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Can Stem Cells Really Repair Regenerate Cartilage Injuries …

Posted: August 19, 2016 at 2:46 am

Dr. Bennett, has for years, been quietly using adult stem cells to regenerate cartilage. Cartilage is the cap of tissue that is on the ends of each long bone in all of our joints. If you have ever had a chicken drumstick and noticed a white cap on the end of the bone, this is what human articular cartilage also looks like. Cartilage provides for a sliding mechanism so our joints glide and move smoothly and provides for a shock-absorbing mechanism.

Types of Stem cells

Stem cells include fetal, embryonic, placental and adult, to name just a few. Interestingly, all humans have adult stem cells. In fact tissue in the human body has some type of stem celleven heart and brain tissue. Adult stem cells, unless engineered cant create sperm or egg and thus avoid any ethical discussion. In fact, adult stem cells can be readily available in our bodies.

There are 3 main types of stem cells utilized in orthopedics, albeit, many orthopedic surgeons dont use stem cells. Bone marrow derived, fat or adipose derived and synovial stem cells are utilized. Some advertising promotes PRP as stem cell therapy. In fact, PRP, or platelet enriched plasma, a concentration of platelets from your own blood, does indeed have stem cells, blood or hematopoietic stem cells. However, these cells are not good for cartilage, ligament or tendon repair.

Bone Marrow derived stem cells in orthopedics

At Bennett Orthopedics and Sportsmedicine. Regenerating the Youth in You! We use only bone marrow derived stem cell, presently for cartilage, ligament and tendon repair.

So! How did we get here? Early use of adult or equine(horse-derived) stem cells have been successfully utilized in some of the Kentucky Derby, Preakness and Belmont stakes competitors.

While this is an arthroscopic photo of a knee surgery in a 24 year old athlete, this depicts what an acute cartilage injury looks like.

From there, animal models have been developed. Interestingly, aside from using too many stem cells-which can contribute to loose bodies in the joint, Dr. Bennett notes that he has never seen a negative study with respect to tissue healing. See below, Dr. Fortier a Veterinarian from Cornell University has actually, and because of her contributions in this area, been the President of the International Cartilage Repair Society-for humans and based out of Switzerland.

Concentrated Bone Marrow Aspirate Improves Full-Thickness Cartilage Repair Compared with Microfracture in the Equine Model. Investigation performed at Cornell University College of Veterinary Medicine, Ithaca, and the Hospital for Special Surgery, New York, NY Conclusions: Delivery of bone marrow concentrate can result in healing of acute full-thickness cartilage defects that is superior to that, after microfracture alone, in an equine model. Clinical Relevance: Delivery of bone marrow concentrate to cartilage defects has the clinical potential to improve cartilage healing, providing a simple, cost-effective, arthroscopically applicable, and clinically effective approach for cartilage repair. J Bone Joint Surg Am. 2010;92:1927-37

Stem cells often are mixed with a scaffold so the cells stay in the general vicinity of the damaged tissue. A study from Singapore has shown that Adipose Derived Stem Cells, which are fat derived, can aid in cartilage regeneration when used with a resorbable scaffold.

Evaluation of Intra-Articular Mesenchymal Stem Cells to Augment Healing of Microfractured Chondral Defects-Steadman/Philippon Research Institute- Conclusions: This study confirms that intra-articular BMSCs enhance cartilage repair quality with increased aggrecan content and tissue firmness. Clinical Relevance: Clinical use of BMSCs in conjunction with microfracture of cartilage defects may be potentially beneficial.

Dr. Bennett has performed simple stem cell injections into joints for patients who do not want surgery with very promising results. However, he notes that given the opportunity to combine adult bone marrow derived stem cells with various types of cartilage surgery that he performs, he can regenerate near normal cartilage. Some of these techniques include using stem cells with microfracture of substituting stem cells for a MACI or AMIC procedure, a type of carticel procedure which incorporates a membrane over the cells to hold the cells in place.

Outcomes After a Single-Stage Procedure for Cell-Based Cartilage Repair A Prospective Clinical Safety Trial With 2-year Follow-up Brian J. Cole -Conclusion: The first clinical experience in using CAIS for treating patients with focal chondral defects indicates that it is a safe, feasible, and effective method that may improve long-term clinical outcomes. Keywords: cartilage; knee; arthroscopy; tissue engineering; magnetic resonance. American Journal of Sports Medicine, Vol. 39, No. 6

Autologous Bone Marrow-Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation An Observational Cohort Study Singapore-Conclusion: Using BMSCs in cartilage repair is as effective as chondrocytes for articular cartilage repair. American Journal of Sports Medicine, Vol. 38, No. 6

The Use of Bone Marrow Aspirate Concentrated for Full-thickness Knee Cartilage Lesions in a One-step Procedure: A Prospective Study-Alberto W. Gobbi MD-Milan,Italy,-Conclusion: This study showed that the use of autologous bone marrow derived and collagen I/Ill matrix in a one-step procedure could represent an improvement on the currently available techniques for cartilage transplantation could be a viable technique in the treatment of grade IV knee chondral lesions.

So, locations from New York to Vail, Colorado to Milan, Italy, to Singapore are in communion with this approach. Come to Sarasota, Florida, home of one of the best beaches in the World and have Dr. Bennett administer state of the art adult stem cells for your injuries.

Call 941-404-2703 or fill out our online form.

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Can Stem Cells Really Repair Regenerate Cartilage Injuries ...

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Stem Cell Treatment – Minnesota Regenerative Medicine

Posted: August 18, 2016 at 4:49 am

Regenerative medicine physicians at Minnesota Regenerative Medicine are among only a few in the region to offer stem cell treatments to relieve pain and inflammation associated with osteoarthritis (OA) and chronic tendinitis. Stem Cell therapy at Minnesota Regenerative Medicine refers to the use of an adult patients own stem cells, which are derived from the patients own adipose tissue. During the stem cell harvesting procedure, surgeons use manual liposuction to extract stem cells from the patients adipose tissue. These stem cells, also called mesenchymal stem cells, are responsible for regenerating and rebuilding the body. Once isolated and concentrated, the stem cells are then injected into the patients damaged joint or tendon or musculoskeletal tissue using real time fluoroscopy or ultrasound guidance to ensure proper placement.

A stem cell treatment represents a complex process that involves multiple steps and takes several hours to perform. Because the stem cell therapy uses the patients own cells, there is no chance of rejection. At Minnesota Regenerative Medicine, strict FDA guidelines in the use of stem cells are followed, and at no time are stem cells manipulated, expanded or grown in culture. Not all prospective patients are suitable candidates for stem cell injection therapy. See the list of frequently asked questions (FAQ) to determine what makes someone a suitable candidate.

Stem cell therapy is currently being used in orthopedic conditions such as:

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Home – Minnesota Regenerative Medicine

Posted: August 18, 2016 at 4:49 am

The specialty of regenerative medicine at Minnesota Regenerative Medicine focuses on the bodys natural ability to repair, replace, and regenerate damaged or aging tissues, and to restore functionality.

Using stem cell therapy, a patient can tap into their bodys ability to regenerate and heal itself by using the healthy regenerative cells found throughout the body. The stem cell treatment offerings available at Minnesota Regenerative Medicine make it possible to harvest these regenerative cells from a patients adipose tissue, then inject them back into the patient at sites of degeneration and injury to restore and repair aging or damaged cells to effectively regenerate tissue in the body. Stem cell therapy allows patients with painful osteoarthritic joints and chronic tendinitis to receive non-surgical orthopedic care on an outpatient basis without being exposed to the dangers inherent with general anesthesia and orthopedic surgery.

The specific type of stem cell treatments being offered at Minnesota Regenerative Medicine is designed for patients with joint or tendon pain due to osteoarthritis or chronic tendinitis involving the knee, shoulder, hip, ankle/foot, wrist/hand, elbow and Achilles tendon.

While stem cell treatments have been used for decades to treat a variety of diseases, stem cell therapy in orthopedic and sports medicine is relatively new. This treatment is for suitable candidates only and presently is not a covered benefit of Medicare or private insurance. At Minnesota Regenerative Medicine, stem cell treatment is neither a research study, nor clinical study.

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Human Induced Pluripotent Stem Cell Derived Neuronal Cells …

Posted: August 18, 2016 at 4:49 am

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Human Induced Pluripotent Stem Cell Derived Neuronal Cells ...

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Diabetes Australia

Posted: August 18, 2016 at 4:45 am

New PBS listing will improve quality of life for people with type 2 diabetes 15 August 2016

Diabetes Australia welcomed the Minister for Health Sussan Leys announcement of the Federal Governments decision to list diabetes drug Bydureon on the Pharmaceutical Benefits Scheme (PBS) and said the move would improve quality of life for many people with type 2 diabetes.

Aged 18 - 35 and living with type 1 diabetes? You can help with a survey into Online Youth Empowerment and Support.The survey aims to find out the usefulness and effectiveness of an online diabetes service on diabetes self-management during life transitions in young adults with type 1 diabetes.

Albert Abdul- Rahman has had a lifetime of adapting to change which stands him in good stead to face one of the biggest challenges in his life: learning to walk again after his left foot was amputated just three weeks ago.

Aged 19, Albert left Papua New Guinea for Queensland where he joined the Australian army: "There was no way I was prepared for the culture shock, I thought I knew about life in Australia, but everything was different to what I was used to." Albert embraced life with the army and spent six years as an engineer, learning a great deal about his new country and remaining an important part of the Papua New Guinea community living in Townsville.

Diabetes Australia and OPSM have partnered to raise awareness of diabetes and eye health in Australia. Each day 280 Australians develop diabetes thats one every five minutes.

From Kim Kardashian to Russell Crowe, masseur to the stars Philip Rule was comfortable dealing with the biggest names in sport and entertainment.

He was on top of the world work-wise and feeling healthy so a diagnosis of type 2 diabetes came out of the blue for 5th generation coalminer who, as well as being a massage whiz, has 30 years experience underground.

I was diagnosed with type 2 diabetes in 2005. I wasnt particularly overweight and I didnt think I was unhealthy so it was a bit of a surprise, Philip said.

Truck driver Jake Williams from Flemington in Melbourne was diagnosed with Type 1 diabetes at 11 years old. Once he and his family got over the initial shock of diagnosis, Jake got into a routine of dealing with his diabetes and throughout his teens gave as little thought as possible to managing his health.

Busy with work and the responsibilities of being a new dad, diabetes was definitely on the back burner during his twenties; I really didnt let my diabetes have much effect on my life. When you have a young family and youre busy with work, its easy to miss appointments and ignore any little warning signs

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Diabetes Prevention and Control – New Jersey

Posted: August 17, 2016 at 10:43 am

Diabetes is an important health concern particularly if you are a person with diabetes or at high risk for developing it; have loved one with diabetes; or are a health care provider or public health practitioner. Diabetes is serious, common and costly, yet it is controllable. The New Jersey Diabetes Prevention and Control Program seeks to reduce the health impacts of diabetes by:

Diabetes Disaster Guidelines [pdf 211kb]

Grant Programs

Commission for the Blind & Visually Impaired/Diabetic Eye Disease Detection Program

NJ 2-1-1 Diabetes Education and Prevention Program Services The NJ Department of Health has partnered with NJ 2-1-1, to provide the most up-to-date information on diabetes prevention and education to New Jersey residents.

NJ 2-1-1 is a statewide non-emergency, information call center and website. NJ 2-1-1 call specialists will provide callers with information on local Diabetes Prevention Programs and Diabetes Self-Management Education programs. Please feel free to visit the website, http://nj211.org/diabetes-management-and-prevention, to learn more about this partnership.

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NJDOH – Family Health services – New Jersey

Posted: August 17, 2016 at 10:43 am

Behavioral Risk Factor Surveillance System (BRFSS) data for 2003-2005 estimate that 473,000 adults 18 years and older, 7.2 % (margin of sampling error .3%) of the population, have been diagnosed with diabetes. It is estimated that 190,000 individuals have diabetes but have not been diagnosed.

For a variety of reasons, it is anticipated that the trend of increasing numbers and rates of people with diabetes will continue unless measures are taken that are geared toward prevention. Among people at the highest risk are persons over the age of 45, persons who are obese, and minorities. New Jersey 's population is aging. The number of persons over the age of 45 went from 2,594,232 in 1990 to an estimated 3,340,127 in 2005. Obesity rates, as estimated by BRFSS, went from 10% in 1991 to 22.1% in 2005. The state has always been diverse and is becoming more so. The percentage of black-non-Hispanics in New Jersey went from 12.7% in 1990 to 13.3% in 2005; while the percentage of the population that is Hispanic went from 9.6% to 14.5%. The Asian population had the fastest rate of growth increasing from 3% to 7.3% of the total population in 2005. The fastest growing subgroup among Asians is Asian-Indians. That group increased from 79,440 in 1990 to 169,180 in 2000.

According to the BRFSS for the period of 2003-2005, the highest rate by age of diagnosed diabetes was for persons 65 and over. For that group, the rate was 16.7% (margin of sampling error .9) compared to 7.2% (margin of error.3) for all persons over age 18. The survey shows blacks have the highest rate by race/ethnicity. The rate among non- Hispanic blacks of all ages was 12.2% (margin of sampling error 1.3).

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Regenerative Stem Cell Injections | Stem Cell Therapy Illinois

Posted: August 14, 2016 at 1:49 am

About R3 and Illinois Pain Network

R3 Stem Cell offers regenerative treatment options throughout the US that bring patients hope along with relief. Hope that surgery may be avoided, and regeneration and repair of damaged tissue without surgery. The person may then be able to participate in desired activities like swimming, biking, hiking, football, golf, playing with your kids again and being Pain Free!

R3 Stem Cell partners with the top pain and orthopedic practices nationwide to offer stem cell and PRP therapy to those desiring state-of-the-art treatment by compassionate, Board Certified providers. The Illinois Pain Network offers the top pain management providers in Chicago, Rockford, Joliet, Peoria, Naperville and surrouding areas. R3 is proud to work with the professionals in the Network, helping patients to receive regenerative therapies with the latest effective technology available.

Conventional pain treatments have been very good at reducing pain by masking discomfort in a band aid fashion with oral or injected medications like steroids, narcotics, or NSAIDs. These therapies unfortunately do not fix the underlying problem.

Fixing Tissue Injury

So how is the condition actually repaired, whether its shoulder/knee/hip/ankle arthritis, back or neck pain, golfers or tennis elbow, rotator cuff tendonitis or a ligament injury?

Regenerative Medicine with the Illinois Pain Network has the potential to restore anatomy with stem cells, growth factors and platelets to facilitate a healing response in ones own body.

Stem Cells are like a blank slate and may differentiate into any number of cell types for tissue regeneration. This is in large part dependent on the environment in which they are placed.

Illinois Stem Cell Procedures

Stem cell injection treatments include:

These are all minimally invasive, same day, low risk, outpatient procedures. The treatments may be partially covered by insurance.

Initial studies are showing these stem cell therapies to offer substantial promise in healing injury while reducing pain. For example, most professional sports leagues have approved of PRP therapy along with the World Anti-Doping Association.

Pro athletes who have received regenerative medicine treatment include the likes of Rafael Nadal, Dwight Howard, Tiger Woods, Kobe Bryant, Bartolo Colon and many more.

All of the treatments with the Illinois Pain Network are performed by Board Certified physicians.

Dr. Mark Farag is a double-board certified and fellowship-trained anesthesiologist and interventional pain management specialist. He attended the University of Illinois at Chicago for his anesthesiology residency and interventional pain management fellowship.

He is compassionate, intelligent, and always dedicated to giving his patients the highest quality of care. He focuses on using a multi-modal approach (procedures, medications, physical therapy, and other therapies) to treat the pain at its source, and help his patients resume a fulfilling personal, professional, and social life.

Dr. Rakic is double-board certified in both anesthesiology and pain management. He was a professor at the University of Illinois, specializing in in general anesthesia, regional anesthesia and pain management. He is interested in spine and orthopedic pain, cancer pain, as well as neuropathic pain conditions.

He brings a University level of care to patients and loves to offer regenerative medicine procedures including PRP and stem cell therapy to help provide relief. Most patients are able to avoid surgery and increase their functional abilities. Dr. Rakic also speaks Spanish and Serbian.

Dr. Pontinen is a double-board certified anesthesiologist and interventional pain medicine specialist. He has also undergone formal training as a resident in general surgery, which allows him to perform the most innovative procedures in pain medicine safely and skillfully.

He is a compassionate physician who works daily to help his patients regain their lives and get back to doing the activities they love. He is passionate about treating the most complex pain cases in a comprehensive, integrative and holistic approach, combining multiple treatment modalities with the most innovative, minimally invasive procedures.

This includes cutting edge regenerative medicine procedures for arthritis, tendonitis, sports injuries, migraines, chronic wounds and more.

Dr. Saldanha is double-board certified in both anesthesiology and pain medicine. Dr. Saldanha is a compassionate physician who is driven to provide healthcare to patients, regardless of background.

His expertise spans both medical management and interventional procedures, which includes PRP and stem cell therapy. Patients with all types of bone, joint and soft tissue conditions are treated with the regenerative medicine procedures to help repair and regenerate injury!

If you would like to receive stem cell therapy partially covered by insurance, CONTACT US or call (888) 885-8675 today!

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Regenexx injections – Stem Cells – The KNEEguru

Posted: August 14, 2016 at 1:48 am

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Does anyone know anything about the newly patented injections of Regenexx. It says it is a mixture of bone marrow stem cells (taken from your hip) and blood from your vein. This mixture is then injected into your knee. Clinical trials have resulted in ~ 30% cartilage regrowth. Not bad.

Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

I have been wondering the same thing.. Sounds great if it works? Has anyone on this list heard or had any involvement with the folks in Colorado?

I'm a little supicious of that. I want to ask my knee doc about it.

I wish we can find someone who tried it.

I am hoping to get the permission of my health insurance to be evaluated by him to see if I am a suitable candidate. Anything that will postpone the TKR for as long as possible.

http://www.alphaklinik.de/en/toft/news/Stem_Cell_therapy

Sue in Germany

1989 big trauma R. knee - sorted 1990-2004 3ACL recons and 20+ arthroscopies -RK 3/06 LK ACL torn! 4/06 ACL recon, kneecap broken 09 &10/06- 2x meniscus trims 3/07 - Notch Plastic & Lateral Release 14/8/08 complete revision ACL plus LCL/PLC recon 6/2/09 returned to skiing! Whoopee

How many injectons did you have and how long did it take to feel better? Did you have any restrictions.

Thanks

Left knee - 1997 debridement, 1999 trochlea paste graft / microfracture), 2002 IAGH injections, 2005 plica and synovium removal, 2009 Regenexx injections Right knee - 1997 debridement, 2000 trochlea paste graft, 2004 IAGH injections, 2008 Regenexx injections

I filled out the online form and got a response back within a few hours. I have emailed back & forth with them several times. They are supposed to open an office in Fla. soon.

TKR finally done!!! 9/9/13 Whew!!

In response to your email, Dr. Centeno and his associates are having good success in treating patients with OA/DJD of the knees as well as degenerative disk disease, with loss of cartilage, with our non surgical procedure. The best method for them to give you their feedback to whether you could benefit from Regenexx is to review your most recent MRIs or x-rays. If you would be interested, we would be happy to do this.

Our website http://www.regenexx.com has the most updated information regarding the procedure along with Dr. Centenos latest publications. Regenexx is currently only available at our Denver location although we plan to open in Florida later in the year. The procedure involves drawing our patients blood and bone marrow, growing their stem cells in our laboratory for approximately 3 weeks and then injecting the stem cells into the affected joint. Patients come to Denver for an overnight stay for their blood and bone marrow draw and then for up to 9 days for a series of injections to place the stem cells. This timeframe is dependent on the course of therapy prescribed to address your particular issues.

Please let me know what additional questions you may have or how I may assist you.

Thank you for your interest.

All the best!

Kelly Fulton, RN Regenerative Sciences Unleash the power of your stem cells

TKR finally done!!! 9/9/13 Whew!!

http://www.pittsburghlive.com/x/pittsburghtrib/s_578202.html

There are overachievers, and then there is Dr. Joe Maroon.

Three or four days a week, he swims an hour at Sewickley YMCA, beginning at 5:15 a.m., before heading to his job as vice chairman of the department of neurological surgery at University of Pittsburgh Medical Center. He'll operate, see patients or both, and then he'll bike or jog for about an hour.

Every weekend, Maroon does his own version of a triathlon, swimming one to two miles, biking 50 to 75 miles and running between eight and 15 miles in one day. Last weekend, it was a 1.5-mile swim, 75-mile ride and 12-mile run.

"The problem is I have to double that for Hawaii," Maroon said.

Maroon, who is the Steelers' neurosurgeon, is in training for the Ford Ironman World Championship in Kona, Hawaii, this October.

The race consists of a 2.4-mile open-ocean swim, 112 miles of biking and 26.2 miles of running.

Maroon is 67 years old and will be 68 at the time of the race.

A year ago, Maroon's colleagues were telling him his racing career was over.

The trouble started five years ago, when the Sewickley resident was competing in his fifth Ironman race and injured his left knee. He continued to race, but his last major competition was in 2005, when he finished in sixth place in his age group in the triathlon at the Senior Olympics, held in Pittsburgh.

Last year, Maroon was told by two orthopedic surgeons that he was going to need a knee replacement.

That was unacceptable.

"They told me if I had an artificial knee, I'd never run again," Maroon said. "I could walk, but I'd never run again."

Maroon started researching on the Internet and found Dr. Christopher Centeno and his Colorado-based company, Regenerative Services. Centeno developed a procedure called Regenexx, in which he extracts stem cells from a patient's own bone marrow, cultivates them, then injects them into the affected area to regenerate bone and cartilage.

Eight months ago, Maroon got the first of two injections into his left knee, and last weekend he completed a half-Ironman distance race in Muncie, Ind. He finished fifth in his age group and qualified for the Ironman World Championship in the process.

The procedure, which costs $5,000 to $7,000, is not covered by insurance. Maroon knows of no one in the Pittsburgh area doing similar work.

Centeno said that while his typical patient is active and between 40 and 60 years old, Maroon will be the first to go on to compete in an Ironman.

"I kid Joe that I think he's the biggest overachiever that I know," Centeno said. "We're thankful he did well."

This will be Maroon's third trip to Kona.

"I started 20 years ago doing triathlons," he said. "Each year I just increased the bar, just like I do with my training now. That's the remarkable thing about it; you see what your body can do and adjust to."

Karen Price can be reached at [emailprotected] or 412-320-7980. Back to headlines

TKR finally done!!! 9/9/13 Whew!!

I have to tell you though, I am mightily impressed that one of their success stories is the vice chairman of the Pittsburg neurological surgery dept. Not too shabby.

This product is considered a new drug because it is used to treat human disease. There are testimonials to that right on his website. As such, the product is subject to FDA regulation, but Dr. Centeno has not gone through the proper procedures to get FDA approval. He has not filed an Investigational New Drug Application, nor has he gotten an approved Biologics License. Do we even know if there have been any clinical trials conducted? Without these, how are we to know about any potential side effects and how often they may occur?

FDA regulations were put into place to safeguard the public against false claims or untested and potentially harmful medicines. I am highly suspicious of anyone who isn't willing to go through the proper channels to get his/her product approved. It can be a long, drawn out process that takes years to complete, but the fact that it is so thorough means that in the end, you can be sure of having a product that is truly effective without being harmful. As much as I would like to believe in this product, I would urge everyone considering it to use extreme caution.

There is one other consideration also. If the product doesn't get FDA approval, insurance companies will never cover the procedure and patients will continue to have to pay out of pocket for it. Anyone considering the treatment should ask the company whether they will still be charged if the harvested cells fail to grow in the lab. My OS has stated that that sometimes happens with cells grown for ACI, but patients are still responsible for the full fee.

Here is the link to the FDA letter, if anyone wants to read it: http://www.fda.gov/CBER/compl/regen072508.htm Terre

RK 7/04 part. m. menisc., plica resect., MF 3/05 part. m. menisc., open OATS 1/07 part l. menisc., MF, patellar chondroplasty 9/08 MF LK 11/04 & 8/06 part m. menisc. 7/07 LR, patellar tendon debrid., part m. menisc.

TKR finally done!!! 9/9/13 Whew!!

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Regenexx injections - Stem Cells - The KNEEguru

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Bridgewater, New Jersey – American Diabetes Association

Posted: August 14, 2016 at 1:44 am

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New Jerseyans are increasingly feeling the effects of diabetes as thousands of people suffer from the disease, and many others may have diabetes and not know it! It is estimated that one out of every three children born after 2000 in the United States will be directly affected by diabetes.

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Bridgewater, New Jersey - American Diabetes Association

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