Sunday, September 14, 2014

Kobe returns to Germany for another Knee Arthritis Treatment
Kobe Bryant returned to Germany this past week to be treated with a blood derived treatment (Orthokine) again for his knee.  He has had this treatment in the past at least twice before.  It involves drawing blood and incubating it over a 24 hour period and then reinjecting a component of blood that has anti-inflammatory properties.  It is similar but not exactly the same as platelet-rich plasma therapy.  It would be most interesting to learn about how this has helped him over the years and in what specific ways. He clearly has thousands of miles of basketball on his knees and is also recovering from multiple other injuries.  We do not, however, have any data about the status of his knee cartilage or joint before or after any of these treatments.  Here is a detailed description of the "Orthokine" treatment.  

Kobe has with his travel and his wallet voted in favor of this treatment.  It will be quite interesting to see how he plays this year in the NBA.   It will also be instructive to follow Kobe's future medical interventions as a way of measuring the value of the one he just had in Germany.

Tuesday, September 09, 2014

Biologic Orthopedics, Forbes, Sports Illustrated and ESPN

This week the Rothman Institute in Philadelphia has organized a meeting dedicated to exploring biologic orthopedics and sports medicine in a unique format.  The group has invited researchers and clinicians from around the world to participate with elite media representatives from Forbes, Sports Illustrated, and ESPN among others.  Dr. Noriyki Tsumaki from the the 2012 Nobel Prize winning CIRA Center in Kyoto Japan will also be lecturing.  Discussion about the FDA regulation and economics of biologic orthopedics will also occur.

Stem Cell and Biologics in Sports Medicine Summit

The meeting represents a special opportunity to bring together a unique group of individuals that are interested in how to best treat tendonitis, arthritis and other orthopedic conditions with stem cells, platelet rich plasma and other biologic therapies.  The moderators of the scientific panels will be editors from world renowned publications.  I expect to have spirited discussions about the state of the art in 2014 in addition to perhaps identifying novel pathways that lead to transformative treatments for professional, collegiate and weekend warrior athletes.

I will report my finding in this space and will tweet out real time information via:  @BloodCure


Monday, September 01, 2014

Why patients are seeking out platelet rich plasma and other biologic treatments.

Platelet rich plasma (PRP) and adult stem cell treatments derived from bone marrow are rapidly evolving into the mainstream of medicine.  As you can see from the chart above, the number of hits for "platelet rich plasma" is rising dramatically.  There are also over 7400 PRP references on  Let's explore why.

Patients are seeking out less invasive treatments.  When presented with the option of surgery or an office procedure, patients typically will choose the office procedure.  Surgery often carries significant more risk and certainly more cost.

Patients want to return to sports, work or life as quickly as possible.
Botox and Lasik eye surgery provide patients with almost immediate improvement for wrinkles and vision.  Patients now expect other specialities to deliver similar almost instantaneous success.   Elite athletes are especially interested in returning to the highest level of function as quickly as possible.  They have been one of the primary drivers of PRP and other biologic treatments.

Patients are dissatisfied with the surgical treatments we have been offering them.
This is particularly true when it comes to knee arthritis.  Presently, there is very little definitive evidence supporting the use of many common treatments and there is a Grand Canyon size hole in our ability to effectively manage tens of millions of patients.  Biologic therapies will likely fill this void within the next five years.

Patients intuitively understand the regenerative abilities of your own blood and bone marrow.  Evidence is mounting across a several specialties supporting the use of blood and bone marrow to treat a variety of conditions.  A new study will begin this fall evaluating the utility of giving Alzheimer's patients blood transfusions from healthy volunteers under 30.  (Stanford Blood-Alzheimer's study)

Patients are willing to be treated without perfect supporting data.
Patients do not often understand the need for large clinical trials and are impatient with the time and effort it takes to generate meaningful clinical data.  The use of their own blood (PRP) or bone marrow simply make sense to them and they are willing and often eager to try a new treatment instead of undergo surgery.

We are presently scrambling to figure out how to develop, execute and pay for the clinical trials needed to best understand how to utilize biologic orthopedic therapies.  The good news is:  hundreds of clinicians, researchers and medical device professionals are working diligently on dozens of new treatment options.

Please post any comments about why you may think patients and clinicians are using PRP, stem cells or other biologic treatments.

AM   (@BloodCure on Twitter)

Friday, August 08, 2014

Billion Second Challenge

“Billion Second Challenge” 
How would I live if I treated every second as precious? 

This is a post about time, not regenerative medicine.

A shiny crimson card was waiting in my snail mail pile when I returned from a special birthday vacation.  I actually had to Google “AARP” to confirm the acronym stood for “American Association of Retired Persons”.  Did this new piece of bloody colored plastic mean I am now “retired”?  Or, did it simply confirm I am officially old and beyond the highly desirable 18-49 demographic?

I quickly picked a number out of the air and said to myself, I’ll make it to 85 years old.  That would mean I have about 35 years left. That is 12,775 days, 306,600 hours, 18 million minutes or about 1.1 billion seconds.  It turns out the Social Security Actuarial Life Table pegs my remaining time at 29.45 more years or about 928 million seconds.  I, therefore, averaged the two numbers and came up with about one billion seconds left on the planet.

To sharpen my time focus, I have started measuring how I spend my seconds.  Each 1000 seconds equals about 17 minutes.  Each 10,000 seconds equals about 3 hours.

Simply measuring how you spend your seconds, much like calorie counting, will alter your behavior. 

How would I live if I treated every second as precious? 

Perhaps you have more or less seconds left in your life than me.  Carefully consider how you spend them.  

I call it the Billion Second Challenge

Post suggestions about how to best spend your next hundred, thousand, million or billion seconds and please share this post with your connections.

Thursday, August 07, 2014

Golf, Back Pain and Disc Surgery

Tiger Woods had to withdraw from a golf tournament last week and is struggling as he starts the PGA championship today.  Just now, Matt Kuchar, another elite professional golfer had to withdraw from that same major tournament.

Hopefully, he won't have to have micro disc surgery.  See video of that procedure below.

The surgery can be quite successful.  We still, however, need better ways to prevent spinal disc degeneration especially in elite golfers.


Wednesday, August 06, 2014

Biologic Orthopedic Society crosses over 2500 Member Mark

The Biologic Orthopedic Society (BOS) is a group of professionals dedicated to the research and development of biologic treatments for musculoskeletal injuries and disorders.  This group has now grown to over 2500 members worldwide.  Much of the group's focus has been on the use of platelet rich plasma, stem cells and bone marrow concentrate (BMC) for tendonitis, arthritis and degenerative spinal disc disease.

The growth of the Biologic Orthopedic Society (BOS) is a testimony to the rapidly rising interest in biologic solutions to difficult musculoskeletal problems.  Significant progress has been made in terms of better published data supporting the use of biologic therapies in the last 2-3 years.  Clearly, more information and research is still needed.  As the group continues to grown, more and more connections are being made.  Ideas and projects are advancing.  All of this should give hope to those patients in search of better treatments.  Many hard working professionals are striving to deliver better biologic options.  

I'll predict within another 5-10 years, we will be staggered by how much will be accomplished.

Thanks to my many colleagues and friends within the BOS for a fantastic journey so far.

If you are a professional working in the area, please consider joining the group.  

Sunday, August 03, 2014

Hamstring Injuries Treated with Platelet Rich Plasma Return to Play Faster than Rehab Alone

Hamstring muscle injuries are very common in a variety of sports including track, soccer, football and basketball.  A recently published study in the American Journal of Sports Medicine (AJSM) found athletes that were treated with platelet rich plasma (PRP) injections returned faster to their sport when compared to rehabilitation alone.  In the study, the PRP patients returned at an average of 26.7 days compared to 42.5 days in the control group (P = .02).  (reference) This greater than two week difference in time to return to play after this common injury is clinically and competitively important.

Another recently published in the New England Journal of Medicine (NEJM) found no difference between PRP injections (2 injections spaced about a week apart) and a control group.  Interestingly, both groups in this study returned to play at 42 days, very similar to the control group in the AJSM study.  (reference)

Why are these results conflicting?

One important difference between the two studies is the type of PRP used to treat the patients.  In the study that did show a difference, white blood cell enriched PRP (leukocyte enriched PRP) was used.  In the study that did not show a difference, white blood cell  poor PRP (leukocyte poor PRP) was used.  This is a clear example of why PRP formulation matters.

The data published in elite, peer reviewed journals suggests leukocyte enriched PRP helps return athletes more than two weeks faster than rehabilitation alone after an acute hamstring injury.  No difference in return to play can be expected if leukocyte poor PRP is used in this patient population.

As PRP and other cell therapies continue to evolve, it will become increasingly clear that formulations much match indication.  Patients, researchers, and clinicians need to realize not all PRP is the same.


Sunday, July 20, 2014

QuadCrunch (TM) The Best Exercise for Your Knee

Quadriceps (Quad) muscle activation is crucial for both athletes and patients.  It is the foundation of any knee muscle development plan or rehabilitation protocol.  Too often neuromuscular activation is ignored or incompletely addressed.  

The QuadCrunch exercise is a simple and effective way to enhance muscle activation and to increase muscle tone.  If executed consistently, the entire quadriceps muscle and especially the VMO (Vastus Medialis Qbliqus) will be more functional.  

The QuadCrunch can be done alone or in combination with a variety of other leg stretches and exercises.  It can be done to simply improve knee strength or it can be used for patients with a variety of knee related problems such as arthritis, kneecap instability, tendonitis or after surgery.  

The video below outlines how and why the QuadCrunch can help both athletes and patients.

QuadCrunch Video
Try a set of 3, Hold for 5 Seconds Each, 5 Times per day

Please share this post with anyone who would like to enhance their knee function and post any comments below.


Please do not start any exercise program without consulting your physician first.

Wednesday, July 02, 2014

Fat Stem Cells help Knee Arthritis

Knee Arthritis is a very difficult problem to solve.  Millions of patients suffer daily from this progressive disease state.  A variety of novel biologic therapies are in development.

Stem cells can come from a variety of sources including your own fat.  These cells are known as adipose derived stem cells.  A recent study from Korea suggests there is value using this type of cell for knee arthritis.  Researchers gave patients escalating dose of the cells and found the high dose resulted in improved pain and function scores.  They also found the cartilage defect defect size decreased while the volume of cartilage in the knee increased.

Fat Derived Stem Cells

This data is encouraging and will need to be repeated prior to broad clinical use.  (See abstract below)

For patients with this problem, the horizon is bright with many potential options like stem cells from your own fat.


 2014 May;32(5):1254-66. doi: 10.1002/stem.1634.

Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial.


Mesenchymal stem cells (MSCs) are known to have a potential for articular cartilage regeneration. However, most studies focused on focal cartilage defect through surgical implantation. For the treatment of generalized cartilage loss in osteoarthritis, an alternative delivery strategy would be more appropriate. The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee. The phase I study consists of three dose-escalation cohorts; the low-dose (1.0 × 10(7)cells), mid-dose (5.0 × 10(7)), and high-dose (1.0 × 10(8)) group with three patients each. The phase II included nine patients receiving the high-dose. The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 6 months. Secondary outcomes included clinical, radiological, arthroscopic, and histological evaluations. There was no treatment-related adverse event. The WOMAC score improved at 6 months after injection in the high-dose group. The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage.

Tuesday, June 24, 2014

Platelet Rich Plasma Helps for "High" Ankle Sprains

"High" ankle sprains are significant injuries that typically result in prolonged recovery and time away from sports.  This type of injury involves the strong ligaments that connect two of the major bones of the ankle.  They are also known as syndesmotic injuries.

A recent randomized, controlled trial found that athletes that were treated with ultrasonic guided injections returned to play faster and has less pain than a control group.  Return to play was almost 20 days faster for the PRP group.  (40.8 days vs 59.6 days, p = 0.006)  (See abstract below)

This data supports the use of PRP for athletes with this type of injury.  Further studies will help confirm this value.


 2014 Jun 18. [Epub ahead of print]

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.



Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.


Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.


All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.


Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.

Sunday, June 08, 2014

Biologic Orthopedic Update from Las Vegas

The TOBI biologic orthopedic meeting this past weekend in Las Vegas was simply outstanding.  Dr. Steve Sampson put together an excellent collection of lectures and then followed by an impressive ultrasound anatomy session by Dr. Jay Smith from the Mayo Clinic.   Hands on injections and bone marrow aspiration in a cadaver lab completed the stellar conference held at the Red Rock Resort.

Las Vegas Red Rock Area

Some highlights of the sessions.  We heard about the use of PRP in soccer players from Dr. Imtiaz Ahmad from London, England, the use of PRP for osteoarthritis from Dr. Brian Cole from Chicago, the use of adipose-derived stem cells for the treatment of knee osteoarthritis from Dr. Yun Choi from South Korea, minimally invasive techniques for articular cartilage damage from Dr. Neil Ghodadra from Los Angeles and the Andrews Institute Experience using Biologics to Accelerate Healing from Dr. Adam Anz.   Lectures about hydrodissection using ultrasound (Dr. Lam, Hong Kong), the current landscape of disc regeneration challenges and promises (Dr. Bae, Los Angeles) and the value of mesenchymal stem cells (Dr. Caplan, Cleveland) were also given.  That was just part of day one of the conference.  Day two included several more interesting and important lectures.  I think there were over 300 attendees and many more following the streaming video (including myself on day one).  In between the lectures, discussions were carried out in the hallways and exhibit area.  Overall, it was a fantastic international event.

The field of biologic orthopedics is exploding.  Worldwide interest in minimally invasive techniques to treat challenging musculoskeletal problems is rising rapidly.  It will still take time, effort and some luck to discover and develop clinically meaningful treatments.  The good news is, progress is definitely being made toward these lofty goals.


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