What Every Knee Pain Sufferer Should Know About

Arthroscopic & Total Joint Replacement Surgery That’s Not Being Told To Them By

Most Doctors.

The “Interventional Orthopedics” Solution for Knee Pain That’s Attributed To An Injury or Arthritis.

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A Personal Message to Our Readers

Dear Knee Pain Sufferer,

When we set out to create this Patient Guide we wanted this to speak directly to people just

like yourself. Our goal was to provide you with real, outside the “Traditional Orthopedic”

medical box (Pain Drugs, Corticosteroid Injections and Sugery) way of thinking.

After personally consulting with literally over 17,000 joint pain sufferers within our California

Clinics and over 250,000 joint pain sufferers throughout our national network of affiliates…it’s

becoming more and more clear that the non-invasive, non-surgical, non-drug approach that

we’ve been a part of pioneering for the past decade, is revolutionizing the way forward

thinking doctors go about treating their patients with joint pain and injuries.

It’s our commitment to the patients we serve to provide them with the valuable information

they need to make the best and safest decisions for how they go about solving their joint pain

due to an injury, arthritis or other degenerative condition that may be involved.

We acknowledge that drugs and surgery have their place in medicine and in certain

circumstances there may be a strong necessity, however more and more studies have begun

to show that the “Traditional Orthopedic” model for treating common joint pain problems

with pain killers, corticosteroid injections, arthroscopic and joint replacement surgeries has left

hundreds of thousands suffering with the same pains they originally walked into their doctors

office with even after undergoing surgery.

Once you’ve gotten through the information and it makes sense, we want you to feel

absolutely comfortable reaching out to us to learn more and to find out if your condition may

be the right fit for one of our Advanced, Non-Surgical, Orthobiologic Procedures.

To Your Health & Healing

The Health Link Medical / Interventional Orthopedics California Team

California Clinic Locations:

Oceanside CA – Headquarters (Serving San Diego and Riverside County)

Laguna Hills CA – (Serving Orange County, South Long Beach/Seal Beach)

Beverly Hills CA – (Serving Los Angeles County)

San Rafael CA – (Serving San Francisco, Marin County, Sonoma County)

877-366-9735

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The Interventional Orthopedics Solution to Knee Problems

Knee pain can come from many things. All too often a quick MRI is taken and without a proper

workup or due diligence, a patient is told that they need surgery based on some finding. We

often see these patients…after the fact. Many still with the SAME or similar knee pain. Often

because what was seen on the MRI wasn’t the CAUSE of their pain.

In interventional orthopedics, we recognize that the body is actually one interconnected

machine, not a collection of individual parts and pieces. The hip, knee, ankle and foot are all

controlled by spinal nerves in your low back and operated by an interconnected system of

tendons and ligaments, which work as finely orchestrated interconnected pulleys. You might

think that if you have pain in the knee area, that it must be coming from inside the knee.

However, “knee pain” can come from many different areas including the spine, muscles,

tendons or nerves.

Problems like arthritis, or meniscus tears in the knee can obviously cause knee pain. However,

sometimes these MRI findings aren’t causing pain.

Some of the more common causes of knee pain include ACL, MCL, LCL injuries, cartilage loss

(arthritis), Meniscus injuries, Patellar Tendon injuries, Quadricep Muscle Trigger Points just to

name a few. Let’s review these problems, some of the potential sources, and the traditional

and interventional orthopedics solutions for knee pain.

Meniscus Injury

The Meniscus is a shock absorbing tissue that lives

between the Femur (upper leg bone) and Tibia

(lower leg bone) and functions as a cushion for

the cartilage in the knee joint.

Meniscus tears happen. If you are middle aged

and don’t have meniscus tears…you are rare

indeed.

However, when Orthopedic Surgeons see Meniscus Tears on an MRI and the patient has knee

pain, Meniscus Surgery is a common solution, so common it plays to the tune of over 700,000

surgeries a year.

The problem with this is that middle aged people WITHOUT knee pain are just as likely to have

meniscus tears, so a Meniscus Tear shouldn’t be assumed to be the cause of knee pain.

Despite this, it’s often assumed and surgery is performed.

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Of course, there are instances where a Meniscus Tear, such as a sports injury or a large

tear may actually be causing some pain. You may be thinking in cases like this, should I get

meniscus surgery? Is meniscus surgery, in either case, at least fixing the knee pain?

It’s such a common surgery, you would think so; however, all of the high-level research to

date shows that meniscus surgery is ineffective and it’s not helping pain any more than

physical therapy. In fact, meniscus surgery is creating the perfect environment for the patient

to develop arthritis in the future. Let’s talk about how a Meniscectomy works.

On the surface, a meniscectomy might seem simple enough: A patient has some knee pain,

an MRI shows a little tear in the meniscus, the surgeon correlates the two, and the patient

decides to have surgery. During surgery, the orthopedic surgeon will access the knee joint

and whack out the torn piece of meniscus. This is where it gets more complicated—the

meniscus tear may be gone after surgery, but so is a chunk of the meniscus, and nothing

good can come of this. Let’s explain.

The problem with Meniscus Surgery…

Think of the meniscus as a cork in a bottle. The cork is the right size and perfectly seated so

that the pressure within the bottle won’t push the cork out. If the cork is too short, however, or

unevenly seated, that pressure’s going to pop that cork out. The same thing happens with a

Meniscectomy. With a chunk of the meniscus missing, there is less meniscus to anchor it in the

joint and the meniscus tends to push right out of the joint. When that happens, the meniscus

no longer has the functional ability to properly protect the joint. Instability occurs and pain

can be very excruciating. It also causes further issues down the line as it increases wear and

tear on the joint.

Knee meniscus surgery is a bizarre topic for many orthopedic surgeons, sort of like a sacred

cow crossing the road in India. While the high-level research continues to show that cutting

out pieces of the knee meniscus doesn’t help patients, these surgeries are still common, and

many surgeons will defend their use. However, when does the research become so

overwhelming that all orthopedic surgeons have to give up routine meniscus surgery? Are we

there yet? Another study was just published that again shows that the procedures can cause

more harm than good.

It all began with the basic concept of a dirty room. When you place an arthroscopy scope

in a knee with damage and arthritis, the “room” looks to be a mess. We all hate a messy room,

so the first orthopedic surgeons to do this in the 1970s figured that “cleaning up” the mess

would help. This procedure is called “debridement” or “cleaning up” the knee. There is just

one little problem: in 2002, research was published comparing this surgery to a fake

procedure. In the end, the operation couldn’t beat the results of a sham surgery. So “cleaning

up the room” didn’t help.

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This problem study was the first self-inflicted blow for the modern orthopedic surgery that

demonstrated its inherent weakness: the research supporting that all of these invasive

surgeries helped patients was the poorest of any medical specialty. In fact, the British Medical

Journal classified it as “scandalously poor.” However, the 2002 study was just the beginning

of a much bigger problem. The most common orthopedic surgery in the world, meniscus

surgery, was about to have real issues.

Many patients believe that when they get meniscus surgery, the surgeon is repairing the

structure. However, this only happens 4% of the time; the other 96% of the time, the torn piece

is removed. So how well does this work? So far we have high-level research that shows that

surgery for meniscus tears with or without arthritis doesn’t work. We also have studies that show

that when there’s locking of the knee due to a meniscus tear, the surgery also fails to work.

So much for meniscus surgery.

While overwhelming research has shown that meniscus surgery is a bust, many orthopedic

surgeons refuse to yield on the topic. While the surgery may still be helpful for select patients,

given our knowledge of how poorly it works, when will most meniscus surgeries be relegated

to the dustbin of medical history?

Well a recent study (Osteoarthritis Cartilage. 2017 Jan;25(1):23-29. doi: 10.1016/j.joca.2016.09.013. Epub 2016 Oct 3)

revealed this conclusion…In patients with knee osteoarthritis arthroscopic knee surgery with

meniscectomy is associated with a three fold increase in the risk for future knee replacement

surgery.

ACL Injury

The ACL is a major stabilizing ligament of the knee

and surgical replacement is never like the original

equipment. ACL tears are common in sports, such as

football, soccer, and volleyball, that put a lot of

pressure on the knees. There are three very different

types of tears, and yet most patients only hear of

two.

Types of ACL Tears:

1. Partial ACL Tear

2. Complete Retracted Tear

3. Complete Non-Retracted Tear

When faced with ACL surgery choices, there are two types of common ACL grafts available,

but is there a difference? When an ACL is reconstructed using a tendon from another human,

this is called an allograft. When the ACL is reconstructed using a tendon from your own body,

this is called an autograft. But the differences don’t stop at the source of harvest; based on

a long-term study of ACL allografts versus autografts, allografts have three times the failure

rate!

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Let’s briefly explore the the importance of graft choice more in depth, however you first you

need to understand what an ACL tear is and what type you have and make sure ACL surgery

itself is the right choice.

Partial ACL tear—These ACL tears don’t require surgery,

and in our experience, they can be easily fixed with a

simple injection under x-ray guidance.

Complete Retracted tear—In these tears the ligament

has snapped back like a rubber band. Most patients

believe that when they see the phrase “complete tear”

on their MRI reports, they have this kind of tear, yet unless

you also see the word “retracted,” you don’t have this

kind of tear.

While complete retracted tears are likely to require surgery, be sure your tear is retracted; if

there’s even a small bit of fiber remaining, repairs may be possible without surgery. Also MRIs

can be misleading. We’ve seen patients with a grade 3 complete ACL tear on MRI but we

discovered that the fibers of the knee were mostly intact.

Complete Non-Retracted tear - On the MRI these tears

look like the fibers are torn all the way through the

ligament, but there’s still something holding the

ligaments together because it hasn’t snapped back.

We see lots of these ACL tears and have fixed many

through injection without the need for surgery.

So how do you find out what type of ACL tear you

have?

Check your MRI report for the word “retracted.” If you don’t see it, your ACL tear may be

easily fixed without surgery using one our Orthobiologic ACL Procedures (We’ll discuss

more in a minute). Also, don’t be dismayed if you don’t see the term “nonretracted”, as

radiologists only sometimes use the term.

Once you know what type of ACL tear you have, it’s time to decide if surgery is the right

choice.

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ACL Surgery Choices: Is ACL Surgery the Right Choice?

During surgery the natural ligament is torn out, and the graft tendon is inserted into tunnels

that have been drilled into the bone. No matter which graft is used, one of the big problems

with the surgery in general is that the graft tendon is inserted at a much steeper angle than

the original ACL.

Most patients don’t realize that there can be quite a few problems with the surgically

replaced ACLs. First, for example, with an autograft, the muscle that the tendon graft is taken

from never fully recovers its strength. Second, the operated knee never regains its normal

position sense to guide normal landing.

Finally, few patients ever return back to their prior levels of sports, and two-thirds of young ACL

surgery patients will have arthritis by the time they’re 30. In addition, the new surgically

installed ACL ligament has no ability to sense stretch, so the knee loses proprioception, or

sense of position. As a result, we often recommend to our patients that they consider newer

precise Orthobiologic Injection options, before considering a surgical ACL replacement.

However, let’s say you’ve made the decision and feel confident ACL surgery is right for you.

Now you need to consider your graft choice: allograft or autograft.

The Two Grafts: Allograft vs. Autograft

An allograft for an ACL surgery comes from a human cadaver donor, typically from a tissue

bank. Donor tendons that are commonly used include the patellar and the Achilles tendons.

An autograft for an ACL surgery is harvested directly from your own body. Tendons that are

commonly used include the hamstrings and patellar tendons.

A study presented at the American Academy of Orthopedic Surgeons Annual Meeting put

its hat in the ring to answer the question of whether an allograft or autograft ACL was better.

The researchers looked at 100 surgeries in young patients (ages 26–28) using either a tibialis

posterior allograft or a hamstring autograft from the patient. The grafts were fresh frozen, and

the patients were randomized (meaning the surgeons didn’t pick who got which ACL type).

The allograft group failed at three times the rate of the autograft hamstrings-tendon group,

which was different from other less-well-designed studies that had shown they were the same.

Why did they see this poor showing for allografts? First, while surgeons have thought for years

that recipients of ACL allografts don’t reject the ligament or tendon, there could be some

minor rejection of the foreign tissue. Second, and perhaps more likely, the preparation of the

graft could be causing the difference. For example, allografts are often irradiated to kill any

possible communicable diseases from the donor. A recent study showed a higher failure

rate in allograft ACLs that were irradiated versus those that were not.

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While an ACL autograft appears to have a lower chance of failure than the ACL allograft,

there’s still the fact to consider that the strength of the muscle the graft was harvested from

never fully recovers.

The upshot? While an autograft may be the better of the ACL surgery choices, it is still not the

ideal choice, and other options should be explored, especially if you have only a partial or

complete non-retracted ACL tear. You may be able to avoid the surgery altogether by

using Orthobiologics precisely injected into the ACL tear. However, if your tear is beyond that

scope, use your own hamstrings tendon for now to replace the ligament, as nobody wants

to undergo a big surgery with big downtime and not give that new ACL its best shot at thriving!

Total Knee Replacement Surgery…What You Need To Know

The sales tail has always wagged the dog in medicine. Meaning sales targets for drugs and

devices and aggressive sales reps have always determined more about what care is offered

to patients than actual medical need. One of the biggest areas of abuse has always been

orthopedics. In addition, one of the biggest abuse areas in orthopedics is joint replacements,

where a number of companies have sales reps in countless American operating rooms

forcing product down the throats of surgeons. Hence, it’s no surprise that academics now

believe that more than 1 in 3 knee replacements aren’t needed.

600,000-Plus Knee Replacements Per Year in the U.S. and Counting!

Knee replacements have more than doubled in the last 15 years, and these invasive surgeries

are being marketed toward and performed on younger and younger patients. A recent

study also suggests that by the year 2030, on the current trajectory, we could see a 600%

increase in the number of knee replacements (though I believe interventional orthopedics

will reverse this trajectory and we will actually see a decrease in knee replacements by 2030).

Why such a drastic increase in these surgeries?

While they should be reserved for only the worst cases (e.g., severe and debilitating bone-on-

bone arthritis), the current surgical orthopedics trend is to perform these in less-severe cases,

in patients who think getting a new knee is the answer to eliminating their pain and increasing

their activity. After all, the device advertisements show “patients” doing just that after a

supposed joint replacement. Unfortunately, especially in younger and more active patients,

many are finding reality doesn’t mimic the marketing. Why? It seems many of these surgeries

are unnecessary knee replacements as the patients don’t actually need a knee

replacement.

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How Knee Replacement Devices Get Sold.

At a recent large orthopedics conference, one of the large medical-device companies

bought out an entire street of restaurants to highlight its new robotic knee replacement

system! Think about how much that costs to pull off and you’ll understand how much money

is at stake if you can increase sales by more than one-third. Hence, knee replacement device

companies have had in place large programs to push these surgeries into the only growth

sector that exists for the industry—younger and more-active patients.

How this gets done is likely a mystery to most consumers. However, physicians get to witness

it firsthand. It’s been estimated that a third or more of the cost of a knee prostheses is the cost

of aggressive sales tactics among company reps. These sales people will traditionally attend

every case (if possible). Does the surgeon really need this help? Not usually. Which is why

orthopedic sales reps are usually chosen to be easy on the eyes. In addition, a rep that can

stay in front of a surgeon sells more product.

Another lynchpin in the sale chain is the creative ways that companies find to get money to

doctors in exchange for using their devices. This can include “medical director” fees, money

to fill out forms about prosthesis failure rates, or speaking fees. While this has become harder

for companies to pull off due to government rules, this just means that companies tend to get

more creative.

An organization called Propublica records these payments, so you can look up your surgeon

right now. As an experiment, we googled knee replacement in our town and then looked up

the first surgeon who popped up on the Propublica website. He got $143.000 in payments

from device companies in 2015! This is actually small potatoes as some of the bigger-named

surgeons collect 3–4 times that much in consulting fees from device manufacturers.

More than One in Three TKRs Are Unnecessary Knee Replacements!

One stucy examined information from a large data set called the Osteoarthritis Initiative. Only

those who’d undergone knee replacement were included in the study, which consisted of

205 patients. The purpose of the study was to determine whether each knee replacement

was appropriate or not. Researchers studied each patient’s preoperative data, including

pain, function, radiology images, range of motion, age, and so on and categorized each to

one of the following categories: appropriate, inconclusive, and inappropriate.

The result?...Over 34% of knee replacements were found to be inappropriate, leading

researchers to conclude that better standard criteria need to be developed for determining

the necessity of knee replacement. Think about that percentage! Over 34% of patients who

get a knee replacement don’t actually need one! That’s more than one in three of knee

replacement patients. And we don’t know what the “inconclusive” numbers represent (which

accounted for 27% of knee replacements); however, it’s reasonable to assume that if all of

the information had been available, some of those patients would have fallen into the

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“inappropriate” category as well, so the 34% of unnecessary knee replacements could likely

be higher.

Knee Replacement and Its Mixed Bag of Side Effects

So maybe you’re in pain, and you just want that new knee, even if there is a chance you’re

in that 34% category. After all, new is better right? Not in this case. Getting a new knee means

potentially getting a mixed bag of dangerous side effects along with it…and it may still not

address your pain.

Chronic knee pain is the biggest reason patients give for ultimately deciding to undergo knee

replacement. Unfortunately, however, the most common complication reported by knee

replacement patients is ongoing chronic knee pain, with nearly 40% averaging 3 out of 10

pain and some even reporting numbers as high as 5 out of 10. And the farther out from knee

replacement surgery (two years or longer), the higher the pain levels seem to rise.

In addition, your knee pain may not be due to your knee arthritis at all. It could be due to a

problem in your lower back. While you may or may not have pain with milder knee arthritis, a

pinched nerve or other damage in the back can refer pain all the way down its nerve branch

and into the knee. It could also be due to a loose knee ligament that simply needs to be

stabilized.

Function is another problem following a knee replacement. Most patients believe they will be

able to return to or even exceed their normal levels of activity. In reality, 19 out of 20 knee

replacement patients never obtain the increase in function they expected. Another

complication is for those younger patients (55 and under), 15 out of every 100 knee

replacement patients will only get a maximum of five years out of their new knee (while the

presurgery expectation is that their knee will last for at least 15 years). Younger patients are

more active, creating more wear and tear and, therefore, faster breakdown of the device.

Additional risks following knee replacement include spinal fractures, hip fractures, heart

attack, stroke, and blood clots, and much more, and the list keeps growing.

The upshot?...We’re seeing an epidemic of knee replacements because we have a system

that’s designed to push product and incentivize physicians to perform more and more

procedures. Hence, it should be no surprise that this and other research studies show that

there are way too many knee replacements happening. How can you avoid getting an

invasive surgery you don’t need? Get an opinion from a doctor who doesn’t do knee

replacements! If that physician still thinks you need one, then you probably really do need

the surgery!

Steroids, NSAIDs, and Other Drugs Not Recommended

Other treatments you will likely be presented with in the traditional orthopedics model for

knee problems include steroid shots or pain medications, such as nonsteroidal anti-

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inflammatory drugs (NSAIDs) and opioids. NSAIDs come with a long and growing list of

dangerous side effects, such as sudden-death heart attacks, stroke, and GI bleeding,

and addiction and overdose due to prescription opioids have reached epidemic

proportions in the U.S.

Steroid shots have been shown to destroy local cartilage in the joint (which can only

progress arthritis) while providing no significant pain improvement. And the list of

problems with steroid injections just keeps growing:

• Steroid injections weaken the tendons.

• Steroid injections damage tissues.

• Steroid injections are toxic to joint cartilage

cells. Steroid injections kill stem cells.

• Steroid injections suppress brain function.

Some supplements can be a good alternative for pain and inflammation. Chondroitin and

glucosamine have been shown to be effective pain relievers, and they preserve cartilage.

Curcumin can also relieve pain from arthritis and other issues.

The Interventional Orthopedic Approach

The Interventional Orthopedics Approach to the knee and the structures supporting it is to

precisely place (using ultrasound and fluoroscopy guidance) Orthobiologics, such as Bone

Marrow Derived Medicinal Signaling Cells (MSC’s) and / or Super Concentrated Platelet Rich Plasma

via a same-day guided injection procedure.

This patented process involves harvesting the patient’s own MSC cells and precisely and gently

reinjecting them back into the ligaments and other injured structures of the knee.

We want you to feel absolutely comfortable reaching out to us to learn more and to find

out if your condition may be the right fit for one of our Advanced, Non-Surgical,

Orthobiologic Procedures. Call us at 1-800-281-3757 and one of our friendly Education

Center Liason’s will be able to assist you.

How To Find Out If You’re A Candidate To Have Your Condition Treated

With Our Advanced Non-Surgical Patented

Orthobiologic Procedures……

Scroll Down To The Next Page

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How To Find Out If You’re A Candidate To Have Your Condition Treated

With Our Advanced Non-Surgical Patented

Orthobiologic Procedures

The first step in determining if you are a candidate is to undergo a Treatment Qualification

Consultation & Evaluation.

Here’s what is typically included:

➢ One on One Direct Meeting w/ our Doctor / Orthobiologic Procedure Specialist (4 California

Clinic Locations – Oceanside San Diego Area, Laguna Hills Orange County Area, Beverly Hills Los Angeles Area and San

Rafael San Francisco Area)

➢ Detailed Musculoskeletal Examination

➢ High Definition Diagnostic Ultrasound of the problem joint and surrounding tissues (if

necessary)

➢ Diagnostic Image Review of MRI, CT Scan or X-rays pertaining to your problem that you

may have previously undergone prior to your initial visit.

➢ Report of Doctor’s Findings indicating if your condition qualifies for treatment, what level

candidate you are based on our proprietary candidacy rating and which of our

Procedure(s) is most appropriate.

To schedule at one of our clinic location most nearest you or if you have further questions

related to the Treatment Qualification Consultation & Evaluation or the multitude of

Advanced Orthobiologic Procedures we provide…call us at 877-366-9735.

*The Treatment Qualification Consultation & Evaluation is often covered by most insurances including Medicare (not including

HMO’s).

**Insurance hasn’t caught up with our advanced technology and doesn’t cover our Orthobiologic Procedures. We do offer

easy monthly payment plans for those who may need assistance (based on approval from an outside lender we have

partnered with).

***We are currently partnered with several self-funded and self-insured companies that are offering our Orthobiologic

Procedures as part of their insurance benefits plan to their employees. Call to ask us if your company is part of our Corporate

Program.

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Health Link Medical / Interventional Orthopedics California Clinic Locations:

Oceanside CA – Headquarters (Serving San Diego and Riverside County areas)

Laguna Hills CA – (Serving Orange County, South Long Beach/Seal Beach areas)

Beverly Hills CA – (Serving Los Angeles areas)

San Rafael CA – (Serving San Francisco, Marin County, Sonoma County areas)