Like many heliskiers, we’re always looking out for the best therapy for knees that have seen a few too many bumps, needles or scalpels. I am not a doctor, although I heliski with them. So, please do not consider any of the following to be medical advice.
Dr. Chris Centeno is pioneering the use of regenerative treatment of joints using stem cells. The innovative Regenexx(TM) procedures are performed at The Centeno-Schultz Clinic in Broomfield, CO (north of Denver) and in Grand Cayman, as well as a network of clinics across the U.S. Our interview follows, although some answers are paraphrased, sorry Doc.
Regenerative Knee therapy
It sounds like Luke Skywalker growing a new hand in Star Wars. Can you give us a brief description of it, please?
The Regenexx SD, or “same day” procedure, uses your own stem cells to regenerate lost tissue (cartilage, disc, bone, meniscus, tendon/ligament). The procedure consists of a bone marrow draw from your hip (which is totally, completely numb). We then isolate your stem cells from that marrow sample, and do anywhere from 1-3 injections back into the joint, depending on the procedure.
What can you treat with my stem cells?
Our Regenexx procedures can be applied to fractures that have failed to heal, joint cartilage problems, partial tears of tendons, muscles, or ligaments, chronic bursitis, avascular necrosis of the bone, and lumbar disc bulges. We are an orthopedics-based clinic, and we do not treat any other problems outside of bone, tendon, muscle, joint, or ligament issues.
What knee maladies can you treat with it?
The Regenexx knee treatments are for people suffering from knee pain due to common injuries or other degenerative problems.
If you have encountered an injury to the knee’s meniscus, ACL or MCL, cartilage or have chronic knee paindue to a past injury or osteoarthritis (also known as “degenerative joint disease” or “wear and tear arthritis of the knee”), you may be a good candidate for the Regenexx procedure.
Knee Pain (I couldn’t resist an image)
Traditional options for patients suffering from these issues include arthroscopic knee surgery to repair ligament tears, or total knee joint replacement. With both surgeries, months of rehab are required, and the patient must be aware of and prepared to take on the risks of other possible side effects including infection.
In general, is Regenexx SD better for acute or chronic conditions?
Typically, Regenexx SD is best suited for sub-acute and chronic injuries. Many of our patients have already had one or two surgeries and may have been dealing with their injury for more than 15 years.
How long does it take to see results?
Most of our patients notice improvement in as little as six weeks. By 12 weeks, most can return to their normal, active lifestyles.
How long before the patient can resume exercise after Regenexx SD?
Patients may resume low impact exercise, such as cardio, immediately following the procedure. A full return to their “normal” work-out routine usually occurs around week 12. So, unlike surgery, there is no weakening of the muscles prior to recovery. In 12 weeks, patients can resume all activity (even bumps!).
How long do the effects of the procedure last?
We have many patients that had their procedures done 7 years ago and counting. Some patients require a second or third treatment a year, two years, three years after their original procedure. However, most are good to go with one treatment.
How many knees have you done?
A lot! We’ve performed the Regenexx stem cell procedures on more than 1,000 knees.
Who is your typical patient?
The same people that use HELISKI.com to find the best helicopter skiing trips are our patients. (Thanks, Doc.) Our patients tend to be active individuals in their mid-30s to mid-60s with one or two prior knee surgeries. They are usually athletes who want to maintain or return to that active lifestyle. Often they have been advised to get a knee replacement or another surgery; and they are looking for alternatives.
What’s the status of FDA approval?
For same day (Regenexx SD), it’s exempt, and therefore not regulated. For cultured procedures (Regenexx C), it is not approved in the U.S, so we have a clinic in the Caymans.
Unfortunately there is no CPT code for the Regenexx procedures. We are the only providers in the U.S. who do this, and typically the American Medical Association needs tens of thousands of doctors performing the procedure before creating a CPT code.
What’s the difference? (Who gets a trip to the Caymans?)
Regenexx C, our cultured procedure, takes your own stem cells and then essentially supercharges them in a lab over several weeks (grows them to much greater numbers) which allows for greater improvement to the joint or ligament. It’s used for severely arthritic knees and other joints and is performed in our clinic on Grand Cayman.
What does Regenexx cost?
Approximately $4K for most procedures done the same-day and much more for cultured procedures.
Does insurance cover the procedures?
No, but we’re finding that the costs are in line with the high deductibles for surgery, so our pricing is very competitive. Editor’s note: It costs less than a week of helicopter skiing.
Does Regenexx also work for chondromalacia petal, ACLs, and meniscus tears?
Yes on all counts. We’re based in Colorado and because of our proximity to Summit/Eagle County and the like, we have treated a lot of skiers. Regenexx can repair partial tears and reconstruct ACLs and, in the case of meniscus tears, Regenexx may be more effective than removing the torn pieces, which also removes the cushioning in the knee.
I have been getting a shot of Synvisc every fall. It helps for about 6 months. Am I a good candidate for Regennex?
Yes. If you respond to any vicso supplementation, it’s a good sign.
Is this the same as PRP (Platelet Rich Plasma)?
No. PRP is concentrating platelets in the blood, not stem cell therapy. Regenexx offers a more detailed discussion on the differences between PRP and stem cell therapy. In addition, while PRP is one component of the therapy, we use a very different “Super Platelet Mix’ which we believe helps to produce many more stem cells.
What’s your opinion of BMP enzymes and how it compares to Regenexx? Bone Morphogenetic Proteins are used to promote spinal fusion, but its off-label for knees. It’s also extremely expensive.
How about steroid injections? Am I limited to three shots per joint of Regenexx in my lifetime?
One word of caution about any steroid injection therapy. Steroids can degrade cartilage. There is also evidence that anesthetic shots can kill cartilage. But now it looks like anesthesia and steroids together, which is typical, have a synergistic effect. Animal studies are showing a multiplicative effect…in a bad way.
There is no limit to the number of Regenexx injections someone can receive over a lifetime
Any negative side effects?
This is a needle-based procedure so the risk of infection is significantly less than the risk when having surgery. Also, the procedure works best on healthy, fit individuals so as the old saying goes, “results may vary.” We require all of our Regenexx patients to join our registry in regards to timelines, follow ups, surveys, etc. so we can track any side-effects over the long term.
Is there anything else you would like to tell heliskiers?
We’d like them to know that we have a network of providers around the country, so people don’t have to come to Colorado For example, there is a new clinic in Mill Valley, CA. However, Colorado is a nice place to visit!
Thanks, Doctor Centeno!