Studies – Dr. Wade McKenna

Ankles and Injuries: How We Can Help

Our bodies are fascinating, and so full of life, but sometimes injuries or age slows us down. Take our ankles. The ankle joins the foot and leg, and the inner bone, the tibia also known as the shinbone, supports most of the weight of your body. So you can say the ankle is pretty important for our mobility.

At McKenna Orthopedics, Dr. Wade McKenna has published a case study on CellR4 Repair, Replacement, Regeneration & Reprogramming on treating severe chronic Achilles tendon injury using bone marrow aspirate concentrate (BMAC), which contains several types of stem cells known to rebuild tissue. After ten weeks ultrasound-guided injections into the tendon, MRI imaging confirmed significant healing. At 32 weeks, MRI images showed that the tendon was almost completely healed.

The study focused on 27 patients that underwent surgery augmented with bone marrow aspirate concentrate (BMAC). Out of this group of patients 25 returned to their sport after six months post-treatment. Patients were walking without a boot in two months and were able to participate in light activity at around three months. This group of patients saw excellent results, which included no re-ruptures and early mobilization.

At McKenna Orthopedics, we are augmenting BMAC with a proprietary, pliable tissue allograft (transplant) derived from human placental amnion, which functions as a biologic structural matrix to facilitate and enhance tissue healing and repair. It contains 108 different growth factors including more than 10 times the amount of WNT-4 and more than 60 times the amount of prostaglandin as competing products.

Prostaglandin inhibits inflammation, which occurs after injury and marks the beginning of the healing process. The faster we can tame this inflammation, the sooner the body can move on to the next phase of healing, regeneration. WNT4 is arguably the single most important molecule required for wound healing.

To learn more or schedule your appointment, contact us info@drwademckenna.com.

 

Abstract: The role of “cell therapy” in osteonecrosis of the femoral head

The role of “cell therapy” in osteonecrosis of the femoral head.

Originally posted on July 17.

Abstract
Background and purpose – The value of core decrompression for treatment of osteonecrosis of the femoral head (ONFH) is unclear. We investigated by a literature review whether implantation of autologous bone marrow aspirate, containing high concentrations of pluripotent mesenchymal stem cells, into the core decompression track would improve the clinical and radiological results compared with the classical method of core decompression alone. The primary outcomes of interest were structural failure (collapse) of the femoral head and conversion to total hip replacement (THR). Patients and methods – All randomized and non-randomized control trials comparing simple core decompression with autologous bone marrow cell implantation into the femoral head for the treatment of ONFH were considered eligible for inclusion. The methodological quality of the studies included was assessed independently by 2 reviewers using the Cochrane Collaboration tool for assessing risk of bias in randomized studies. Of 496 relevant citations identified, 7 studies formed the basis of this review. Results – The pooled estimate of effect size for structural failure of the femoral head favored the cell therapy group, as, in this treatment group, the odds of progression of the femoral head to the collapse stage were reduced by a factor of 5 compared to the CD group (odds ratio (OR) = 0.2, 95% CI: 0.08-0.6; p = 0.02). The respective summarized estimate of effect size yielded halved odds for conversion to THR in the cell therapy group compared to CD group (OR = 0.6, 95% CI: 0.3-1.02; p = 0.06). Interpretation – Our findings suggest that implantation of autologous mesenchymal stem cells (MSCs) into the core decompression track, particularly when employed at early (pre-collapse) stages of ONFH, would improve the survivorship of femoral heads and reduce the need for hip arthroplasty.

 

Read Full Article.

Abstract on Stem Cell Research from AlphaMedPress

In Vivo Effects of Mesenchymal Stromal Cells in Two Patients With Severe Acute Respiratory Distress Syndrome

Originally posted on August 18

Abstract
: Mesenchymal stromal cells (MSCs) have been investigated as a treatment for various inflammatory diseases because of their immunomodulatory and reparative properties. However, many basic questions concerning their mechanisms of action after systemic infusion remain unanswered. We performed a detailed analysis of the immunomodulatory properties and proteomic profile of MSCs systemically administered to two patients with severe refractory acute respiratory distress syndrome (ARDS) on a compassionate use basis and attempted to correlate these with in vivo anti-inflammatory actions. Both patients received 2 × 106 cells per kilogram, and each subsequently improved with resolution of respiratory, hemodynamic, and multiorgan failure. In parallel, a decrease was seen in multiple pulmonary and systemic markers of inflammation, including epithelial apoptosis, alveolar-capillary fluid leakage, and proinflammatory cytokines, microRNAs, and chemokines. In vitro studies of the MSCs demonstrated a broad anti-inflammatory capacity, including suppression of T-cell responses and induction of regulatory phenotypes in T cells, monocytes, and neutrophils. Some of these in vitro potency assessments correlated with, and were relevant to, the observed in vivo actions. These experiences highlight both the mechanistic information that can be gained from clinical experience and the value of correlating in vitro potency assessments with clinical effects. The findings also suggest, but do not prove, a beneficial effect of lung protective strategies using adoptively transferred MSCs in ARDS. Appropriate randomized clinical trials are required to further assess any potential clinical efficacy and investigate the effects on in vivo inflammation.
SIGNIFICANCE:
This article describes the cases of two patients with severe refractory adult respiratory syndrome (ARDS) who failed to improve after both standard life support measures, including mechanical ventilation, and additional measures, including extracorporeal ventilation (i.e., in a heart-lung machine). Unlike acute forms of ARDS (such in the current NIH-sponsored study of mesenchymal stromal cells in ARDS), recovery does not generally occur in such patients.

Read Full Article.

UCLA Wide Receiver and Canadian Decathlon Standout Zack Bornstein Bounces Back After Stem Cell Therapy

UCLA Wide Receiver Zack Bornstein
UCLA Wide Receiver Zack Bornstein

UCLA wide receiver and Canadian decathlon standout Zach Bornstein suffered a hamstring tear 18 months ago. Conventional treatment and therapy were not working so Zach decided to undergo stem cell therapy at Riordan-McKenna Institute in late June 2015. Dr. McKenna treated Zack with precisely guided injections of bone marrow aspirate concentrate (BMAC) harvested with the patented BioMAC bone marrow aspiration cannula and *AlphGEMS amniotic tissue product.

Complete healing was confirmed by MRI 8 weeks after treatment:

1) No evidence for hamstring strain or denervation and no evidence for tendon tear.
2) No evidence for focal atrophy or hematoma.
3) No osseous abnormalities seen.

After receiving the MRI results, Zack’s father Dean said, “I am not a doctor but looks like you and your procedure has performed a medical miracle! …Thanks for all of your efforts.”

Zack is currently a red shirt freshman at UCLA. He played football at Oaks Christian High School from 2011-’14 and lettered 3 years in football and all 4 years in track. In 2013, Zack was named to the All-Marmonte 2nd team. He played in the FBU Youth All-American game in 2010. In track, he is considered to be one of the top decathletes in the country. Zack competed at the 2013 Pan American Junior Championships in Medellin, Columbia, finishing in 5th place with 7,097 points. In July of 2013, he became the Canadian Junior National Champion (6,918 pts). Zack won the silver medal at the 2013 Arcadia Invitational Decathlon, scoring 6,967 points to set a new California state record for juniors (2nd highest score in California state history). Zack is a 12-time National Champion, 44-time All-American and a member of three National Championship cross country teams.

*Amniotic tissue is donated after normal, healthy births.

 

Originally posted on RMI.

Case report of non-healing surgical wound treated with dehydrated human amniotic membrane

Dr. Riordan and Dr. McKenna recently published this case study demonstrating how amniotic tissue products promote wound healing. You can view the original article on the Journal of Translational Medicine website: Case report of non-healing surgical wound treated with dehydrated human amniotic membrane.

Authors
Neil H Riordan, Ben A George, Troy B Chandler, Randall W McKenna

Abstract

INTRODUCTION
Non-healing wounds can pose a medical challenge as in the case of vasculopathic venostasis resulting in a surgical ulcer. When traditional approaches to wound care fail, an amniotic patch (a dehydrated tissue allograft derived from human amnion) can function as a biologic scaffold to facilitate and enhance tissue regeneration and rehabilitation.

BACKGROUND
Amniotic AlphaPatches contain concentrated molecules of PGE2, WNT4, and GDF-11 which have angiogenic, trophic, and anti-inflammatory effects on tissues that may be useful in enhancing wound healing.

AIM-CASE REPORT
We present a case of a severe non-healing surgical wound in a 78-year-old male 17 days post right total knee arthroplasty. The full-thickness wound exhibited a mobile flap, measured 4 cm long × 3 cm wide, and showed undermining down to patellar tissue. We treated the wound conservatively for 6 weeks with no evidence of wound healing. Upon failure of the conservative treatment, two amniotic AlphaPatch (Amniotic Therapies, Dallas, TX, USA) were applied to the wound, and the wound healed completely in 10 weeks.

METHODS
In the OR, the wound was irrigated with three liters of double antibiotic solution under pulse lavage. Two dry amniotic AlphaPatch (4 cm × 4 cm) were placed over the wound with Acticoat applied on top.

RESULTS
At the two-week follow-up visit (following the incision and drainage of the wound dehiscence and application of the amniotic AlphaPatch), a central scab had formed centrally in the wound dehiscence area. At the four-week follow-up visit, the wound dehiscence area had completely scabbed over with no open areas left. At the eight-week follow-up visit, the scab had just fallen off, and the wound was healing well with immature skin representing the size of a penny. At the ten-week follow-up visit, the wound was completely healed.

DISCUSSION/CONCLUSION
Sterile, dehydrated amniotic tissue AlphaPatches (containing trophic factors known to enhance wound healing) have proven effective in completely healing an otherwise non-healing wound in a 78-year-old male who failed six weeks of conservative wound care treatment.