Since starting my specialty in Interventional Regenerative Orthopaedics, I have been amazed at the ability of the human body to heal itself. When we harness this unbelievable capability and deliver it to the patient using precise image guidance to the area of need, the potential is endless.
The complexity of the human body has interested me since I was a young boy and this passion has grown immensely since I commenced my clinic, OrthoRegen. Over the last two years, I have been working tirelessly on investigating the function and interactions of cells and the many growth factors they produce. A particular area of interest has been nerve repair and regeneration. So, can orthobiologics be used to heal damaged nerves? Whilst, there is much work to be done, this case shows us we can regenerative nerves by harnessing what lies within the human body.
The Case of Deep Peroneal Nerve Damage
A 29 year old male underwent bilateral fasciotomies of his lower legs for a condition called compartment syndrome in September 2016. Compartment syndrome is a build up of pressure within a muscle compartment, which can lead to compression of blood vessels and nerves that traverse the muscle compartment. A fasciotomy is a surgical procedure where the muscle compartment is "cut" open to release the pressure within this compartment. In this case, the excision for the fasciotomies were on the anterolateral side of the proximal lower legs. This region is where an important nerve called the deep peroneal nerve is situated.
Post-operatively, it was found he had a left sided foot drop. He was unable to raise his foot at the ankle joint and extend his big toe. He also had some mild sensory loss which improved over a few days. Initially, the surgeon commented that it was due to swelling around the deep peroneal nerve and that once the swelling settled, the nerve should return to normal function. The patient was placed in a brace called an Ankle and Foot Orthoses or "AFO" and discharged from hospital. Unfortunately, the left sided foot drop never returned and the deep peroneal nerve damage was confirmed on multiple nerve conduction studies. These studies measure nerve function and unfortunately in this case, the deep peroneal nerve had absolutely no activity.
The patient presented to OrthoRegen at the end of 2018, approximately two years after his surgery. I took a detailed history and performed a thorough examination. It was clear that the deep peroneal nerve was damaged. The patient had a complete left sided foot drop and loss of extension of his left big toe. He was obviously devastated by this complication. It had affected his ability to play sport and he had to wear the AFO brace constantly in order to walk normally. The video below shows his foot drop and the lack of function.
Pre-Treatment Video
When this patient presented to me, I was on the verge of completing a proprietary system in which I could harvest and concentrate certain growth factors important in the repair of nerves from a patient's blood. The patient was very keen to try this treatment and so we began treating his deep peroneal nerve in early 2019.
Treatment consisted of precise, ultrasound guided injections to multiple areas of the left deep peroneal nerve using the patient's own growth factors obtained from his blood cells . We treated the damaged nerve on eight occasions approximately one month apart and the video below shows the amazing results we have achieved.
11 months Post-Treatment Video
Two weeks ago, the patient presented me with a Christmas card and gift. He has given me permission to share his comments in this blog post. It is extremely fulfilling and humbling to receive such thanks from our OrthoRegen patients and instils us with the motivation to continue to push the boundaries of what can be done with regenerative medicine. Like all my patients, I feel extremely honoured that this patient trusted me with his medical issue and that I was able to change his life for the better and improve his quality of life. He is currently commencing rehabilitation with our Exercise Physiology team and is back playing sport and is very happy that he hardly needs to wear the AFO brace!
Dear Dr Schiavo
Merry Christmas!
I thought I would use the festive season as an excuse to reach out and extend a huge thank you for all that you have done for me over the past year. I truly can not thank you enough. You have literally changed my life. Not only physically with helping me to walk again, but also mentally with helping find peace in my head and get my confidence back. I hope you like plants, as I got you a peace lilly as a little token of this.
Merry Christmas again. I hope you have some amazing time away with your loved ones planned over the silly season and have the time to recharge and get excited about 2020. I know I am! RG