery. Sounds like science fiction? Not really, as this procedure using your own stem cells to repair the damage is now being used reduce recooperation times. No surgery, less recovery. To learn more, click the video below:

January 4, 2009

Ligament Tear Symptoms

Ligament Tear Symptoms

Ligament Tear Symptoms

What are ligament tear symptoms? Think of ligaments as the duct tape that holds your bones and joints together. What happens when the duct tape gets stretched or gets torn? In this case, the duct tape (your ligaments) don’t hold the joint together, allowing for too much movement. While the area of the ligament tear can hurt and swell, once that initial several weeks of healing is over, if the duct tape hasn’t mended completely, the joint can be left unstable (read moving around too much). This instability can cause popping, clicking, and/or further swelling and pain in the joint. Over a few months to years, this can cause arthritis to develop much more quickly. How do you fix this ligament issue? Surgery is a possibility, but a bit more traumatic than the repair needs to be in most instances. A newer method is injecting your own stem cells into the ligament to get it to heal. The ligament grades above show that grade 1 and 2 are when the ligament is stretched or partially torn, grade 3 is completely torn. This stem cell treatment works best in grades 1 and 2. If you have a grade 3 tear, then surgery may be the only answer at this point.

Torn Ankle Ligament

Filed under: ankle — Tags: , , , , , , , — D @ 4:49 pm
torn ankle ligament

torn ankle ligament

The outside (lateral) ankle ligaments are the ones that are usually injured. These are the anterior and posterior (front and back) talo-fibular ligaments (the duct tape that holds the talus bone to the heel bone) and the calcaneo-fibular (the duct tape that holds the outside small leg bone (fibula) to the heel bone (calcaneus)). As a physician with a torn ankle ligament, there are three ways to fix a torn ankle ligament that hasn’t healed on it’s own:

1. Tendon graft surgery. The surgeon will take a tendon from the foot and sew it into place to substitute for a torn ankle ligament. The surgeon may also sew up any partial tears in any of the ankle ligaments. There are tow big downsides. The first is that this is a tight space and getting an arthroscope into the ankle can by itself cause some tissue damage. The second is that the tendon graft may end up either causing biomechanical issues (you need all of your tendons, so borrowing one from another spot may cause problems) or it can be placed too tightly and cause further ankle arthritis.
2. Prolotherapy. This is the injection of substances to cause a brief inflammatory healing reaction in the ligaments. For more information on prolotherapy.
3. Percuteneous stem cell assisted repair. This is where the doctor takes the patients own stem cells, grows them in a lab over a few weeks to bigger numbers, and then injects them back into the torn ligaments to repair the tears. This is the future of dealing with this problem and has just become available in the US. For a vido on the subject, see below:

December 24, 2008

Strained Ligament in Ankle

As a physician with a bad ankle, I know this one first hand.  A strained ligament in ankle means that the ankle ligaments are stretched but not completely broken.  The ankle ligaments are like duct tape that hold the bones together.  Normally, the area swells as the body attracts resources to heal the small ligament tears.  However, in some people, the tears are too big and the ligaments remain stretched out and the ankle is unstable (too much movement between the bones).  This instability causes other problems including swelling and extra wear and tear on the cartilage.  If left untreated, the ankle will develop arthritis much quicker than normal. While the only way to treat this was surgery or bracing, newer stem cell injection based treatments can heal the tear and restore normal stability without surgery.  For more information, the video below is helpful:

December 23, 2008

ACL Laxity and Knee Braces

ACL Laxity and Knee Braces.  The ACL is the inner duct tape (otherwise known as a ligament) that holds the knee together in a front-back direction.  This means that it prevents the lower shin bone (tibia) from moving forward on the thigh bone (femur). This ligament can be stretched or torn completely.  In these cases the joint is said to be “lax” and in need of either surgical repair, non-surgical repair, or knee bracing.  Bracing a knee with ACL Laxity involves stabilizing the femur and tibia in a front-back direction. However, there are pros and cons.   One of the problems is that bracing still allows some movement, which ultimately injuries the joint.  Up until now, there has been no way to repair a stretch injury to the ACL without surgery. However, the development of injection based therapy for partial ACL tears and laxity has been a big advancement beyond surgical grafts.  As an example, the Regenexx procedurenow allows doctors to inject the patient’s own stem cells onto the stretched ACL ligament and tighten that ligament back to it’s normal strength and length.  This development allows the patient to get rid of the brace all together.  Since there is no surgery needed, the recovery is much quicker and bracing is only used for a few weeks after the procedure if the laxity is severe.  This newer technique doesn’t work when there is no ACL left, but only if there are ACL fibers that can still be detected on MRI.  

As a physician who treats patients with these injuries, the best brace is the one that fits well.  For general fitting and measuring instructions, click here. Also, I often advise my patients to consider getting a slightly used brace.  Ebay can be a great place to to find a knee brace that will help with ACL laxity.

Below is a short video on the topic of repairing ligament tears by injecting your own stem cells.  While this shows an ankle ligament example, this could just as easily be a partial ACL tear.

December 15, 2008

supplements that help prevent torn tendons

Supplements that help prevent torn tendons usually involve various components of tendons such as collagen.  Collagen is a natural substance that acts as the mortar for the brick building blocks (cells) that make up much of the body.  Taking more of this collagen “mortar” may help provide better masonry building blocks in areas like tendons.  In addition, another major component of tendons and ligament repair is Vitamin C or ascorbic acid.  Vitamin C is a catalyst for this repair and building up of collagen.  Think of it as the food for the brick mason so he can lay more cellular bricks to make more tendon and ligament using the collagen mortar.  Another major tendon and joint component are GAG’s (glycoaminosglycan’s).  These are the chemicals that help to hold onto water and help provide elasticity to tendons, ligaments, and joints.  GAG’s include glucosamine and hyaluronic acid.  Another major strategy for preventing torn tendons is activity.  Activity helps to build up tendons and ligaments and make them stronger.  In this case, walking the mall may not be enough activity, but walking to the mall is more like the kind of activity levels needed.  Once a tendon tears, avoiding surgery should be the goal.  Sewing a partial tendon tear may make the tendon too tight and cause other problems.  Non-surgical methods to heal the tendon can include prolotherapy or adult stem cell injections.  Prolotherapy involves injecting substances to cause a brief inflammatory healing reaction to try and get the torn tendon to heal.  Injecting stem cells into the tendon provides more building blocks or bricks in our mason example above.

mri knee anterior and posterior ligament tears

MRI knee anterior and posterior ligament tears. The knee has ligaments in the font and back (ACL and PCL) that keep the knee stable in a front-back direction. These ligaments can be seen on MRI and will usually have bright areas in them under certain special MRI sequences if they are partially torn or stretched. These areas are called “high signal intensity” in medical radiology jargon. If the ligament tears are complete (broken in half), then surgery is needed to reconnect those ligaments. However, if the ligaments are only partially torn or stretched, newer techniques to treat these ligaments without surgery are available. Surgery to treat an ACL/PCL partial ligament tear may cause more problems than it’s worth, in that sewing these ligaments may result in ligaments that are too tight. Ligaments that are too tight can rapidly increase the wear and tear forces on the knee. This can lead to further degeneration of the cartilage and arthritis. However, leaving the ligaments stretched out and too loose may result in the same fate, as the extra motion of the knee joint will lead to extra wear and tear as well.

While surgical repair may well lead to more arthritis down the line, non-surgical repair has advanced greatly in the past few years. The ability to inject the patent’s own stem cells into the partially torn ligaments without surgery may be able to heal these tears without over tightening the ligaments. Research in the arena of using adult stem cells (not from embryos, but from the patient) has blossomed. This technique (see the first link in the above paragraph) allows for much less downtime than surgery and also allows the patient to remain active while the ligaments are healing. In addition, it’s believed that this more physiologic repair reduces the risk of over tightening the ligament.

For more information on these ligaments, see below:

The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are the primary restraints to front and back motion of the tibia on the femur. The femur (thigh bone) sits on top of the tibia (shin bone), and the knee joint allows movement of the mid leg. Without ligaments to stabilize the knee joint, the joint would be unstable and prone to excessive wear and tear and loose much of it’s bio mechanical advantage. The ACL and PCL prevents the tibia from sliding too far in the font-back direction. The ACL and PCL also contribute stability to other movements at the joint including rotation at the knee joint. The other major ligaments of the knee are the medial and lateral collateral ligaments (MCL and LCL, respectively).

What happens when there is an ACL or PCL injury?
When an ACL injury occurs, the knee becomes unstable. The ACL injury is a concern because this instability can make pivoting movements difficult, and it may make the knee more likely to developing arthritis and cartilage injury.

Why are ACL and PCL tears a big problem with daily activities?

When the knee is unstable, patients complain of a feeling that the knee will ‘give out’ from under them. When this “giving way” is because of an ACL injury, the knee joint is sliding around too much. This can be a problem because each occurrence of instability (the ‘giving way’ feeling) can lead to damage to the knee cartilage. Therefore an ACL or PCL injury can make a patient more likely to develop knee arthritis and meniscus tears.

December 13, 2008

Ligament Injuries in Elbow

There are several ligaments that help support the elbow and a host of tendons that also help support the joint.  The collateral ligaments are the main structural support and act like duct tape that holds the elbow together.  Ligament injuries in elbow are very similar to other areas such as the ankle.  They can be caused by repetitive use or trauma.   While many heal, some do not.  Surgery for this condition can be difficult, as sewing damaged ligaments may or may not result in a good physiologic reapir.  The problem is that many times, the repair will either be tighter or looser than the original.  If the repair is not at the right physiologic tension, then the joint can be beat uo by the extra force and degeneration in the joint can increase.  I have several patients that are young and in this category.  They had a ligament repair that regrettably ended up too tight and now in their 20’s and 30’s the joints are wearing out. 

Is there a better way to treat a partial elblow ligament tear?  Yes, injecting the patient’s own stem cells into the ligament tear can help that ligament heal.  This way, the body sets the right level of tension in the ligament, more like a natural ligament repair.  For more information on this new procedure, see the link above.

Create a free website or blog at WordPress.com.