Oliver Starr is no stranger to pain. The 49-year old former professional road and mountain bike rider is also a hard-core skier, big wave surfer, and avid outdoorsman who is a lifelong wolf advocate and trainer. It comes as no surprise that he has endured his fair share of accidents and injuries over the years.

Most remarkable is his recent recovery from an accident that tore the anterior cruciate ligament (ACL) in his knee joint.

The injuries were sustained while Starr was enjoying a day on the slopes. Feeling on top of his game, skiing hard and fast, Oliver was pushing himself physically and testing the limits presented by the steep terrain. The snowpack, however, had a surprise in store. Upon entering into an unexpected patch of “Sierra cement” – a particularly unforgiving, dense, wet snow – his speed and direction shifted very abruptly. The sudden impact literally ripped his knee apart and rendered his leg useless. Starr decided to remove the ski from his injured leg and continue down, skiing on the good leg, backwards at times, until he finally reached the parking lot.

Starr had an MRI at Barton Memorial Hospital and was evaluated by top US Ski Team orthopedic surgeon Terry Orr, who explained to him that his injury was irreparable, and he would need an ACL reconstruction using patellar tendon allograft. Rather than proceed with surgery, Starr wanted to try an experimental procedure – namely an ultrasound-guided bone marrow aspirate concentrate (BMAC) injection of cells between the torn ends of the ligament. He went to see Dr. Marko Bodor, Director of Research for Napa Medical Research Foundation.

Dr. Bodor had already successfully treated him in the past with platelet rich plasma (PRP) injections for the injured discs in Starr’s spine. He knew it was Dr. Bodor he wanted to see about his ACL. Dr. Bodor began by explaining that there was no guarantee of success with the bone marrow aspirate concentrate procedure. He proceeded by harvesting bone marrow from two locations on the back of Oliver’s hips and created a concentration with a centrifuge in the lab.

The hardest part would be the injection. Dr. Bodor had to precisely visualize the defect using ultrasound, then pass a needle into the gap between the torn ends of the ligament and at its proximal and distal attachment to ensure direct delivery to the damaged areas. Additional injections of platelet rich plasma were also administered to further promote the regenerative process.

Starr was advised to avoid dynamic movements for 4 weeks, after which he approached his rehabilitation with typical intensity – working hard with his physical therapists, optimizing his nutrition to support recovery and basically living in a DonJoy brace to ensure a stable environment for his knee.

Within 6 weeks, Oliver was able to do a single leg squat with his injured knee, a major milestone. At 6 months, MRI performed on the same machine, with the same protocol and radiologist reading the scan, showed complete regeneration of the anteromedial bundle of his ACL.

The follow up MRI, taken one year after the procedure, showed complete regeneration of both bundles of ACL in his knee.

For Starr, “It was an unequivocal success.”

Recognized for his expertise in diagnostic and interventional ultrasound and regenerative treatments, Dr. Bodor comments, “We are always happy when we are able to diagnose and treat, for instance, chronic problems that were thought to be incurable. In the case of Mr. Starr, however, we are frankly amazed that healing of a completely torn ACL was possible. We are doing our best to learn from his case and determine how successfully this could be done in other patients.”

PRP and BMAC harness the healing power of the human body. With PRP, a patient’s blood is drawn and spun in a centrifuge to yield a high concentration of platelets that are re-injected into the affected area. The platelets work like nanorobots, pulling torn collagen together and binding everything within a sticky fibrin matrix. Platelets also secrete growth factors to promote increased healing, recruiting stem cells that are able to differentiate into various cells needed to continue and complete the repair process. With its small concentration of mesenchymal stem cells (MSCs), the bone marrow can also be extracted from the body and concentrated in a manner similar to platelets in PRP.

We think that in Mr. Starr’s case, they were able to promote healing by instigating new cell growth and, together with the PRP, pulled the cellular structure of the ligament back together and held it there so the bonds would reform and the ligament reconstitute its structure.

Through the advances being made in the leading-edge field of regenerative medicine, Oliver Starr gets to continue living his life to the extreme.

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