Pre-Procedure Explainer Repairing Torn ACL’s with Exosomes

Join host Susan Bratton and Dr. Jeffrey Gross to discuss the latest advancements in repairing torn ACLs with exosome injections. Learn about the benefits of this cutting-edge therapy and how it can help patients recover faster and with fewer complications. This pre-procedure explainer will give you a comprehensive understanding of the process and what to expect.

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Pre-Procedure Explainer

“Hello again, Susan Bratton here, and I’m here with Dr. Jeffrey Gross. We’re at We Celebrate in Henderson, Nevada, Las Vegas, but it’s nice to say Henderson. It is. We’re in Summerlin, a fancy schmancy area of Las Vegas. It’s wonderful. It’s very nice. And I came in today to talk to Dr. Gross because I had a ski accident, and he sent me to get MRIs. We learned that, unfortunately, I had torn my ACLS, which I did not know. So, we will do some exosome injections into my bones.”

“We are. And I wanted to know if Dr. Gross could explain why I’m doing exosome injections and not stem cells, what the difference is, and what the procedure will be like. Because I feel like this regenerative therapy is the cutting edge of healing for simple traumas like tearing tendons and ligaments and all those kinds of things. So, take it away.”

“Well, thanks. There are two main points to make here. First is what we’re injecting, and second, where and why. So, let’s start with the first one. I’m a big fan of exosome injections because many things were available when I entered regenerative medicine after being a neurosurgeon treating spines traditionally for over 20 years. There was PRP; there were stem cells, and now exosomes. Exosomes are the cell-to-cell messaging modality that tells cells to do something. In this case, when we take a youthful signal, a youthful exosome from a mesenchymal stem cell, that signal is a very youthful, regenerative, restorative healing signal. It’s an anti-inflammatory signal. And although healing does involve some inflammation, we want restorative, restorative healing.

“So, when one gets stem cells or even PRP, one is probably getting some exosomes because the stem cells don’t last all that long. And those exosome injections activate and stimulate someone’s stem cells. And at the ripe age of 57, and you’re almost 29 now, these stem cells start to get sleepy, senescent, and not too active. But they can be re-energized and reinvigorated by receiving a youthful signal. And that signal comes in the form of exosomes.

Even if someone receives stem cells, those stem cells give exosomes. The stem cells then don’t last too long, and they’re a wonderfully useful biologic ortho-biologic. But in this case, I can give exosomes at a much higher concentration that would take me multiple stem cell doses. And an individual stem cell dose would take multiple PRP doses to get that restorative effect. So, exosomes are the most efficacious and biggest wallet of our regenerative healing potential that someone can receive. Thank you.”

“I want to ask you another question about that. I’m going to come back, and we’re going to go into an operating theater. What are we doing? This is a procedure at the surgery center. Thank you, and you’re going to give me anesthesia, and you’re going to administer exosome injections into the bone where the ligament attaches to the bone, right?”

“Correct. Okay, because that’s where it’s torn off, pulled off the bone, and can tear further from it. But the bone is the source of our stem cells, the bone marrow. Okay, the area closest to that injury or that problem is called the subchondral bone, just under the cartilage or the joint. And we want to reactivate those subchondral stem cells because they will help the local cells deliver and produce the proteins and the collagens that created that ligament in the first place when we were a fetus. So, we want to try to restore that ligament. And if there’s a chance of having it heal, this would be a great way to accelerate that. So, the ligament grows off the bone; it grows out of it?”

“Yeah, the one way to think of this is our soft structural parts, cartilages, discs, ligaments, and tendons, tissues that arise from mesenchymal stem cells when developing fetuses. Babies come out with not all their bones formed; they’re still soft. But it arises from those stem cells. And as we develop and age, soft things still get their blood supply, nutrients, and new proteins. They’re regenerating proteins from the local bone. So yes, the tendons arise from the bone. That makes sense.”

“So, understand, you’re going to put exosomes, signaling molecules like, ‘Hey, come here and repair this. Bring your stem cells here.

“Yeah, right. You’re putting the communication devices where the growth needs to occur to regrow that ligament tissue out of the bone.”

“Yes, that’s essentially correct. For clarity, exosomes are derived from a stem cell, or any cell can make an exosome. And that exosome is a little bit of a membrane. It’s almost like a mini cell. It’s 50 to 100 nanometers in diameter, which is much smaller than a cell, measured in micrometers. And these exosomes have what the cell gives it. They have heat shock proteins, and we talked about that earlier, right? They help certain cells survive. It has other growth factors and peptides. You can also take them separately. It has micro RNAs that have been identified in secret tomes.

Secret tomes mean in the fluids of cells doing good things, healing, and anti-inflammatory. So, it’s this little packet of health and love, and we’re delivering it to another cell. And those cells take it in, telling the genes in those cells what to produce. It changes that factor. It says, ‘Hey, we’re not making airplanes anymore. We’re making cars. Switch over everything. We’re making cars because cars are what we need.'”

“Stem cells, I’ve heard the word pluripotent, which means I can make anything out of this stem cell. And the extracellular vesicles stimulate the stem cells to make the new tendon when you inject it into that area. Did I track that right?”

“Yeah, stem cells, the ones we use that I’m asking about, are great. And it’s like a little biochemistry class, but I like that. The stem cells are multipotent. They can develop into any of the tissues in the body we need. But they have things in common. They are restorative and anti-inflammatory cell pathway stimulation. And they suppress all the slow-down inflammatory pathways. Cells can become pluripotent; they can even be induced to become pluripotent. And we find pluripotent cells in our cells when we are just an embryo. And those, we still need to harness all the safety and things with that. So, okay, we use clinically multipotent stem cells. We want to activate multipotent stem cells, especially in an adult. That’s what we’re dealing with, for the most part.”

“Why are you so bullish on the exosomes versus stem cells? So many people are talking about using stem cells to repair my shoulder, rotator cuff, and ACL. Stem cells are the big conversation happening in the regenerative world. What is it that you prefer to use exosomes over stem cells?”

“Well, there’s nothing wrong with stem cells, just for the record. They’re super helpful. We have them; we want them in our bodies. We want them to work great. But with exosomes, I can give a much higher dose for the same cost and volume than I could with multiple doses of stem cells to get that kind of response, at least biologically. And that’s really what we’re going for. They’re easier to manage and deliver. And we are using them to stimulate our body’s very stem cells. So their stem cells know what to do. They know us well. I’m not here to say one is better than the other, necessarily. I’m a big fan of exosomes, and we have a great experience with them, and I hope to continue to gain that experience.”

“Alright, well, we learned a lot today about exosomes. And if you have yet to see the prior videos that I did, I’ve been here once before at We Celebrate, and I did an exosome IV. That was just to do a general cleanup of things that had been damaged in my body. Now, I wanted to use exosomes again to repair these tears that I didn’t even know I had, such bad tears.

I’m using exercise, red light therapy, cryotherapy, and the Vasper machine, which helps release my growth hormone. I’m also using Blood Flow Restriction to generate more and cooling to regenerate more. It’s an endocrine cascade of growth hormone, testosterone, and other things that help me generate my tissue and tendons. These are all the things that I need to do to fix myself. But I want to goose the system with exosomes.

So, Dr. Gross and I decided today that we want to get exsome injections, but we’ve got to inject it in the bone. It’s not just a general thing, so I’ve got to go under anesthesia. I’m going to come back, and we will do that. Any last things that you want to say?

Yeah, these are general anesthesia; this is sedation, and it’s mild. We do it at a surgery center because I have fluoroscopy, which is x-ray guidance. We can target the spot we see on the MRI, then get us close to the root of that ligament and give you the best chance to heal. It’s just slick and easy. It doesn’t take but 10 minutes, but it’s great. It is a bone injection, so I don’t want you to suffer from feeling the pain from that.

So, I was like, ‘I can take it,’ and he’s like, ‘I don’t think so.’ [Laughter] Well, I feel so happy to be under the care of Dr. Jeffrey Gross at We Celebrate, and I’m looking forward to returning. Well, we will shoot another video because we like to shoot videos. I want you to know the things that are available to help you grow your body back again. That’s what I’m all about—keeping ourselves young, vital, and feeling great. Getting rid of the aches, pains, and tears that come from having some fun sometimes as you age. So, thank you so much.”

“You’re welcome. Thank you anytime. You did a good job walking me through the logic of what we should do and how we should approach it. So, thank you so much.”

“Yeah, it’s my pleasure. Check out the videos we’ve done. They’re on my BetterLover channel and at I’ll see you on the other side. Thanks.

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