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A League of Fans Special Feature

Christopher Centeno, M.D.

Q’s & A’s with Leading Sports Reformers

Dr. Chris Centeno has dedicated his career to creating therapies that could eventually make 70-80% of traditional orthopedic surgeries unnecessary. He believes many of the surgeries today will be replaced by less invasive, interventional orthopedic procedures. Centeno is a specialist in regenerative medicine and an innovative sports medicine physician.

Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible – directly and indirectly — for a large amount of the published research on stem cell use for orthopedic applications.

Centeno treats patients of all ages — from across the U.S., as well as internationally — with innovative non-surgical treatments, including stem cell and PRP (platelet-rich plasma) injections. He has a growing sports medicine practice and has successfully treated athletes, young and old, from multiple sports.

Dr. Centeno also maintains an active research-based practice, with multiple publications listed in the U.S. National Library of Medicine. He trained at the Baylor College of Medicine, Texas Medical Center and the Institute for Rehabilitation Research.

Centeno was recently interviewed by League of Fans’ Sports Policy Director, Ken Reed.

Reed: I don’t know exactly how many years you’ve been at this but you basically bet your career on interventional orthopedics, didn’t you?

Centeno: I did, I started doing this 12 or 13 years ago. At the time, we were the only human beings on Earth doing what we were doing. It was interesting. We were the classic early adopters. We tried to do a lot of different things and eventually ran up against FDA regulatory issues. Eventually, we honed in on the things we could do in the United States at the time.

Reed: You see a bunch of advertisements for stem cell treatments in the media these days. I assume there are a variety of stem cell treatments, some legitimate and some not.

Centeno: They’re largely all scams.

Reed: Can you explain what differentiates your stem cell treatments from most of the others in the marketplace?

Centeno: There are really two things out there in the marketplace. There’s bone marrow concentrate, which is what we use for the ACLs (knee injuries). That treatment is currently allowed in the United States and we think we do that a lot better than anybody else because we’ve been doing it for a very long time. There are various gradations on that.

But then on the other side, some of the stuff you run into in the media, is the amniotic stem cell stuff, which is really an out-and-out scam. It is illegal to sell or possess amniotic or cord stem cells for orthopedic use. If there really are actual stem cells in those treatments, it’s an illegal drug, which hasn’t been approved.

Reed: It seems like the Wild West out there in the stem cell field. What’s going on in terms of regulating the stem cell industry?

Centeno: You know, I think the FDA is playing whack-a-mole right now. They’re starting to crack down. They closed down some stem cell clinics in Florida, for example.

What you have is a lot of chiropractors that are taking out ads claiming to do amniotic stem cell procedures. Not only do these things not contain stem cells – we tested them and it was all dead tissue – they’re regulated to be dead tissue. If they actually did contain live stem cells it would be considered a drug product and that could land someone in federal prison.

Reed: So, for you, from a business perspective, this has to be a huge problem because you’re getting grouped in with these scam artists.

Centeno: Well yes, we’re invested in doing this the right way. We’ve been doing the research. We see patients from all over the world now, because we’ve been doing this for so long.

But I think what we’re seeing in the field is that it’s becoming extremely scammy, and the biggest example of that is when we started seeing this dead tissue amniotic stuff come in, with chiropractic offices advertising these treatments as legitimate.

Then it started getting crazy because despite some of these claims, we know there’s no way to regrow a new knee for someone with severe arthritis. But you’ve got chiropractic offices going out there telling patients that they can basically regrow them a new knee. These are 80-year-old patients with severe arthritis in their knees and none of these claims are remotely true.

Reed: So, people can basically throw out a shingle and say they’re in the stem cell business?

Centeno: Right now, yes. I mean these people are buying amniotic fluid usually that is regulated to be dead, treating it like a live stem cell treatment and calling it good.

Reed: So, there are some muddy waters out there in stem cell land, but what you’re doing is significantly different and patients are getting measurable results.

Centeno: Yes, for example, with ACLs – athletes and non-athletes – if you answer the ad in the paper, go into their free seminar in a chiropractic office, or wherever, what are you going to get? You’re probably going to get a physician’s assistant – God knows where the physician’s assistant’s supervisor is – who’s going to inject dead tissue into your knee. Who knows where that ends up or if it even gets into the knee.

On the other hand, what we do with an ACL is a bone marrow aspiration under guidance. We process that for about two hours in the lab. We then inject that while imaging the knee. We’re looking to make sure we get the proper origin and insertion, in order to make sure that we can document that we got cells where they need to go. This process takes about an hour compared to the 20-30 seconds it often takes for a lot of the scam treatments.

We have a randomized, controlled trial on our procedure. We’ve published our first paper on it. We have a second paper submitted to a journal. We have pre-and-post-MRIs showing there’s substantial healing in the ACL. So, it’s definitely a little frustrating to see what these scam stem cell centers are doing.

With these scam centers, 100% of the people walking through the doors are candidates, as long as they have credit cards. With our clinic, we tell 30-40% of the people that this procedure isn’t going to help you. You need to go get your traditional ACL surgery done.

Reed: What percentage of traditional orthopedic ACL surgery is unnecessary, or doesn’t work today?

Centeno: A lot. Over 50%, for sure. For example, we know that meniscus surgery — a meniscectomy — removing the torn part of the meniscus, is no better than placebo or physical therapy. We know that from three randomized, controlled trials.

Meniscectomy accounts for about 96% of all meniscus-related surgeries. The rest, the remaining 4%, is meniscus repair, which can work if the meniscus tear is in the right place, and especially if the patient is younger.

Meniscus surgery is the most common orthopedic surgery in the United States.
We also know that a lot of rotator cuff and spinal stenosis surgery is ineffective. For example, a randomized trial showed that it doesn’t matter if you do a fusion or not in spinal stenosis surgery, you get the same result.

As our interventional orthopedic procedures continue to evolve in the coming years, the percentage of unnecessary orthopedic surgeries will continue to increase.

Reed: Do you treat UCL injuries, i.e., the elbow injuries that typically require Tommy John surgery?

Centeno: Yes, we treat Tommy John – UCL — injuries quite a bit. It has to be the right kind of tear within the ligament to be a candidate for our treatment. That said, we’ve been doing bone marrow injections in UCLs for seven or eight years. It’s quicker recovery and less down time.

About 70% of those getting Tommy John surgery could get the injection and experience less down time because with our procedure you’re not trying to reattach something and then keep it absolutely immobile.

Reed: What have you done to educate NFL, MLB, NBA and NHL franchises about regenerative medicine and interventional orthopedics?

Centeno: I lectured two years ago at the NFL Combine, which is where the NFL’s physician society gets together. We’ve seen a lot of NFL players. We have autographed pictures of 30 or so NFL players on our walls.

Quite a few sports orthopedic centers are doing these procedures now. However, too often they haven’t been sufficiently trained, or they don’t have the right equipment. For example, they typically use ultrasound machines to guide their needles, which doesn’t produce the best results.

But their focus is different than ours. Our goal is to avoid surgery, that’s what we hang our hat on, and that’s not necessarily what’s happening at the average orthopedic surgeon’s office. It’s more, “Let’s give this a try and see if it works. If not, we’ll just do the surgery.”

Reed: What’s the recovery time with your procedure on ACL injuries vs. the typical orthopedic surgeon’s recovery time with traditional ACL surgery?

Centeno: About half. The average ACL surgery recovery is at least six months, and to get back to the playing field it’s about nine months, minimum. Our goal is getting athletes back to playing in the four-to-five month range.

Now, that’s for appropriate candidates. About 30% of the people we see we say, “We can’t help you, go get the surgery. This is likely not going to work for you.”

Reed: What about the side effect profile for your stem cell and PRP injections vs. traditional surgeries?

Centeno: This is not a surgery; it’s an injection, so there are fewer side effects. That’s the whole focus of interventional orthopedics, why we’re doing it.

Reed: What are you seeing with teenage athletes these days?

Centeno: Well, it’s a big problem in the sports medicine field. We’re seeing younger and younger athletes, some around 14 years old, getting major surgeries.

There’s one study out now that shows athletes getting ACL surgeries as teens will have osteoarthritis by the age of 30. So, obviously, that’s huge. And so our thought process with these young athletes is to say, “Why are we doing this? Why are we subjecting these teenagers to invasive ACL surgeries? Why don’t we just try to get those ACLs to repair without surgery through regenerative medicine and interventional orthopedics?”

Reed: Why is the United States, through the FDA, looking at some of these types of procedures as a drug? That’s not the case in other countries.

Centeno: What we have here in the United States is a pharma-based market. And pharma is still trying to get its arms around this type of treatment.

The FDA is going after some of the crazy stuff that’s happening with stem cells and I will give them credit for that because there is some crazy stuff going on.

Reed: There are quite a few critics out there who say your treatments aren’t proven through things like randomized controlled trials. What’s your answer to them?

Centeno: We have done and are doing the research. We just did our first randomized, controlled trial in knees. That was positive and is being submitted for publication. We are in the middle of another trial now. We are doing everything we can to prove that this works. It’s expensive but the onus is on us.

Reed: Where do you see this going in the next 10-15 years in terms of its impact on traditional sports medicine?

Centeno: We’re already seeing traditional sports orthopedic clinics incorporating PRP (Platelet-Rich Plasma Injections) and stem cell treatments with traditional surgery.

We are going to see the rise of what we call interventional orthopedics, similar to interventional cardiology.

We will see a split orthopedic market. We’ll see orthopedic surgeons doing surgery. And we’ll see interventionalists doing interventional procedures.

We’ll see more data on both approaches and the United Healthcares of the world will have some decisions to make. For example, do I want to cover an ACL injection for appropriate patients and drop the surgery for those people and do I want to cover the surgeries just for the ones that don’t work with the injections?

I think that’s probably what we’ll end up seeing. It’s certainly a lot cheaper if you’re United Healthcare to go the injection route vs. the surgery route, especially when you consider the complications side of traditional surgeries, because they’re responsible for that part as well.

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