TRC

Giving hope to thousands of people with Multiple Sclerosis, the Scottish Health Technologies Group (SHTG) has announced that is believes there is now sufficient evidence for it to recommend making ground-breaking HSCT available on the NHS in Scotland.Treatment would be offered to patients who have the relapsing-remitting form of the disease – where relapses last at least 24 hours – and who were not responding to treatments.Lucy Clarke from the Scottish HSCT Network said the recommendation was “a huge step forward” for people. The Scottish Health Technologies Group (SHTG) is a national health technology assessment agency. They provide evidence, support and advice to NHSScotland on the use of new and existing health technologies which are not medicines and which are likely to have significant implications for people’s care.SHTG independently examine health technologies; these might be working as an intervention, product or service developed to prevent, diagnose or treat medical conditions; or promoting health; providing rehabilitation; or organising healthcare delivery. The health technology could be a test, device, procedure or patient pathway.The assessments that SHTG carry out are multidisciplinary processes that use explicit methods to assess the value of a health technology at points in its lifecycle. The process is comparative, systematic, transparent and involves multiple stakeholders. The purpose is to inform health policy and decision-making to promote an efficient, safe, sustainable, equitable and high-quality health system. You can find out more SHTG here: http://www.healthcareimprovementscotland.org/Lucy Clarke underwent HSCT in Russia and credits it with substantially reversing her disability, she said; “This important decision supports HSCT as a treatment option where other treatments have failed. We will continue to push so that this treatment is available to people in Scotland who need it.”Scotland has one of the highest rates of MS in the world. Until now Scottish patients seeking HSCT have had to travel overseas while bankrolling their own private treatment at a cost of around £40,000 to £60,000. It is also available privately in London but costs around £100,000.Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells. Results have shown that HSCT is most effective for people with the following symptoms; With signs of active inflammation, as seen by frequent relapses alongside new or active lesions on an MRI scan; Who are early on in their disease course; WithoutThe Multiple Sclerosis Society recommends that it will mainly include people with highly active relapsing MS who are still having relapses despite taking disease modifying therapies (DMTs).If someone has progressive MS and still has active inflammation (either relapses or lesions on an MRI), HSCT may be able to stop or slow this.But HSCT can’t regrow nerves or repair damaged myelin, so it can’t help those with advanced progressive MS who are no longer having relapses and don’t shown signs of inflammation on an MRI.Researchers are working hard to find effective treatments for people with progressive MS.HSCT aims to ‘reset’ the immune system to stop it attacking the central nervous system. It uses chemotherapy to remove the harmful immune cells and then rebuilds the immune system using a type of stem cell found in your bone marrow, called haematopoietic stem cells.The stem cells used in the treatment can produce all the different cells in your blood, including immune cells. But, they can’t regenerate damaged nerves or other parts of the brain and spinal cord.https://www.mssociety.org.uk/about-ms/treatments-and-therapies/disease-modifying-therapies/hsctIain Robertson, chairman of the SHTG, said; “Our committee members were able to advise that this treatment should be considered for those with this particular type of MS who have not responded to treatment with disease modifying therapies. We hope that our advice will be of use in helping decide the best course of treatment for these patients. It uses chemotherapy to wipe out patients’ “faulty” immune systems before replenishing it with a transplant of stem cells harvested from their own bone marrow. It puts patients at high risk from infections, which can be fatal.”But the theory is that the treatment works by enabling patients to “reset” their immune system to stop it attacking the central nervous system – as is the case in MS.HSCT is not considered an effective treatment for patients with the progressive form of MS.However, as stem cells cannot regrow nerves or repair damaged myelin – the protective sheath coating nerves.It will also be unavailable to patients with relapsing-remitting MS who no longer show signs of inflammation on an MRI brain scan.Morna Simpkins, director of MS Society Scotland, said: “The decision from SHTG to approve HSCT for the treatment of MS is good news and could help in the development of a clear pathway, for people who could potentially benefit, to access it. We will push to ensure this decision leads to real change for people with MS by continuing to engage with other groups to offer the treatments, including HSCT, which are right for them.”The SHTG said eligible patients must have equal access to the procedures regardless of where they live, but it is unlikely all health boards will be able to provide it.

The feet and ankles are an extremely complex structure and many common problems can occur in this area. Indeed around 1 in 5 of all people will suffer from foot and ankle pain in their lifetime. As feet and ankles bear the full body weight and cushion all impact when walking, running, and jumping it is not surprising that injuries arise.The feet and ankles are more complicated than we think. The feet are actually made up of 26 different bones and more than 33 joints arranged in columns and arches that vary in both stiffness and flexibility. There are 3 different parts to the structure- the back of the foot (hind foot) which is made up of the heel bone and the ankle (talus).They are joined together by joints which allow the foot to move from side to side. The ankle bone is joined to leg bones at the ankle joint which acts like a hinge allowing the foot to bend up and down.The middle of the foot (midfoot) is made up of 5 tarsal bones which form the arch of the foot. Tarsal bones are connected to the front and back of the foot by muscles and the arch ligament (the plantar fascia). They also act as the shock absorbers when walking and running.The front of the foot (forefoot) is made up of toe bones which are connected to 5 long bones by joints. The forefoot takes on half of the body’s weight. Muscles in the lower leg are attached to bones in the feet by tendons which control movement. The heel bone is connected to the calf muscles by the Achilles’ tendon, which is the most important tendon for movement and where injury can often occur.Foot and ankle pain; Both foot and ankle injuries are common especially in sports persons or people who lead active lifestyles, however there are other causes that can lead to pain and damage. Pain can occur in the ankle joint itself, the heels, toe, sole and ball of the foot. Symptoms can include swelling, bruising, sharp pain between the heel and the arch of the foot, and pain when standing on tip-toes. One of the main issues in any ankle/foot injury is that if left untreated it can have a knock on effect in other parts of the foot. For example if an ankle is sprained and damage is caused to the ligaments which hold the bones of the joint together, other stressors are put through other joints in the foot as the walking gait is forced to change.Pain can mean that weight cannot be put through the foot and the shape and mechanics of the joint can actually change.There are several causes of foot and ankle pain. One of the most common is arthritis.Arthritis damages the joints and causes pain and significant inflammation. In the UK alone, more than 10 million people have arthritis or suffer from similar conditions that affect the joints.Arthritis in the ankle doesn’t gain as much attention as other joints in the body but it can take a significant toll on mobility and quality of life. Arthritis in the ankle can lead to pain, swelling, deformity, and instability in the ankle joint. Arthritis here affects the tibiotalar joint, which forms between the shin bone and ankle bone and 70% of arthritis in feet and ankles are caused by previous injury.There are differing kinds of arthritis that affect the foot and ankle. Osteoarthritis is a degenerative joint disease where the cartilage that cushions the ends of the joint wears away gradually due to wear and tear. Injury can damage the cartilage directly or change how the ankle joint works leading to deterioration over time. Post traumatic arthritis develops in the foot as a result of injury e.g a sprain, fracture, or dislocation that can lead to premature deterioration of the joint. Rheumatoid arthritis is a chronic inflammatory disease where the bodies immune system attacks itself. Standing and basic walking becomes uncomfortable.Achilles tendinopathy and tendonitis is a common overuse injury resulting in repetitive injury to the Achilles’ tendon, the band of tissue at the back of the lower leg which connects the calf to the heel bone. It causes pain and stiffness to the back of the heel and means there is an inability to move freely or play sports. This is a common injury for those who play racquet sports, football, and run. Age can also be a factor as the tendon becomes less flexible over time and less able to cope with movement. Other causes include weight, genetics, and existing medical conditions such as high blood pressure and cholesterol.Peroneal tendinopathy is common in athletes and runners and causes pain and swelling to the back of the foot and the outside of the lower leg. It can also be caused if you have a muscular imbalance or a high foot arch.Other causes of ankle pain include Plantar fasciitis – where you have pain on the bottom of your foot and around your heel, bursitis – fluid filled sacs which become inflamed, bunions, tarsal tunnel syndrome, fracture, ligament injury and ankle instability.When surgery is an option;If an ankle is fractured or arthritis interferes with its function and causes pain which cannot be controlled by traditional medication, surgery is an option.Fracture repair is the most common reason for ankle surgery. A fracture can range from a clean break to a break that means the bone is left in small pieces. The exact procedure will depend on which bone is broken and how severely. Surgery may include the placement of metal plates and screws to hold the bones in place as they heal.Total ankle replacement- ankle replacement is far less common than a hip or knee replacement. In this procedure, damaged cartilage and bone are removed and replaced with new metal or plastic joint surfaces to restore the joints function. During ankle replacement, the surgeon makes an incision in the front of the ankle , removes the damaged bone and joint cartilage, reshapes the involved bones and attaches the parts of the artificial joint. The surgeon creates a bone graft between the end of the fibula and places screws through the two bones to support and stabilise the ankle. This procedure helps preserve joint motion. Ideally patients will have good bone quality and normal tendons and ligaments. This surgery will help patients who have existing arthritis in smaller joints which would be further worsened by loss of ankle joint motion. The surgery, however, can have mixed results as risks include implant failures and is not ideal for people who have deformity or prior infections that have lead to the joint damage. The ankle joint, also because of the load going through the foot, and the amount of stress placed on it, doesn’t always fare well for the implant as they are not as good as natural bone. The surgery will preserve movement in the ankle joint but outcomes for a replacement for a weight bearing, poorly supported joint like the ankle needs a lot of surgical expertise in the operating theatre.Ankle arthroscopy is a minimally invasive surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin of the ankles. Surgeons may use this procedure to remove pieces of cartilage or bone debris from the joint space or to evaluate and repair a damaged ligament. Ankle arthroscopic repair is helpful in the early stages of arthritis in the ankle and for those with limited ankle arthritis but it is often ineffective in advanced ankle arthritis as because when a significant amount of cartilage has worn away, the procedure will not help the joint.Ankle fusion is for end stage ankle arthritis. This procedure involves surgically removing the surfaces of the joint affected by arthritis and joining the bones with plates and screws until they grow together or fuse. While the procedure leaves the ankle with permanent pain relief, it means that the ankle is left with no up and down or side to side movement at all.The surgery is ideal for those with excessive bone loss, poor ligaments, poor bone quality, or a previous infection. It isn’t always a good option for everyone as sometimes the bones don’t heal and join together and arthritis can be developed in the adjacent joints of the ankle and foot from increased stress after surgery. The patient will be pain free but not be expected to walk the same again.Ankle distraction arthroplasty – this procedure uses an external fixation or frame which is assembled around the lower leg and foot and surgically attached with pins and wires. The frame pulls the damaged joint surfaces apart and in return allows cartilage lost from arthritis to regenerate through the body’s natural healing process. This helps to preserve the joint and bone rather than replace it.Surgery risks and recovery include infection, bleeding, nerve damage, skin complications, blood clots, fat embolism, and bone misalignment. After surgery it can take up to 3-6 months for the foot to feel better but recovery will depend on the complexity of the operation. With minor surgery and simple fractures patients can be back on their feet within 4 to 8 weeks but with major surgery it may take up to a year for the swelling to go away and for movement to improve. After an ankle replacement it may not be possible to return to running or other sporting activities at all.What are the other alternatives to surgery – ankle arthritis doesn’t have a cure but there are many alternative treatments that can help which can help relieve pain and improve function.Medication are important parts of treatment – they can help slow bone loss and relieve inflammation. Steroid injections into the ankle joint can help relieve inflammation, analgesics can help with pain relief, and topical creams are good for helping with pain. Lifestyle changes can help such as exercise and healthy eating, icing, physical therapy and supportive devices can also help.Many of these injuries such as arthritis, plantar fasciitis, Achilles tendinopathy, peroneal tendon pain and ligament injury can be treated with stem cell therapy – AMPP – activated mesenchymal pericyte and plasma using Lipogems® technology and PRP therapy.PRP is an effective and well researched procedure which provides a great alternative to ankle surgery. Treatment is administered via an injection, 2-6, performed at weekly intervals and patients see improvements within 4- 6 weeks. It is a safe treatment option which uses a concentrated dosage of platelets prepared from the patient’s own blood to repair the damaged cartilage, tendons, ligaments, muscles and bones in the ankle. Activated mesenchymal pericyte plasma injections uses the bodies own adipose (fat cells) to treat the pain and inflammation immediately. The procedure takes an hour with a minimal recovery time of 3 hours. This is a minimally invasive procedure and can also be used after surgery to help aid in healing. Early results show an improvement for 75% of all patients undergoing treatment. Stem cell therapy offers a much shorter recovery time and proposes less risks than conventional surgery and also means that the patient is often up and walking the same day. A patient who had suffered from two broken legs which resulted in extreme pressure and ankle pain underwent Lipogems® treatment on both ankles and 6 months later could walk further than before and was no longer awoke at night with terrible pain.“Anyone with painful ankles should consider Lipogems®. I’m feeling very positive now about things and much happier. It means that I don’t have to have major surgery which is not without risks so Lipogems® is a much better option!” Patient testimonial.

According to a new study in the journal Science Advances, it has been found that cartilage in human joints can repair itself through a process similar to that used by creatures such as salamanders and zebrafish to regenerate limbs.Humans may not be able to regrow entire amputated limbs like salamanders can but we do have a “salamander-like” ability to regrow damaged cartilage.The study could open the door to new treatments for joint injuries and diseases like osteoarthritis and perhaps even one day in the future lead to human limb regeneration.Salamanders, axolotl, and other animals with regenerative abilities have a type of molecule called microRNA, which help regulate joint tissue repair. Humans have microRNA too, but our mechanism for cartilage repair is stronger in some parts of the body, the study found. For example, the microRNA molecules are more active in our ankles, and less active in our knees and hips.“We were excited to learn that the regulators of regeneration in the salamander limb appear to also be the controllers of joint tissue repair in the human limb,” said Professor Ming-Feng Hsueh. “We call it our ‘inner salamander’ capacity.”The study also found that the “age” of cartilage depends on its location in the body. Cartilage is “young” in the ankles, “middle-aged” in the knees, and “old” in the hips. This correlation lines up with how animals regenerate fastest at the furthest tips of their bodies, like tails or the ends of legs.These combined factors of activity level of microRNA; and the age of cartilage together explain why ankle injuries heal faster than knee and hip injuries, and there are fewer instances of arthritis in the ankle compared to the other two areas.Scientists have known for years that humans do have some regenerative capabilities, for instance, when children’s finger tips are amputated, it has been documented that the tip regrows when treated correctly.This has potentially huge implications for athletes or people with joint injuries. MicroRNA could be injected into joints or developed into medicines that prevent or reverse arthritis, the study said. In the more distant future, it could even “establish a basis for human limb regeneration.”Read the scientific paper here

Walking is Britain’s most popular outdoor recreational activity and it is also still an important mode of transport.According to Britain’s most comprehensive survey of sport and recreation participation, 9.1million adults in England, or 22% of the population, walk recreationally for at least 30 minutes in any four week period. This is almost twice the number that swim (5.6million, 13.4%), more than twice the number that go to the gym (4.5 million, 10.7%) and nearly three times the number that cycle (3.5million, 8.5%). (Source ramblers.org.uk)Walking is the joint most popular activity (along with eating out) for people taking days out in England, and the most important reason for 18% of the 3.6 billion trips taken each year. It is the main activity undertaken during 36% of countryside and 33% of seaside visits and the most popular activity for UK visitors to Scotland and Wales.Furthermore, a third of adults in Britain say walking for more than 10 minutes is their only form of exercise in a typical month.Add to this the fact that nearly all journeys involve walking, often to connect with other modes of transport and its importance in maintaining our daily lifestyle increases. 23% of all journeys in Great Britain are made entirely on foot and 75% of journeys under one mile are on foot – the average person travels 197 miles a year just by walking!The most popular reason for walking is to go shopping (21%), followed by education (including taking children to school) (20%), and leisure or social purposes (20%). 17% of walk trips are ‘just to walk’ including dog walking. It’s increasingly apparent that we all enjoy that breath of fresh air and time for reflection that walking provides.The UK Chief Medical Officer recommends adults do at least 150 minutes a week of moderate physical activity – and an easy way of achieving this is to walk for 30 minutes, five days a week. The recommendation for children is at least 60 minutes every day and preferably more. All walking is beneficial, but for the greatest benefits to heart, lungs and blood pressure, brisk walking is best making breathing a little faster and hearts beating a little faster, while still feeling comfortable and able to talk.Walking is known to improve general well-being and can help fight stress and depression. Like other physical activities, walking helps release endorphins which improve mood and reduce stress and anxiety. The extra benefit of walking as a pastime is that, unlike some means of keeping fit, it can be done alone or as a sociable activity in a group and take place anywhere, at any time with no expensive kit required!Almost everyone – the fortunate majority – is capable of walking. Only 4% of people either need help when walking outside the home or are unable to walk on their own at all. So, with all able-bodied people using their bodies in this way, it’s vital that hip, knee and ankle joints are kept healthy to be able to ensure that walking is a lifetime privilege that is never taken for granted.Accidents injuries can happen at any time and it is often the all-important joints that take the brunt of any mishap – those hips, knee and ankles are all liable to damage from the mildest incident. Yet the short or long term impact of this damage on the ability to walk comfortably should not be underestimated.Following damage to the joints, many people find that intervention is required to help restore limbs and supporting joints to previous working order and it is here that Hydrodilatation – a ground-breaking treatment recommended for joints that are painful and stiff due to the formation of scar tissue may be beneficial.In other cases, Lipogems® has been found to restore patients’ own cartilage and is a cheaper and less risky alternative to knee replacement. Alternatively, Platelet Rich Plasma Therapy (PRP) takes advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles and bones. At the Regenerative Clinic this procedure – which involves drawing blood from a patient’s vein, processing in a centrifuge machine and reinjecting into the joint – takes under an hour under the supervision of one of the Clinic’s expert medical consultants. The main aim of this treatment is to reduce pain, improve joint function and potentially slow, halt or repair damage to cartilage.So, if you’ve been taking walking for granted and suddenly find yourself in need of help to restore any aspect of your mobility, don’t suffer in silence. Take remedial action to make sure your body continues to allow you to take part in Britain’s most popular outdoor recreational activity.

Three Scientists, including one Briton, have been awarded The Nobel Prize in Physiology or Medicine for their research into how cells detect oxygen and react to ‘hypoxia’, the conditions when oxygen is low in tissues.The work is a major breakthrough into human understanding of the way oxygen works within cells and how it impacts healing and the creation of red blood cells.The three new Nobel laureates are William Kaelin Jr. at the Dana-Farber Cancer Institute in Boston, Peter Ratcliffe of the University of Oxford, and Gregg Semenza of Johns Hopkins University School of Medicine in Baltimore, Maryland.The work has led to a better understanding of how more than 300 genes in the body are regulated, including the one for the hormone erythropoietin (EPO), which controls the production of red blood cells.One of the main goals of the field now is to show that the knowledge can be used to help patients. Many drugs are being developed to alter the response of this system to treat everything from cancer to anemia.Randall Johnson of the Karolinska Institute in Stockholm, was on the prize selection committee, he said; “Applications of these findings are already beginning to affect how medicine is practiced.”Amato Giaccia, cancer researcher at the University of Oxford said; “How oxygen is sensed by both normal tissues and tumors is an incredibly important discovery that is highly deserving of a Nobel Prize. It’s a fundamental aspect of nature. Many of the genes that are turned on when oxygen is scarce are also turned on in tumor cells.”Celeste Simon, a cellular biologist at the University of Pennsylvania Perelman School of Medicine, said; “Oxygen limitation is a part of virtually all diseases, not just solid tumors or stroke, but inflammation, wound healing, peripheral arterial disease. All of these involve decreased oxygen.”Read detailed accounts of the medical theory behind the award at The New Scientist https://www.newscientist.com/article/2218951-nobel-prize-for-medicine-goes-to-discovery-of-how-cells-sense-oxygen/

Regenerating Knee Cartilage with intra – articular injections of peripheral blood stems with PRP improves clinical outcomes in knee surgery, a new 5 year study proves positive results.In this study, 20 otherwise healthy Caucasian patients were chosen who had a knee lesion which was otherwise non responsive to non surgical interventions. The patients consisted of 7 women and 13 men, aged from 21 to 47 years old. The criteria was clear – the lesion showed no improvement with non surgical treatment for up to 4 months, there was no osteoarthritis present, no systemic disease, after MRI the lesion was 8.5 -25 mm in diameter, the time between diagnosis and treatment was less than 6 months, the patient was fit for surgery, and each patient would undergo the exact same treatment by the same surgical team including anaesthetic and management of pain.The patients were chosen as all performed physical activity 5 times a week and MRI scans were taken 6 months before the operation to assess the knee condition.Professor Adrian Wilson of the Regenerative Clinic, where PRP is used, commented, “This is a great paper to promote the use of orthobiologics in knee surgery. In this paper a commonly performed operation to regenerative cartilage was carried out (microfracture). In the group which also received PRP there were significantly better results of cartilage regeneration at 4 years follow up. I’m convinced it will become standard practice to use PRP for improved outcomes for cartilage regeneration surgery and is already the standard of care for the OS and The Regenerative Clinic.”Patients with knee Chondral lesions- all patients had this common type of knee injury which shows damage to the articular cartilage, the smooth substance that covers the ends of the bones and keeps them from rubbing together as you move.Cartilage, or chondral, damage is known as a lesion and can range from a soft spot on the cartilage or a small tear in the top layer to an extensive tear that extends all the way to the bone. Sometimes a piece of cartilage can actually break off and cause damage to the cartilage and bone as it grinds into the joint.The lesions can be degenerative due to wear and tear, osteoarthritis, or due to trauma such as falling on the knee, jumping and landing, or playing a sport which requires a rapid change of direction.There are not always clear symptoms at first as there are no nerves in the cartilage but over time these lesions can disrupt normal joint function leading to pain,inflammation, and limited mobility. The lesion can then gradually worsen and cause additional problems to the joint.The cartilage lacks blood supply, so the body cannot usually repair chondral lesions on its own. Some severe tears that injure bone can promote growth of fibrocartilage , scar tissue which is a tough material that replaces missing articular cartilage but it is not as smooth as a gliding surface for the joint to articulate.To treat this injury is difficult and has proved to be an important study because of this low self healing capacity of the articular cartilage and standard health care treatments which do not consistently restore both structure and function. The cartilage in the knee only tends to regenerate with fibrocartilage and the knee itself responds poorly to mechanical stress over time.This study aimed to use typical arthroscopy procedure with PRP stem cell therapy.Arthroscopy- each patient underwent arthroscopy surgery, which is a minimally invasive procedure that allows the doctor to examine the tissue inside the knee. A thin fibre optic light and magnifying lens and tiny television camera are inserted into the knee. A few additional instruments are inserted through small incisions around the joint.For 3 consecutive days before the surgery patients received a dose of 30 MU of filgrastim each day.On the day of the surgery 450 ml of blood was obtained and centrifuged to remove coat and plasma. It was then centrifuged again to obtain PRP fraction and preserved for later use.After surgery the lesion was measured and healthy cartilage reached and the calcified plaque resected. Following the procedure 10ml of PRP was injected into the lesion. The joint was immobilised for 24 hours and injections of cryopreserved PBSC and PRP were administered into the joint once a week for three weeks. Each patient underwent the same pain management and rehabilitation protocol. The patient had to avoid loading the limb with no weight bearing for 4 weeks. Exercises were performed with only stability and flexibility in mind and patients were to avoid running and jumping up to one year after.Clinical evaluation- the IKDC or International knee documentation committee insured that visual analog scale scores were recorded before surgery, 6 months, and then 1 year after surgery, then yearly for 5 years to collect the data. They were evaluated by musculoskeletal radiologists who were blinded to the patients statistics and data so they were completely unbiased. Comparisons were made with regards to the cartilage state of repair and using a specific score system. Each year improvements were recorded and there were no infections, tumours,or synovitis reported at the end of the follow up and trial. The injections with platelet rich plasma improved these clinical outcomes for knee chondral lesions at the end of the 5 year follow up.What is PRP- Platelet Rich Plasma? This therapy is also known as Autologous Conditioned plasma. PRP takes advantage of the bloods natural healing properties to repair damaged cartilage in the knee and reduces pain, inflammation, and improve joint function.The treatment of PRP in the knee facilitates tissue healing, shows the capacity in the results for restorative healing, inflammation modulation and actual cartilage repair.PRP supports the body’s self healing processes through its own cells. Blood which is mostly made of plasma also contains solid components such as red cells, white cells and platelets. These platelets are important for clotting blood and contain proteins called growth factors which are important in the healing of injuries. With a higher concentration of these growth factors than typically found in blood,the PRP injections after the initial surgery support the restoration of injured tissue in the knee and inhibit painful inflammatory processes.This research was the first study which used clinical follow up data over more than 4 years and proves that cell therapy can promote the regeneration of articular cartilage in a lasting way. The study proved that the use of these intra articular injections of PBSCs with PRP regenerated articular cartilage improved the outcomes for knee chondral lesions.Around 85% of all patients all returned to participating in sporting activities and saw clinically significant improvements. There was no deterioration of neoformed cartilage or any reoccurrence of the lesion at the follow up 5 years appointments. The tissue was of a higher quality.Stem cell treatment is highly effective as the cells can be easily acquired and expanded, and used in cartilage injuries. In this research they have been extensively studied with promising results. They have a high capacity for self renewal, multipotentiality, and plasticity. This treatment of PRP into the knee can facilitate tissue healing, actually shows the capability for restorative healing, inflammation modulation and cartilage repair.This study has proved the use of orthobiologics in common knee surgery and that the use of PRP delivers significantly better results at the 4 year follow up.Sources:*Intra-articular administration of peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesionsPublished August 2019 https://www.thekneejournal.com/article/S0968-0160(19)30094-8/fulltext

From incessant pain, through tears and emotional farewells, Andy Murray has stumped the world in his first tournament victory since hip surgery.“This is one of the biggest wins I’ve had,” he said, notwithstanding Murray has previously won Wimbledon twice under immense pressure as a home favourite, the US Open, two Olympic gold medals, and the Davis Cup. But recognising the importance of this return to his career he ranks this lowly ATP 250 event – the lowest tier of tournament on the ATP Tour – among the most memorable and special moments in his glittering career.The two-and-a-half hour tussle with fellow three-time Grand Slam champion Stan Wawrinka ended in tears of joy. Andy Murray is a tennis champion once again. The 3-6 6-4 6-4 victory was particularly sweet because even Murray himself had been prepared write himself off forever.Simon Checkley, CEO, The Regenerative Clinic, said; “Murray is an elite athlete. We’ve followed his journey and we’ve cried with him. What is most extraordinary is the low form which is had risen. We remember seeing the pain etched in his face as he tried to perform. We shared his pain, watching him withdraw. Not all of us can be elite athletes and compete at his level but we can empathise with someone so obviously in pain and rejoice at his defeat of chronic illness.”Talk of retirement, and grand gestures from court officials, commentators and the tennis world proved to be premature. He previously revealed that he could potentially retire in January. It looked as if he would finally throw in the towel. He arrived in Melbourne a broken man. Obituaries were written after he admitted he couldn’t carry on fighting through the pain in a tearful press conference. British sport mourned the loss of its greatest tennis export. His peers, including greatest rivals Roger Federer, Novak Djokovic and Rafael Nadal, essentially retired him on court after a five-set defeat to Roberto Bautista Agut in the first round of the Australian Open.Yet, only nine months on, he has made everyone look like fools.“I think the tennis world, including me, was really sad in Australia after that press conference, defeated opponent Stan Wawrinka said. “To see you back at this level, it’s amazing. We’re all really happy. I’m sad I lost today but I’m really happy to see you back. You’re an amazing champion and you deserve that.”Murray came from behind to beat Stan Wawrinka. It’s set to be a joyous few weeks for Murray, who is expecting his third child with wife Kim in the coming weeks. Childbirth faces a tough task, though, in matching the pure ecstasy of this victory in Belgium.“I didn’t expect to be in this position at all. I’m happy, very happy,” Murray said. “It means a lot. The last few years have been extremely difficult.” We watch in anticipation and excitement as Andy Murray proves to us all that there is way back from chronic illness.Read more from the BBC on Andy Murray’s treatment and recovery: https://www.bbc.co.uk/sport/tennis/46865821

“Any treatment only gets you off the blocks – time and rehab gets you to the end of the race,” so says Mr Ali Noorani, Upper Limb Orthopaedic Surgeon Royal London and one of our regenerative medicine ‘champions’ here at The Regenerative Clinic.However, if you are experiencing problems with your elbow, what are the options for tennis elbow and elbow surgery?The elbow is without doubt a complex joint. The elbow is formed by the joining of three bones – the humerus, (upper arm bone), ulna, (outer forearm) and radius, (inner forearm). The elbow joint is surrounded by muscles on the front and back sides and there are 3 major nerves that cross the elbow joint itself and must be protected. The elbow has two basic movements – bending (flexion) and straightening (extension) and forearm rotation (palm up, palm down).Tennis Elbow – is a common elbow injury that causes pain around the outside of the elbow and is clinically referred to as lateral epicondylitis. It occurs after overuse of the muscles and tendons of the forearm near the elbow joint causing swelling and pain. Pain will occur on the outside of the upper forearm just below the bend of the elbow when lifting or bending the arm, gripping small objects such as a pen, or twisting the forearm when turning a door handle or even opening a jar. There may also be extreme difficulty in fully extending the arm.The elbow joint is surrounded by muscles that move the elbow,wrist, and fingers. Tendons in the elbow join the bones and muscles together and control the muscles of the forearms.Tennis elbow is caused by overusing the muscles attached to the elbow which are used to straighten the wrist. If the muscles and tendons are strained, tiny tears and severe inflammation can develop near the bony lump (lateral epicondylitis) on the outside of the elbow.Tennis elbow is not solely caused by playing tennis but by any activity which causes repetitive stress and movement in the elbow – for example decorating, throwing, playing a musical instrument. Golf can also cause ‘Golfers elbow’ which is pain that occurs on the inner side of the elbow.So what are the invasive procedures that can help restore motion and relieve pain in the elbow?In the past there has been so much surgery performed on elbow injury, however leading Orthopaedic surgeons have confessed that the evidence for successful outcomes are not completely there.A patient can turn to alternative simple treatments to relieve pain such as rest or completely stopping the activity altogether. Stopping doing the tasks altogether will alleviate the strain on both the muscles and tendons from the repetitive action. Regularly using a cold compress or physiotherapy could also help.The physiotherapist will use a variety of methods to restore function and movement to the area such as massage and manipulation to relieve pain and stiffness and to encourage the blood to flow to the arm. Exercises will keep the arm mobile and help to strengthen the forearm. Braces, straps, support bandages and splints could also be used but only in the short term.Shockwaves are a non invasive procedure where high energy shockwaves are passed through to the skin to help relieve pain and promote movement in the area, however in some cases this method proves ineffective.Minimally invasive regenerative alternatives to surgery and such things as steroid injections can also offer pain relief and allow a patient to return to a full and active lifestyle quicker, and there is also no risk or replacement joint failure and revision surgery.Steroid injections contain man made versions of the hormone cortisol and are used to treat painful musculoskeletal issues. The injection is made directly into the painful area around the elbow. They are, however, only likely to provide short term relief and long term effectiveness is not guaranteed.Noorani says; “Compared to steroid injections, PRP therapy is more effective treatment for tennis elbow.”Leading orthopaedic surgeons are now looking to stem cell therapy to treat elbow conditions to eliminate pain completely and remove the need for surgery. The treatment is minimally invasive, avoids all the complications and risk of surgery and allows less time for full patient recovery. Stem cell therapy includes the use of PRP, Lipogems®, and AMPP® therapy (a combination of the two – PRP and Lipogems).The use of orthobiologics including Platelet Rich Plasma (PRP) are an extremely effective way of treating tennis elbow when both physiotherapy and rehabilitation has failed. It uses growth factors from your own blood and involves injecting them in the area affected by tennis or golfers elbow and this helps the healing process. There is overwhelming evidence that PRP injections are far more effective in the healing properties than more traditional steroid injections.PRP takes advantage of the bloods natural healing properties to repair damage to the cartilage, tendons, ligaments, and bones etc. It reduces pain, improves joint function, and enables the patient to resume activities far earlier. PRP supports the body’s self healing processes by using its own cells. Blood including platelets are important for clotting blood and contain proteins called growth factors which aid in the healing of injuries. PRP injections contain higher volumes and concentration of these growth factors which restores the injured tissue and reduces inflammation. The procedure is performed in an outpatient clinic and only takes an hour to complete. It is administered in three weekly intervals and ranges from only 2 to 6 injections and carries a low risk.AMPP® is also a minimally invasive procedure that uses PRP and Lipogems®. Lipogems® uses adipose tissue (fat) and uses its natural healing capacity to inject into the painful area.AMPP® treats injuries and ailments such as tennis elbow that limits daily physical activity and helps painful joints with a limited range of motion such as arthritis,osteoarthritis, joint degeneration, and soft tissue defects in tendons, ligaments, and muscles.The advantages of AMPP® are numerous – minimally invasive, a successful alternative to surgery, it can aid patients in post surgery, there are no major incisions or cuts, it helps with long term conditions that limit daily activity, aids pain relief, and helps with tendon,ligament and muscle problems.Surgery – Elbow surgery is always challenging as it is such a relatively small and complex hinge joint. This alongside the fact that patients are living longer means that longer lasting and more durable solutions and implants are needed. Revision surgery is never ideal. Surgical options are only considered when medications and other measures don’t relieve severe joint pain and loss of motion.Arthroscopy – elbow arthroscopy has been traditionally used since the 1980s and the term literally means to look within the joint. Arthroscopy is recommended if the condition has become so severe that it is unresponsive to any non surgical treatment.During the arthroscopy a surgeon inserts a small camera into the elbow joint. The camera displays pictures on a television screen and the surgeon uses these images to guide miniature surgical instruments.Because the instruments are so thin, the surgeon can make very small incisions and cuts rather than the larger ones needed for open surgery. This means less pain for the patient, less joint stiffness, and a shorter recovery period so that they can resume activity as soon as it is possible. Arthroscopy relieves the painful symptoms of many problems that damage the cartilage surfaces and other soft tissues that surround the joint. This procedure can also remove loose pieces of bone and cartilage and release scar tissue blocking the bone.Common arthroscopic procedures include – tennis elbow treatment, removal of loose cartilage and bone fragments, release of scar tissue to improve range of motion, treatment of osteoarthritis through wear and tear, rheumatoid arthritis, and treatment for activity related to the humerus seen in both sports throwers or gymnasts.Recovery from arthroscopy is often faster than open surgery but can still take weeks for the elbow joint to completely recover. There will be pain and discomfort for over a week after surgery and for more extensive procedures, it can take several weeks before the pain subsides. Pain medication will be needed and anti inflammatory drugs. The elbow has to be elevated for the immediate 48 hours following surgery to reduce the risk of swelling and pain. It also has to rest higher than the heart and the hand higher than the elbow. Both ice and elevation methods are used and the fingers and wrists are encouraged to move immediately and frequently to aid circulation and reduce swelling. Exercises and moving regularly prevents joint stiffness. The wound will be dressed and the splint removed 2/3 days after surgery.There are always risks to any surgical procedure. In elbow arthroscopic procedures the risks include infection, nerve irritation, injury to the elbow itself, excessive bleeding, blood clots, and damage to the blood vessels and nerves. Recovery times are dependent on the elbow damage itself. Minor repairs may not need a splint and a range of motion and function may return after a short period of rehabilitation even meaning a return to work and activity within a few days. In more complicated procedures, it can take several months to recover and it can be a slow process. The patient must follow strict guidelines set by the surgeon and a strict rehabilitation plan of physio for the elbow.Total elbow replacement/open surgery – in a total elbow replacement surgery, the damaged parts of the humerus and ulna are replaced with artificial components, similar to a hip or knee replacement. The artificial elbow joint is made up of metal and a plastic hinge with 2 metal stems. The stems fit inside the hollow part of the bone called the canal. The two components – the numeral and the ulnar aren’t mechanically joined, relying instead on surrounding tissue for joint stability. The average recovery time for this replacement is 12 weeks.There are differing types of elbow replacements for different requirements and needs. They can involve different components of different sizes and full or partial replacements. The causes again include rheumatoid arthritis, degenerative joint diseases, post traumatic arthritis, severe fracture, and instability. They can treat golfers/ tennis elbow, repair ligaments, repair fractures, replace the elbow joint itself and decompress the ulnar nerve ( funny bone).Replacement surgery is usually reserved for older and less active patients with end stage inflammatory arthritis as the surgery successfully relieves pain and restores motion to severely damaged and deformed joints but wear and tear on the replacement is always a concern and the fact that the implant may not last long.Complications- the complication rate for elbows is larger than any other joint. They can loosen and they do wear out. The linked implants wear out and the unlinked implants can dislocate easily. Indeed 25% of elbow replacements fail at 5-7 years and this can sometimes be caused by the original poor quality tissue in the joint and sometimes even due to the effects or arthritis drugs themselves. In addition to this there are very few revision options for a failed elbow. ‘ You can go from having an arm that can do light things quite well to an arm with no function at all.’The advice seems to be clear that when considering treatment for a troubled elbow that all non invasive methods must be considered and tried first and that improvements will only be made by following a strict recovery plan afterwards

As reported in leading healthcare journal, Health Europa, The Regenerative Clinic is launching AMPP® a combination therapy for joint rejuvenation and preservation.The new treatment is called Activated Mesenchymal Pericyte Plasma injections (AMPP®). AMPP® is a day case procedure performed in approximately one hour with minimal recovery time. The combined treatment is thought to increase the effectiveness of the process at a cellular level offering a bold treatment option for people with arthritis and other issues.The Regenerative Clinic leads the way in bringing the latest advances in orthobiologic medicine to patients in the UK. Simon Checkley, CEO, The Regenerative Clinic says; “We are proud to have created AMPP as thrilling development to our treatment portfolio. AMPP is a minimally invasive procedure and can be an alternative to major surgery even aiding post-surgery recovery. There are no major incisions or cuts. AMPP can help if you have an injury or long-term condition that limits daily activity, or if you have pain or limited joint movement. We are finding that is particularly helpful for people with arthritis who may have already tried physiotherapy, NSAIDs or steroid injections as a powerful and minimally invasive alternative to pain relief.”AMPP® combines two already well-established treatments; Lipogems and PRP:· Lipogems® has now been conducted on over 40,000 patients worldwide. The Lipogems® technology prepares fat cells to trigger a healing response when injected directly into the affected area. The cells detect injury and attach themselves to damage where they react and regrow tissue. These pre-cursor stem cells have a pro-antibiotic effect which reduces pain and inflammation.· Platelet Rich Plasma (PRP) involves drawing blood from a vein in the arm and processing the blood in a centrifuge to extract the platelet rich part of the blood.· The Lipogems® and PRP is then injected into the area or areas causing pain under ultrasound guidance.The Regenerative Clinic has pioneered rejuvenating therapies around the world providing pioneering treatment for healing, pain relief and rejuvenation of joints and other tissues to restore mobility and function. Led by Professor Adrian Wilson the team of specialist Harley Street consultants, each one an expert in their own field (orthopaedic, radiology, gynaecological, spine, maxillofacial and cosmetic) have found that for the successful regeneration of tissues three components are important and need to be present. This includes a scaffold; cells that are able to reside within this scaffold; and the factor’s substances that allow communication between the cells.The harvested fat contains the cells that are required for the regenerative process as well as some scaffold in the form of adipose tissue. The PRP used provides growth factors that improve the activity of the cells in scientific studies and also provide some of the scaffold. Basic science research has shown that there is improvement in the survival of the cells within the fat by using PRP.

In a fast and furious version of the game of netball Loughborough Lightning beat Wasps after an afternoon-long tournament at the London Copper Box Arena to win the British Fast 5 All-Stars Tournament. Adding a five-point and three point shooting line, Golden Buzzer Power Plays which double points scored for two minutes, and 12-minute matches, this fast-format showcases the twists and turns, the talent and popularity of netball as a leading UK sport.This comes fast on the heels of an additional 160,000 women taking up netball or playing more netball as a result of the Netball World Cup held in Liverpool in July 2019. There were 112,000 tickets sold for viewing over 20 sessions of live netball, plus live television coverage and radio commentary on all key games, putting the tournament on a par with other more mainstream spectator sports, such as football, tennis, golf and rugby, for the first time.There were high hopes that home advantage would give the England Roses under the guidance of Tracey Neville an additional boost, especially since their 2018 Commonwealth Gold Medal beating the home favourites Australia 52-51 in the last second of the match. However, in the World Cup earlier this year England lost out to New Zealand by two points in an exciting and closely-fought semi-final and then managed to put their disappointment behind them to go on and win the bronze medal, beating South Africa in the play off by 58-42 as New Zealand went on to beat the favourites Australia by just one point in a thrilling final to be crowned Netball World Cup winners for the fifth time.All of these knife-edge encounters and the high quality netball played in the Netball Superleague which is transmitted live on Sky TV is putting the game very much front and centre in the UK. As women’s sport begins to take greater priority, netball is one that has historically been available solely to girls and women (although there is a form of men’s netball gaining popularity), has been played in schools around the country for decades and with minimal kit required to get started, is easily accessible to many thousands of girls and women around the country.According to Sport England’s Active Lives Survey (May 2016 to May 2017), over a quarter of a million adults in England (286,200) take part in netball at least twice a month. And that number is steadily growing as netball participation continues to take off. There is also a new take on the game becoming popular with walking netball aimed at the older participant which is gaining increasing popularity around the UK. Walking Netball is a slower version of the game – simply netball at a walking pace. The game has been designed so that anyone can play it regardless of age or fitness level. From those who have dropped out of sport altogether due to serious injury, to those who believed they had hung up their netball trainers many years ago, it is a game for everyone.Maintaining long-term health and wellbeing is one of the main drivers for many in taking up netball in the first place but continued playing depends on personal fitness and healthy bodies. For many netball players, professional and amateur, continual twisting of the knees and ankle joints brings risk of injury. Many players wear knee and ankle supports from a very young age, but for many these can make the problem worse rather than better.To keep playing, some people find they need to resort to intervention to help maintain their joints and it is here that Hydrodilatation – a ground breaking treatment recommended for joints that are painful and stiff due to the formation of scar tissue may be beneficial.In other cases, Lipogems has been found to restore patients’ own cartilage and is a cheaper and less risky alternative to knee replacement. Alternatively, Platelet Rich Plasma Therapy (PRP) takes advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles and bones. At the Regenerative Clinic this procedure – which involves drawing blood from a patient’s vein, processing in a centrifuge machine and reinjecting into the joint – takes under an hour under the supervision of one of the Clinic’s expert medical consultants. The main aim of this treatment is to reduce pain, improve joint function and potentially slow, halt or repair damage to cartilage.So as netball continues to encourage girls and women into regular physical activity, even those who have niggling injuries can be encouraged to play again – with a little help from one of the many forms of regenerative therapies readily available.

Many surgeries have been developed to repair the muscles, connective tissues, or damaged joints that can arise from traumatic or overuse injuries to the shoulder. These are often extremely common injuries that may be helped with physiotherapy or for more chronic conditions may require medical intervention. Although not an exhaustive list, here are some of the most common significant shoulder problems with possible treatment pathways and estimated recovery times.Rotator Cuff RepairsThe rotator cuff is a group of tendons and muscles in the shoulder that helps you lift and rotate your arm and also keeps the shoulder joint in place. Sometimes these rotator cuff tendons tear or get pinched by the bones surrounding them.An injury can occur from a sudden fall on the arm, lifting something heavy, or wear and tear over time. You are more likely to cause damage if you have a job where you repeatedly move the arm in a certain way over and over such as a painter, carpenter or athlete.Other causes of damage to the rotator cuff include slouching or chronically pushing the head forward. As you age, the rotator cuff can be irritated or pinched by calcium deposits in the shoulder area or bone spurs due to arthritis. These rotator cuff injuries can vary and be inflamed from overuse or partially or fully torn.Home care such as rest and icing, painkillers, and physio should always be considered first when dealing with the rotator cuff but surgery could be the answer if the pain doesn’t go away or improve after six to twelve months. Surgery is also considered if all strength has been lost from the shoulder area and it’s painful to move, if the arms cannot be raised or lift, and if there is a clicking or popping sound. Also if there is an actual tear in the rotator cuff tendon and the patient relies on shoulder strength and activity for either their employment or to participate in sports.The surgery is designed first and foremost to relieve pain, and then restore function to the shoulder. If surgery is delayed the issue can become more serious and lead to problems such as frozen shoulder or arthritis.Common types of rotator cuff surgery are- Arthroscopic repair – after making 1/2 cut in the skin, the surgeon will insert a tiny camera called an arthroscope and specialised instruments into the shoulder. This allows the surgeon to see which parts of the rotator cuff is damaged and how to repair them. The surgeon will use the instruments to reattach the tendon to the bone.Once the tendon is in the right place, the surgeon will attach it with sutures. Often surgeons will use small rivers called suture anchors. These rivets may be made of metal or a material that eventually dissolved. The rivets do not need to be removed. The sutures attach to the rivets, reattaching the tendons to the bone from where it was torn.Open tendon repair -historically, this was the first technique used to repair the rotator cuff and has been the most traditional form of surgery. If the tear is large and complex, this is the method the surgeon will choose. A large incision is made in the shoulder, then the shoulder muscle is detached so the surgeon has direct access to the tendon. The incision could be 2.5 to 4 inches long for an open repair or 1.5 to 2 inches for a mini open repair. Direct access is needed should the tendon or shoulder need replacing. Both of these surgeries are done under general anaesthesia or a regional block which allows the patient to be awake while the arm and shoulder stay numb.Open surgery, mini open surgery, or an arthroscopy might be necessary if the surgeon wants to remove calcium deposits or a bone spur. A bone spur is a bony growth that can press on nearby ligaments, nerves or tendons causing severe pain. Bone spurs often develop as people age.Rotator cuff surgery is major surgery and there are risks involved such as infection, nerve damage and excessive bleeding. In rare occasions, patients may also have an allergic reaction to the anaesthetic or suffer from breathing problems. Patients who smoke, who are over 65, who have larger tears or have shoulders which are already weak will need a longer time period to heal.The shoulder will still be painful post surgery and in recovery, and will be extremely stiff due to the lack of movement. After surgery it is normal to keep the arm in a sling for 4-6 weeks and wear a shoulder immobiliser strap wrapped around the chest. This protects the shoulder by holding it in its place.It takes the repaired rotator cuff tendons about 6 weeks to heal to the bone, 3 months to form a relatively strong attachment to the bone, and 6-9 months before the tendon is completely healed to the bone. Most patients will take 9 months before the shoulder feels normal and there will continue to be pain and soreness for several months.The chances of surgery reducing and eliminating shoulder pain is very good, however surgery may not restore the shoulders full strength. Time and physiotherapy will regain function but there may still be some weakness,stiffness and chronic pain. It will take a few months before sport can be played and other activities that require shoulder strength and a full range of motion can be performed.Another complication can also arise that not all tendons heal back to the bone after surgery, some do not heal completely and some do not heal at all. Large tendons can have far too much extensive damage to heal.Once a tendon has failed an attempted surgical repair, the odds are that it will be difficult to repair again and to get it to heal. In some cases, the tear may be small enough after failed surgery to be repaired again, but the larger it is the more unlikely it will be successful. In most cases a second attempt at repairing a tendon will not be successful.The operation can fail not due to bad surgery or bad aftercare and therapy but that the reality is that the surgery is not perfect and not all tendons will and can heal with surgery.