Muskuloskeletal Conditions

Most athletic injuries whether professional or amateur are to the knee ligaments and cartilage.
The second most common areas of injury are the shoulder and elbows.

Our treatment for ligament and cartilage injuries to all these areas consist of ultrasound guided injections to the affected ligaments or cartilaginous structures using umbilical cord stem cells – (the number may vary based on the patients condition) with a special combination of fat cells and mesenchymal stem cells from the patient themselves.

The treatment consists of harvesting a small amount of fat with its inherent mesenchymal stem cell component and them mixing this with the umbilical cord stem cells prior to the ultra sound guided injection to the injured sites. The whole process takes approximately one hour, under local anesthesia. Patients can ambulate immediately.

Results are commonly seen and felt in 2 to 4 days and continue to improve with pain reduction and increased joint and ligament function over the next 4 to 6 months. All patients have evidence of their before and after ultrasound films so they can see the improvement in their original conditions.

More than one treatment may be necessary based on the original degree of damage to the joint involved.

Our treatment for ligament and cartilage injuries to all these areas consist of ultrasound guided injections to the affected ligaments or cartilaginous structures using Umbilical Cord Stem cells – ( the number may vary based on the patients condition )with a special combination of fat cells and Mesenchymal Stem cells from the patient. themselves .

Over the last few years, human microfragmented adipose tissue (MFAT), containing significant levels of mesenchymal stromal cells (MSCs) and obtained from fat lipoaspirate (LP) through a minimal manipulation in a closed system device, has been successfully used in aesthetic medicine as well as in orthopedic and general surgery. Interestingly, in orthopedic diseases, this ready-to-use adipose tissue cell derivative seems to have a prolonged time efficacy even upon a single shot injection into osteoarthritic tissues. Here, we investigated the long-term survival and content of MSCs as well the anti-inflammatory activity of LP and its derived MFAT in vitro, with the aim to better understand a possible in vivo mechanism of action. MFAT and LP specimens from 17 human donors were investigated side by side. During a long-term culture in serum-free medium, we found that the total cell number as well the MSC content in MFAT decreased more slowly if compared to those from LP specimens. The analysis of cytokines and growth factors secreted into the conditioned medium (CM) was similar in MFAT and LP during the first week of culture, but the total amount of cytokines secreted by LP decreased much more rapidly than those produced by MFAT during prolonged culture (up to 28 days). Similarly, the addition of MFAT-CM recovered at early (3-7 days) and late stage (14-28 days) of culture strongly inhibited inflammatory function of U937 monocyte cell line, whereas the anti-inflammatory activity of LP-CM was drastically reduced after only 7 days of culture. We conclude that MFAT is an effective preparation with a long-lasting anti-inflammatory activity probably mediated by a long-term survival of their MSC content that releases a combination of cytokines that affect several mechanisms involved in inflammation processes.

IT’S NOT MAGIC …. IT’S TOUR OWN BIOLOGY

For those who don’t want or can’t have invasive surgeries for chronic joint pain, there are effective ultrasound guided non-surgical options. The treatments are providing significant benefits from pain, with improved joint function in the vast majority of patients we have treated. This includes the shoulder, rotator cuff, hand, hip, knee, meniscus, spine, ankle and neuropathies that have failed to respond to other methods.

These include “bone-on-bone” joints and even those who failed arthroscopic surgery. Our results on the knee joint have been presented at international conferences, scientific posters and recently our knee study has been submitted for publication. Our recent shoulder study has just been published in The Orthopedic Spine and Sports Medicine Journal. A link to these reports is at the end of the post.

When you hear the term stem cells, it’s important to note for ethical concerns that these are not embryonic stem cells. The stem cells used in treating joint pain are adult stem cells, also termed “mesenchymal stem cells”. They are found primarily in bone marrow and adipose tissue (fat). Adipose cell therapy has a much higher percentage by volume of these adult stem cells, as well as a host of other reparative cells and growth factors preserved in small clusters of adipose using the new technology developed in Milan Italy, LIPOGEMS. By preserving the fat cluster, the LIPIGEMS Orthopedic cellular therapy contribute to the cell therapy adhering to the damaged tissue as well as increasing longevity of the cells.

With stem cells like those found in a patient’s own adipose tissue, we can now take advantage of what the body does naturally, repair damaged tissue and generate itself anew. Many of the adult body’s organs and tissues, including adipose, are equipped with their own stash of adult stem cells whose sole job is to repair and regenerate cells and tissues when joint damage occurs and joint tissue cells die off leading to arthritis, meniscus and ligament tears. The adipose tissue can now be non-invasively harvested from the same patient it will be used to treat, with this new FDA cleared technology, in a single office visit. The micro-adipose cell therapy injected contains a host of cells, including adult stem cells, pericytes, adipocytes, as well as growth factors and many substances involved in reducing inflammation, support and repair of damaged or injured joint tissues such as ligaments, meniscus, cartilage, and tendons.

With adipose cell therapy we can now get to the root cause of inflammation that leads to irreversible joint damage.

The injection of micro-adipose cell therapy is not referred to as a “stem cell” injection. This is due to the fact that the adipose is injected as an intact cluster of many types of cells, and bioactive elements in addition to the the adult stem cells. Basically, it’s much more than stem cells.

Currently there are more than 8,400 publications on the adipose derived stem cell. It’s a super exciting time in the field of treating orthopedic pain, naturally, and biologically by harnessing the power of a patient’s own cells to reduce inflammation, pain and provide the support, cushion, repair and replacement of damaged or injured tissues.

What sets RMI-International Orthopedic treatment apart?

Expert plastic surgeons with adipose tissue.

Certification in point of care diagnostic musculoskeletal ultrasound imaging enables on-the-spot viewing of joint structures such as tendons, ligaments, joint cartilage, bone, bursa and the meniscus to obtain current diagnostic information about structures contributing to pain, reduced mobility and function.

With this current information in hand, collated with any prior imaging, a specific and individual treatment strategy can be made, ensuring each relevant joint structure is individually treated. The ultrasound imaging provides visual confirmation in real-time that each individual structure is precisely treated. We never deliver a “non-guided” injection. Research has shown non-guided injections have an accuracy of only 30%-60%.

A Typical Joint Injection:

  • No certification diagnostic musculoskeletal ultrasound imaging.
  • No imaging to diagnose each relevant issue.
  • No imaging to guide the injection precisely where it needs to be.
  • No imaging to ensure when injecting a joint that the needle doesn’t bump into other structures, or cartilage creating damage.
  • A single injection into the joint.

The RMI Method: Certified in diagnostic ultrasound imaging.
Point of care diagnostic ultrasound coupled with any prior radiology to diagnose each issue related to pain, loss of function and quality of life. Like an MRI ultrasound imaging views bone, ligament, bursa, meniscus, tendon, cartilage, nerve and muscle.

Continuous ultrasound imaging is used precisely guide the injection of LIPOGEMS individually treating every single relevant issue.

Ultrasound image guidance ensures that no other tissues or cartilage are bumped into or injured as the needle is guided to the location in need of treatment.

RMI’s approach means multiple injections individually treating each structure related to pain, and loss of function with continuous ultrasound imaging providing live visual confirmation that each structure has been flooded with LIPOGEMS micro-adipose cell therapy with pin-point accuracy.

Typical injection:
Knee Joint:
No imaging “blind injection”, one injection into the joint. 5 minutes.

The RMI Method:

Knee joint:
Ultrasound guided injection following a complete diagnostic ultrasound examination of the entire joint by a doctor certified in diagnostic Orthopedic ultrasound at the time of the visit.

Individually inject each structure that is damaged and clinically relevant with continuous real-time ultrasound image guidance. This may include one or many of the following: 1 hour or more.

While this explanation seems complex, fixing joints requires a complex approach. Many structures in and surrounding the knee contribute to pain, and the overall loss of mobility and function. It only makes sense therefore, that each must be treated, and our approach illustrates what relevant structures may require treatment, and why it’s critical each is individually treated by precision imaging to ensure best outcomes.

Relevant structures contributing to knee pain that may require treatment:

  • Aspirate fluid / joint effusion if present
  • Quadriceps muscle / tendon (thigh muscle)
  • Quadriceps tendon enthesis (tendon insertion on the knee cap)
  • Patella tendon (tendon below the knee cap)
  • Patella tendon enthesis Tendon attachment below the knee cap)
  • Deep infrapatellar bursa (fat pad below the knee cap)
  • Medial joint compartment (joint on the inside of the knee)
  • Medial meniscus (fibrocartilage cushion on the inside of the knee)
  • Medial collateral ligament (ligament on the inside of the knee)
  • Medial collateral ligament bursa (fat pad under the ligament)
  • Anterior cruciate ligament (ligament in the middle of the knee)
  • Posterior cruciate ligament (2nd ligament in the middle of the knee)
  • Pes anserine bursa (bursa below the inside of the knee joint)
  • Lateral joint compartment (joint on the outside of the knee)
  • Lateral meniscus (fibrocartilage cushion on the outside of the knee)
  • Lateral collateral ligament (ligament on the outside of the knee)
    Iliotibial band (tendon-like band causes pain on the outside of the thigh to the outside of knee)
  • Tibial-fibular joint (a 2nd small joint just below the outside of the knee joint)

RMI LIPOGEMS Orthopedic Adipose Cell Therapy: Protect, cushion, repair, and regenerate the damaged the joint. The procedure is performed using a local anesthetic, no sedation required and completed in one 2-3 hour visit. Adipose tissue is abundant in many regenerative cell types including adult stem cells, pericytes and others. Research has shown the effectiveness of adipose cell therapy in orthopedics in the spine, shoulder, hip, knees and other joints where other methods have failed.

We also have the ability to treat multiple joints during the same day procedure, thus saving patients the extra expenses associated with multiple visits to treat multiple conditions.

To ease concerns and gain an understanding of treatment options, we provide phone consultations, with MRI review at no charge. This is an easy, no pressure way to gain important information about a specific case before deciding on a treatment option.

ITS NOT MAGIC, ITS YOUR BIOLOGY … COUPLED WITH EXPERT SKILLS AND A UNIQUE DELIVERY … BOUTIQUE DESTINATION NON-SURGICAL ORTHOPEDIC TREATMENT

With certification in precision ultrasound imaging to guide injections, of Lipogems adipose cell therapy, the power of regenerative cells including stem cells packaged in a new technology to prepare adipose tissue ( a little of belly fat taken from the same patient is is used for) releases the body’s own biology to deliver a broad palette of reparative activity to reduce painful inflammation, support, cushion, repair and replace damaged or injured joint tissues. Non-surgical precision image guided autologous (from you, back to you in the same visit) LIPOGEMS adipose cellular therapy treatment for the shoulder, spine, knee and other joints providing success where other methods have failed. Including “bone-on-bone” joints is now available at RMI-International.

Why is our approach unique? We blend experts in plastic surgery, diagnostic point of care ultrasound imaging, precision ultrasound imaging guiding treatment with laser-like accuracy, new adipose cell therapy technology, science, and research.

Is arthritis and joint pain in the shoulder, spine, knee or other joints restricting mobility and the ability to function normally? The good news is there is successful non-surgical treatment.

There are three keys to RMI’s success in biologically treating joints non-surgically. AND not only does this repair, but patients avoid the domino effects of pain medication and opioids that create a downstream of conditions, disease and family crisis.

  • ONE: Accurate diagnosis of all structures that are responsible for pain, lost mobility and functionality. Certified in ultrasound imaging, we can view each and every structure, ligament, cartilage, tendon with high-definition detail. Unlike an x-ray that only shows bone, ultrasound imaging fine detail in the joint, bone surface, cartilage, tendons, ligaments, muscle and nerves. The painful joints are scanned at the time of the visit. With this information in hand, a patient specific treatment strategy can be made.
  • TWO: Using advanced skills with precision ultrasound image guided injections of biologics such as adipose cell therapy or platelet rich plasma therapy that is taken from same patient it is used for, each individual structure is injected. This pin-point accuracy ensures best outcomes.
  • THREE: While a typical injection to a joint is a single shot, done blind without imaging to guide it, studies show these typical injections can have a “miss rate” of up to 40%. Not so with The RMI-International Method using ultrasound image guided skills to visually confirm that each and every individual structure in and around painful joints is thoroughly treated. The benefit with ultrasound imaging is that the patient and our doctors have visual confirmation the biological adipose cell therapy is placed directly into the damaged tissues. No guesswork.

The treatments are same-day procedure, completed in one office visit using only a local anesthetic, no sedation required, and patients are ambulatory afterwards. We stay with each patient tracking our outcomes for two years.

Why is skill with diagnostic and ultrasound image guided injections so important? The results. We see significant improvement in the vast majority of cases treated, including bone-on-bone joints.

RMI tracks, researches and publishes outcomes in treating pain from arthritis and joint damage. We know the results. Trust the experts. One call might change your life. We educate patients, and offer free of charge, no pressure phone consultations and MRI review. For more information or to schedule a consultation call RMI-International at ….. one call may change your life. Our outcomes show it has for the majority of cases we treat.

Are you too young for old shoulders and knees and feel you look too old as well?

RMI international offers non-surgical, adipose derived (fat) orthopedic and cosmetic treatment.

A little belly fat can make you feel and look young again, non-surgically.

Lipogems is an FDA approved technology developed by a leading plastic surgeon in Milan, Italy. The Lipogems technology is a method of processing a little of a patient’s own belly fat into an injectable treatment that contains a robust population of adult stem cells, pre-stem cells (pericytes) and dozens of substances preserved in the Lipogems process (growth factors, proteins and secretomes) that drive tissue repair. Whether it’s damaged skin or damaged joints, or both, the results we deliver are impressive.

RMI cellular cosmetics:

Leading board-certified plastic surgeons rejuvenate the face by injecting facial lines and wrinkles with the Lipogems adipose clusters, that deliver a bioactive cellular treatment. The result is that the wrinkles and lines aren’t simply filled, they are filled with the subcutaneous fat that is lost with aging that causes facial lines and wrinkles. The subcutaneous tissues are supported and regenerated delivering impressive long-term results without surgery

RMI Cellular Orthopedics:

Certified in diagnostic ultrasound imaging of joints, and a board member of the Interventional Orthopedic Foundation, the orthopedic treatments start with a complete imaging examination of the joint or joints. Point of care diagnostic ultrasound imaging precisely pin points each of the causes of joint pain. With this information in hand, unique to RMI, using the high-definition ultrasound imaging we deliver the Lipogems to each damaged structure individually. Members of our orthopedic team and others have published peer reviewed studies demonstrating statistically impressive results for the vast majority of cases treated.

Whether you want to look younger, or arthritic joints are stopping you from doing the things you used to when you were younger, or both, RMI doctors have the science, and the experience of board-certified plastic surgeons, certified medical orthopedic sonography and published studies patients can trust,

For more information or a free phone consultation simply call 1-800-635-3838 and out staff will be happy to assist you.

Pain in the spine or joints does not have to hold you back, and invasive surgeries or pain management is no longer the only option when other methods fail.

There is non-surgical relief in most cases treated with adipose (fat) cell-based orthopedic treatment with a new FDA cleared technology. The Lipogems technology uniquely preserves, in a pristine injectable, the cells and substances needed to tackle even the most stubborn and chronic joint pain and return function where other methods have failed.

Why don’t damaged joints like the shoulder and knee no heal and get worse over time?
Meet “The Butterfly Effect”

In nature, flowers produce pollen and nectar, and responding to the “biological signals” they attract the butterfly, and in so doing the butterfly germinates the flower, promoting new life and seeds by delivering the signals to local flowers. Damaged joint tissues also produce “biological signals” and in so doing attract stem cells, and substances called secretomes to the damaged cartilage or structures such in a joint such as ligaments, rotator cuff, meniscus and tendons to promote life and plant seeds in neighboring cells in the local joint environment.

So why are these signals biologically ignored?
The problem is that joints, ligaments and tendons, and the knee meniscus lack the blood supply that the human body needs to transport the cells needed for repair in response to the signaling. In addition to a lack of blood supply to deliver what’s needed, a recent Stanford study also demonstrated the joint capsule that protects joints presents a road block that stops the repairative cells from gaining access into the joint to do their job.

It’s like putting the flowers in a cage. The flower produces pollen and nectar, signaling the butterfly, but it can’t get in to germinate the flower. The same is true in joints where the lack of blood supply in the joint and surrounding structures lack the blood supply and the joint capsule blocks the reparative cells from getting in.

How can we get around “the butterfly effect” in joints to reduce pain, inflammation and deliver tissue repair and functional recovery?

By harvesting the cells needed for repair from a little of a patient’s own belly fat that is abundant in secretomes, including stem cells and pre-stem cells called pericytes with the FDA cleared technology by Lipogems.

Certified in high-definition musculoskeletal ultrasound imaging we are then able to inject the Lipogems, navigating the openings in the “anatomical cage” and directly inject with pin-point accuracy the “biological signaling cells” into each structure in need of repair, one-by-one with live streaming visual confirmation the Lipogems is flowing into and filling each tissue defect.

Delivering germinating cells into the joint and all surrounding structures that is intended to reduce damaging inflammation and pain, lubricate, cushion, support, repair and replace the damaged or injured tissues.

We know this because we and other researchers have treated, tracked and published outcomes following Lipogems treatment. There is science on the characteristics and orthopedic outcomes following non-surgical Lipogems adipose derived cell-based orthopedics that have delivered long-term and impressive results, including where other methods have failed.

The same-day visit:
Certified in diagnostic musculoskeletal orthopedic ultrasound the visit begins by examining each structure of the joints to be treated in high-definition fine detail with the latest ultrasound imaging machines. Prior MRI is reviewed to correlate clinical information. With this current information in hand a plan to address each structure contributing to pain and limiting function is targeted for individual treatment. Following the Lipogems treatment, patient outcomes are tracked for two years. We stay with patients following treatment to support and monitor recovery.

The treatment can include multiple joints, completed in a single visit that may take 2-4 hours, using a local anesthetic, with no sedation required.

Whether deciding to treat with us here at our RMI-International.com location in Montclair NJ or our RMI-International clinic in San Jose Costa Rica, we are happy to educate and provide guidance in seeking treatment. Patients should know exactly what they are getting and that science, experience, imaging technology and published studies on the outcomes of that treatment are available.

For additional information or a link to Lipogems studies simply call and our staff and they will be happy to assist. We offer phone consultations and MRI review with no charge to individuals. In this way individuals can gain current information and understand the treatment options to make an informed decision they are comfortable with.

Simply call 1-862-333-4181 and our friendly staff will be happy to help.
Thanks for reading our posts.

This case is an example of elastography of a rotator cuff, supraspinatus tendon having been treated for a partial thickness articular surface tear. Elastography provides a color image of the mechanocharacteristics of a tissue.

This case is a 59 YO Fe. The elastography images shown are 3 ½ months post treatment. The patient was treated with “amber” platelet rich plasma (PRP) void of red and white blood cells. 60cc of blood was drawn and 4cc final PRP. Precision ultrasound guided injection of 1cc into the Supraspinatus, 1cc into the Acromioclavicular joint, 2cc into the Glenohumeral joint.

MRI revealed tendinosis with partial thickness tear 7x4mm with bursal side fraying.

Ultrasound elastography is technology that has experienced major developments in the past two decades, however, rarely reported as an outcome measure in musculoskeletal treatment. We have begun developing elastography as an additional outcome measure following PRP or Lipogems adipose cell-based treatment of the rotator cuff and knee. The post treatment imaging is impressive.

The assessment of the main mechanical properties of tissues can be made with this technology by characterization of their response to stress.
Tendinopathy is characterized by the proliferation of tenocytes (why pathological tendons on US appear enlarged), collagen fiber disorganization (why pathological tendons on US appear heterogeneous), intrasubstance defects (why pathological tendon tears appear anechoic (black voids), increase of non-collagen matrix, fluid accumulation, ground substance between fibers (why pathological tendons appear on US hypoechoic (dark), capillary proliferation and calcification (why pathological tendons on US may show increases color flow), which can all induce modifications of the viscoelastic properties of the tendon and, consequently, be noticeable on ultrasound imaging.

The supraspinatus tendon in the imaging is viewed on the right as the ultrasound image and on the left the same image as an elastogram. The central structure coming to a point in a “bird beak” appearance is the supraspinatus tendon.

In grading tendons the pathological tendons become soft, filling with ground substance and fibrillar defects. The scale from blue to red, blue is hard and red soft. The percentage green/red reveals the degree of pathology. Using this initial image as a baseline, the post biological imaging reveals nearly all green and red within the supraspinatus tendon has been resolved. The elastography image now shows a nearly all blue supraspinatus tendon. Not simply the 7mm tear site but the entire tendon has changed.

This demonstrates objectively that the anatomical and physiological characteristics of the tendon having taken on a more native and less pathological characteristic and of course less pain and increase in function. NPS (numeric pain scale) 0-10 was 8/10 now 4/10 and ASES 0-100 was 48/100 now 86/100.

For information of a free phone consultation on the Optimum Joint Adipose Cell-Based or Platelet Rich Plasma non-surgical treatment of the shoulder and rotator cuff or knee and meniscus simply call 862 333-4181 and the staff will be happy to help.

Full Study: Perineural PRP for diabetic neuropathy

Perineural Platelet-Rich Plasma for Diabetic Neuropathic Pain, Could It Make a Difference?

Hassanien M1
Elawamy A2
Kamel EZ2
Khalifa WA3
Abolfadl GM2
Roushdy ASI4
El Zohne RA5
Makarem YS1

Author information

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
  2. Anesthesia, Intensive Care and Pain Department Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
  3. Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
  4. Anesthesia, Intensive Care and Pain Department, Faculty of Medicine, Minia University, Minia, Egypt.
  5. Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.

Abstract

OBJECTIVE: To evaluate the clinical effect of perineural platelet-rich plasma (PRP) injection for pain and numbness alleviation in diabeticperipheral neuropathy (DPN).

STUDY DESIGN: A randomized prospective clinical trial.

SETTING: Pain clinic and Rheumatology and Rehabilitation Departments, Assiut University Hospital.

METHODS: Sixty adult patients with type II DM accompanied by DPN of at least six months’ duration were assessed by modified Toronto Clinical Neuropathy Score (mTCNS) and randomly allocated into two groups. Group I underwent ultrasound-guided perineural PRP injection and medical treatment, and Group II received medical treatment only. Patients were followed up at months 1, 3, and 6 with regard to pain and numbness visual analog scale (VAS) and mTCNS scores.

RESULTS: Significant improvement was recorded in pain and numbness VAS scale scores in group I vs group II (P ≤ 0.001 during the whole study period for both parameters); at the same time, mTCNS improved in group I in comparison with group II with P = 0.01, 0.001, and <0.001 at months 1, 3, and 6, respectively.

CONCLUSIONS: Perineural PRP injection is an effective therapy for alleviation of diabetic neuropathy pain and numbness and enhancement of peripheral nerve function.