REGENERATIVE MEDICINE

Regenerative medicine involves helping the natural healing process of the body repair and regenerate injured or degenerative tissue. For cartilage, tendon and ligament injuries, a combination of stem-cell treatments and platelet-rich plasma injections can be used for regeneration of theses damaged tissues and accelerate healing time.

• Stem-Cell Techniques

Stem-cells are immature or undifferentiated cells that can transform into various mature cell types. In Orthopedic Surgery, stem-cell treatments can be used to stimulate healing and replacement of damaged tissues that might not normally heal. This includes cartilage, ligament, and tendon structures. Each person has a supply of stem-cells in their periosteum(tissue covering bone) and their bone marrow. These stem-cells can be harvested and transported to the area of tissue damage that needs help to repair.

• Platelet-Rich Plasma

A concentrated mixture of growth factors can be obtained by centrifuging blood. These growth factors can be injected or surgically incorporated into damaged tissue to accelerate a healing response. Common conditions which may benefit from this treatment include: tendonitis/tendinosis, tendon tears, ligament tears, fasciitis, and bursitis.

BIOREGENERATIVE KNEE SURGERY

Bioregenerative knee surgery is the surgical intervention to optimize arthritic knee function with the restoration of cartilage function, ligament stability, and knee alignment without artificial joint replacement. Many active individuals do not want to go down the path of artificial joint replacement if there is another alternative. Bioregenerative knee surgery involves restoring the optimal anatomy and function of the knee with the following techniques:

1. Cartilage Regeneration and Restoration

Both meniscal cartilage and articular cartilage is damaged in the arthritic knee. These cartilage structures act as shock absorbers in the knee and must be restored to regain knee function. Cartilage regeneration can be stimulated with stem-cell transplants from periosteum combined with the addition of concentrated growth factors from the patient’s own body. If the meniscus cartilage is destroyed, a meniscal transplant can be performed.

2. Ligament Stability     

Normal knee function requires stability from the knee ligaments. Arthritic knees often have instability from damaged or stretched ligaments and these structures can be repaired or reconstructed to provide normal knee stability. Common ligament injuries include the anterior cruciate ligament, posterior cruciate ligament, medial and lateral collateral ligaments and the patellofemoral ligaments.

3. Alignment Restoration

Most arthritic knees have a component of malalignment. This malalignment causes uneven wear and tear in the knee joint and needs to be restored to normal. Alignment can be restored with shoe modifications, bracing or an osteotomy which involves a bone cut. Special radiographs are needed to measure knee alignment.

ACL TREATMENTS

The anterior cruciate ligament(ACL) is a major stabilizing ligament of the knee. When the ACL tears, it will not heal and the knee develops instability which can lead to further joint injury. ACL treatments involve the following options:

1. Ligament Repair

In some acute ACL injuries, there may be enough healthy ligament tissue to stitch together and reattach. This is not common, but when this repair is possible, an excellent outcome can be obtained preserving the patient’s normal anatomy.

2. Single-Bundle Reconstruction

The torn ACL is replaced with a new bundle of tissue obtained from a different part of the knee or from donor tissue. Each graft type has specific advantages and disadvantages that can be reviewed for each patient to determine the best option. The body heals in the new graft and makes it a ligament.

3. Double-Bundle Reconstruction

The torn ACL is replaced with two bundles of tissue. The normal ACL is actually composed of two bundles of tissue. This technique attempts to restore the normal ACL anatomy. It involves more graft tissue and more surgical intervention so Dr Rupp reserves this technique for revision ACL surgery and patient’s with severe knee instability.

4. Hybrid Tissue-Preserving Technique

The optimal ACL reconstruction involves preservation of as much of the patient’s original ACL fibers as possible. Dr Rupp is often able to combine a single-bundle reconstruction with stitching of the original ACL fibers to the graft. This allows the healed ACL to retain balance receptors and function as normal as possible.

Anyone considering ACL surgery should be confident that their treatment is specific to their injury. One size does not fit all in ACL surgery. Your surgeon should have a variety of techniques and procedures available at the time of surgery to customize the treatment that is best for you. 

MENISCUS TRANSPLANTATION

The meniscus cartilage functions as a shock absorber in the knee and protects the articular cartilage which covers the bone in the joint. Unfortunately, the meniscus is often injured in impact and twisting trauma to the knee. If the meniscus is severely injured it may not be amenable to repair and the protective function of the meniscus is lost. In these circumstances, knee arthritis may develop. The knee meniscus can be replaced with an uninjured donor meniscus from a tissue bank. After the transplanted meniscus heals into the knee, the protective function of the meniscus is restored.

ARTICULAR CARTILAGE REGENERATION

Articular cartilage is the protective cartilage covering the bone surfaces in the joint. This cartilage does not have a natural healing response if it is injured. Surgical and injection techniques can be used to stimulate the regeneration of injured articular cartilage:

1. Microfracture

The bone underlying an articular cartilage injury can be penetrated with small awls or wires to cause bleeding and a healing response. The bleeding in the base of this cartilage lesion can form scar tissue cartilage. Unfortunately, this scar tissue cartilage is not as effective as the original articular cartilage for protecting the joint.

2. Autologous Chondrocyte Implantation

A biopsy of articular cartilage can be taken from the knee and these cartilage cells can be grown in a lab for later implantation into the articular cartilage injury. This procedure attempts to restore the normal articular cartilage composition without any scar tissue cartilage formation.

3. Stem-Cell Periosteal Transplants

Stem-cells can regenerate cartilage tissue and they exist in our body. The tissue covering our bones is called periosteum. This fibrous tissue has abundant stem cells and can be harvested for use in cartilage injuries. The periosteum stem-cells can be transplanted into cartilage lesions through arthroscopic and open surgical techniques. The healing response of these cells can be stimulated further with concentrated growth factors.

ROTATOR CUFF REPAIR

The rotator cuff refers to a set of shoulder muscles which arise from the shoulder blade (scapula), and insert in the shoulder joint (humeral head). These muscles help control shoulder motion and strength. The rotator cuff is commonly injured with lifting activities or falls. The rotator cuff tendons can tear and cause persistent shoulder pain and loss of shoulder function. If the tear is full-thickness, operative repair is needed to allow healing of the injury and restoration of painless shoulder function. Repair techniques include:

1. Arthroscopic Repair

A rotator cuff tear can be repaired arthroscopically through small openings as an outpatient procedure. This involves reattachment of the torn tendons so healing can occur.

1. Double-Row Repair

The rotator cuff tendons normally attach to the humeral head over a broad insertion area. To restore the normal anatomy, two rows of fixation or repair are required to reattach the torn tendons. Traditional rotator cuff repairs involve only one row or point of fixation.

1. Revision Rotator Cuff Repair

Sometimes a rotator cuff repair does not heal. If this has occurred, it is important for the treating surgeon to review all possible reasons and be prepared to treat any circumstance if a repeat repair is considered. Failure of the rotator cuff to heal is often multifactorial. Dr Rupp has successfully used stem-cell periosteal transplants to improve healing rates for rotator cuff repairs.

HIP ARTHROSCOPY TO AVOID HIP REPLACEMENT

Hip arthroscopy is a procedure to treat hip disorders through minimally invasive surgery. Small skin incisions allow placement of a camera (arthroscope) into the hip joint to treat injury. A common source of hip pain is arthritis. Most people who develop hip arthritis have bone changes in the hip that cause impingement. Impingement is caused by bone spurs or abnormal bone formation and this impingement injures the hip causing cartilage breakdown that leads to hip arthritis. If the hip impingement is treated before major cartilage injury occurs, then hip arthritis and the need for a hip replacement can be avoided. Hip arthroscopy allows remodeling of the abnormal bone in the hip so the impingement is removed. Any associated cartilage injury such as a labral tear can be treated simultaneously. Hip arthroscopy is an outpatient procedure.

Click here to view our Hip Arthroscopy Brochure

Click here to view our Hip Replacement Brochure

ANTERIOR HIP REPLACEMENT

Dr Rupp offers patients with hip arthritis the option of an anterior hip replacement. An anterior hip replacement is performed from the front of the hip joint and has several advantages over the traditional posterior hip replacement. The anterior approach is a minimally invasive surgery that separates muscles instead of cutting them. This allows a faster recovery from hip replacement surgery with less pain and scarring. The anterior hip approach does not destabilize the posterior hip ligaments so there are fewer activity restrictions after surgery and sitting or bending positions are not discouraged. A special robotic table is used to assist with this type of surgery.

HIP ARTHROSCOPY VIDEOS

• Hip Arthroscopy Bone Grafting an Acetabulum Cyst
• Hip Arthroscopy Labrum Reconstruction
• Hip Arthroscopy Sciatic Nerve Decompression
• Hip Arthroscopy Iliotibial Band Release and Trochanteric Bursectomy
• Hip Arthroscopy Excision of Heterotopic Ossification
• Hip Arthroscopy Acetabuloplasty Without Labrum

KNEE ARTHROSCOPY VIDEOS

• Knee Arthroscopy Double Bundle ACL Reconstruction
• Knee Arthroscopy Isolated Anteromedial Bundle ACL Reconstruction

SHOULDER ARTHROSCOPY VIDEOS

• Shoulder Arthroscopy Treatment of Snapping Scapula