Wednesday, November 28, 2007

Superkids Charity

A friend of mine back in NY told me about a wonderful charity. Her brother and sister in law (Stephen and Janet Fink) started this organization after they adopted their daughter from China.

Superkids is a non-profit organization that sends physical therapists and volunteers to the Shanghai Children’s Home. They work directly with the children, donate equipment to the orphanage, and work in partnership with the orphanage staff to incorporate easy, fun therapeutic exercise games in the children’s daily routines. These kids range in age from infant to teen and their medical problems range from minor to serious. Most of the children have mild and routinely correctable problems such as club feet and cleft palate. More serious problems include cerebral palsy and spina bifida. Because of their medical conditions, most of these children show delays in motor and/or speech development.
Special needs orphans are also called "waiting children." Their age and medical conditions make them difficult to place. They wait longer to find homes. Many are never adopted.

Janet and a group of occupational therapists returned from Shanghai 3 weeks ago and met four teen orphans with spinal cord injuries. She has been trying for months to get them the appropriate wheelchairs.

Wheelchair companies will not donate or give discounts. Charities that can donate wheelchairs do not have the appropriate type of chair. These teens are already starting to develop scoliosis and breathing problems because they are not in good chairs. They have found a company that will make good, pediatric wheelchairs for only $3,000.

They are trying to raise money to purchase chairs for all four teens. If they can raise the money and have the chairs shipped to the orphanage, Janet will go to the orphanage in china with the therapists to make sure that the chairs are fitted properly to these children.

Please spread the word about these terrific kids and their need for good wheelchairs. If anyone is interested in making a donation, log on to the Superkids website

Sunday, November 18, 2007

New Article on Osteoarthritis and Platelet Rich Plasma

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A European Study from Oct 07' by Anitua & Sanchez et al. injected 10 osteoarthritic patients with PRP & studied the cellular effects of PRP. They found an increase in hyaluronic acid concentration, balancing cell proliferation (angiogenesis). However, there was no effect on IL 1-B, which generally plays a role in osteoarthritis. This information gives us insight into how PRP may potentially benefit arthritis.

Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients

It's important that we better understand the mechanism that PRP may potentially benefit arthritis. New insights may direct more specific treatments in the exciting realm of Biologics.

Autologous Blood Use in Horse Osteoarthritis

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Another subset in "biologics" is the use a (ACS) Autologous Conditioned Serum. This treatment primarily used in Europe, invlolves production of a substance known as IL-1Ra that attacks the effects of arthritis. While this specific treatment is not approved in the U.S., similar treatments using PRP (Platelet rich Plasma) are being used here to address knee arthritis.

A recent study from Colorado State University published in The American Journal of Veterinary Research; demonstrated significant clinical improvements of Horse osteoarthritis affected joints with ACS compared to placebo.

The process like PRP, involves drawing blood and spinning it down in a machine called a centrifuge. However, afterwards the blood is incubated at 37 degrees Celsius for 24 hours. The serum is then frozen until use.

This system, is used throughout Europe in professional race horses to treat arthritis. Also, it is used in Dusseldorf Germany on humans for osteoarthritis.

We are using a modified treatment performing a series of 3 PRP injections into the human knee joint under ultrasound guidance at 3 week intervals. We will be reporting on our findings.

Thursday, November 8, 2007

U.S. Professional Soccer Athlete Injected with Platelet Rich Plasma

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In addition to chronic (long term) injuries, Platelet Rich Plasma is being applied to the high level athlete to accelerate recovery. Numerous professional athletes have received PRP for a common knee injury, an MCL (medial Collateral Ligament) sprain. While I'm not an elite athlete by any means, I received a similar injection following a surfing accident. I just ran full speed tonight without any limitations, now appx 9 wks post injection.,1,3735874.story?coll=la-sports-chivas
Another athlete was injected by myself & my colleague Mike Gerhadt MD. This positive outcome was reported on CBS Evening news with Katie Kouric.

Bone Marrow Aspirate, Using Adult Stem Cells To Treat Osteoarthritis

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Platelet Rich Plasma provides a potent delivery of the body's healing properties, called growth factors. However in some patients with severe cartilage loss and less viable cells, a stronger pool of healing properties lies in obtaining adult "mesenchymal stem cells" from the hip (iliac crest). In this procedure, Bone marrow is taken from the hip and like PRP is prepared for injection into an arthritic hip or knee. While further studies are needed, preliminary reports are encouraging. PRP is probably a more reasonable first line treatment, given it's ease of use. However particularly challenging cases may consider the marrow application. A blog on bone marrow aspirate is:

Thursday, November 1, 2007

American Academy of Orthopedic Surgeons New Article on Biologics

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"Orthobiologics" or "biologics" are quickly becoming recognized amongst the sports medicine/orthopaedic community as one of the fastest growing industries with tremendous potential. Merging our understanding of how the body heals itself with cutting edge modern technology, we are developing exciting alternatives to standard care.

In the Sept 07 AAOS (American Academy of Orthopedic Surgeons) Now Magazine, there was an article discussing this very subject matter. "Biologics in sports medicine: from BMPs to bone formation."

The article describes this Field of "biologics" and cell based therapies to create new approaches to treating old injuries. Tems introduced include BMP (bone Morphogenic Protein and mesenchymal stem cells). These may be paramount to facilitating healing in various injuries including rotator cuff cuff tears in the shoulder and knee arthritis and meniscal tears. As the community of "babyboomers" and recreational ahletes grow, we are seeing younger patients with cartilage injuries that are too young (<60) years for knee replacements. Thus biologic solutions provide promise in this population base.

At my practice, Santa Monica Orthopaedic & Sports Medicine Group we are beginning to treat patients with knee arthritis with a series of PRP injections. I have been corresponding with Physicians from Bologna Italy to learn from their early experiences as well. There is a link to their data on my blog. We are conducting outcome studies on the many patients we have injected for various injuries. Furthermore we hope to perform a knee arthritis PRP study in the near future. In general we are seeing tremendous outcomes in patients that have failed conservative treatments and were considering surgery or activity modification.

New Platelet Rich Plasma Article in the American Academy of Orthopaedic Surgeons Now Magazine

As PRP use is increasing, we are seeing more articles surfacing discussing it's potential benefits. In a monthly publication for orthopaedists, the AAOS (Amer Academy of Orthopaedic Surgeons) released an article titled "Clinical use of Platelet-rich plasma in orthopaedics."

In general, the article familiarizes the reader with the science behind it's uses and advocates is use in soft tissue and wound repair, while cautioning it's application in bone grafting. Once again, further research is encouraged.