The Future of Regenerative Joint Repair - Episode 347

I raised my hand up and then Dr. Murray said, Mark, you have a question? I said, yes. Is there any way to cure arthritis? Is there any way to grow cartilage back? Is there any way to repair a knee and not replace it? And the chief resident pointed at me. He's like, no, there's no way. That moment I realized there was such thing as a dumb question, but a light bulb kind of went off in my head and I said, I'm going to prove that guy wrong.

Welcome everybody to the Gladden Longevity Podcast. I'm your host, Dr. Jeffrey Gladden. And today we're going to be speaking with an orthopedic surgeon. His name is Mark Petropoli. He's a very innovative orthopedic surgeon that's been involved with a procedure to repair the ACL when it's been freshly torn. It's called the BEAR procedure. We're going to talk about that. We're going to talk about many other things with regards to regenerative orthopedics. And he wrote a book, Repair Not Replace, and he's on a mission to end joint replacements, actually. So this was a very fun and interesting conversation. He has a sophisticated approach to getting somebody's joint to heal. I think you're going to really enjoy hearing this.

He went from saving hearts as a cardiologist to rewriting the entire aging playbook. Dr. Jeffrey Gladden believes 100 is the new 30, and he's got the science to back it up. This is the Gladden Longevity Podcast.

So Dr. P, welcome to the Gladden Longevity Podcast. It's good to see you.

Great to see you, Dr. Gladden.

So, you know, you are working in a really interesting field, and I love this field of, you know, regenerative orthopedics, this idea of rejuvenating as opposed to replacing. And maybe we can start off with the audience and just talk a little bit about your own transition from traditional orthopedics, which I'm sure you were trained in a traditional fashion, into kind of this regenerative reparative space. Not everybody makes that kind of move, and there must have been something that stimulated it, either curiosity or your own knee or something. But anyway, maybe talk us through that.

Yeah, absolutely. No doubt. Thank you for having me on, and thank you to your audience. And that's correct, I'm a sports medicine fellowship-trained orthopedic surgeon, regenerative medicine specialist, And that means I was truly trained in orthopedics and sports medicine. So I still perform very minimally invasive surgeries. But regenerative medicine, obviously, as you know, and your audience knows, is our bodies have an amazing ability to heal ourselves. And so I was very fortunate in my training and how things went along that I was exposed to that. So, but it really, it kind of first started just that, you know, I knew I wanted to be an orthopedic surgeon. I wanted to go into sports medicine. My uncle was the original Dr. Patrick Pauley. He was an internist and he said, well, if you're going to go into sports medicine, you have to be an orthopedic surgeon. So I was like, okay, I'll be an orthopedic surgeon. So my first day of orthopedics as a third-year medical student when I was in Syracuse going to medical school was at the end of my third year, literally about 35 years ago. And, and so I found out I was going to be watching Dr. David Murray perform a knee replacement, and he's one of the original inventors of knee replacement surgery. He was also our chairman of orthopedics. So I got there really early the next day, and I'm a third-year medical student, so kind of a peon, and and the junior resident said, hey Mark, you're not gonna scrub in, but you know, stand in the corner there, feel free to watch everything, you know, don't touch anything. And then he said, you know, but feel free to ask any question because there's no such thing as a dumb question. You know how that goes in med school, right? You did it.

Sure.

So the patient gets wheeled into the room and the nurses transfer the patient onto the operating room table and the anesthesiologist puts the patient to sleep. And then Dr. Murray walks in, he's a tall stately man, glasses on, and he and the chief resident's there and he's gonna take the chief resident through the the case. So they prep and drape the patient, and then Dr. Murray says, knife, and they hand the knife to the chief resident. And so they start the surgery, and next thing I know, there's like this incision about this big, and there's saws and drills and hammers, and there's blood and cartilage and bone flying all over the place. And at first I was very excited. I was like, wow, this is really cool. My dad taught me how to use power tools, and I get to use power tools to fix people. Who would've ever thought of that? But as I watched it and I saw all that cartilage and blood and bone flying all over the place, I'm like, there's gotta be, a better way to repair a knee or cure arthritis. So I remembered what that junior resident said about asking the question. So I was kind of afraid, but my mom always said, you know, feel free to ask questions. So I raised my hand up and he looked at me like, this guy's going to actually ask a question, but he didn't say anything. And the nurses kind of scowled at me and the chief resident scowled at me and the anesthesiologist's eyes opened wide. And then it was just complete silence. And so I was about to put my hand down and Dr. Murray looked over his Spectacles and he said, Mark, you have a question? I said, yes, Dr. Murray. First of all, thank you so much for letting me be here. This is amazing. But my question is, is there any way to cure arthritis? Is there any way to grow cartilage back? Is there any way to repair a knee and not replace it? And before Dr. Murray could even say anything, the chief resident pointed at me. He's like, no, there's no way to cure arthritis. There's no way to grow back cartilage. There's no way to repair a knee and not replace it. So, I mean, at that moment I realized there was such thing as a dumb question and I was also very embarrassed. But a light bulb kind of went off in my head and I said, I'm going to prove that guy wrong. So it's kind of selfish. I was like, I want to prove that guy wrong someday. So 35 years later, you know, I've written a book, if you can see it, Repair, Not Replace. And but that was, that was my impetus. You know, my dad had a, had a hip replacement and I tried to—

That's a profound— let me just interrupt. That's a profound moment, quite honestly. Right. I mean, that's a, that's a deeply profound moment when you, you bump into the dogma. Right. And you see just how deeply rooted the dogma is to to the point where, you know, any person off the street would ask the question, you know, can we repair this, right? Do we have to tear it apart and put in a prosthesis? Anybody on the street would ask that. And yet inside the hallowed halls where, you know, doctrine is basically taken over and everybody's waving that flag, there's no room for that question. That's one of the tragedies of medical training. I think we were all brainwashed, quite honestly, as we came through. And then it's just, right?

Amen.

And it's just a question of whether or not you can be curious enough and stand outside of it and, and re-ask what's actually the obvious and most important question. So kudos to you.

Yeah, well, I appreciate that, you know. And then, but I will say, Dr. Murray afterwards came up to me and he was like, well, that was a really good question. Sorry for that, you know. There's no way to cure arthritis right now, but maybe someday you'll come, you'll join us in the lab, and you'll figure it out. So I actually did join him, and I was, and I was trained traditionally, you know, to be a surgeon you have to learn a lot of surgery, but I didn't really learn how to take care of patients very well in the office or outside of the operating theater. So when I went and did my fellowship with Dr. James Andrews, who's, you know, the greatest sports medicine doctor of all time, I went with— learned how to actually take care of patients. Yeah, he might do 20 surgeries a day, but he could have done 60. He had great therapists, he had great athletic trainers, he had great strength and conditioning people, nutrition people, just a great team. I learned the team effort and I learned that probably 80% of the people he saw, great athletes, but also moms and pops, even my knee, you know, they ended up not needing surgery. Now I did need surgery, but about 80% of people ended up not needing surgery. So that told me, you know, that there's something to this. You don't have to operate on everybody. And Dr. Andrews would even say the mark of a great surgeon is knowing when not to operate. Yeah. And, you know, so when I came back to the New York area after my residency and my fellowship, my father was being told he needed hips and knees replaced and everything. And I was like, Dad, I don't think you need that yet. There's a lot of things I learned. But, you know, the parents don't listen to their kids because it's payback for us not listening to them as we were growing up. So he got his hip replaced and his knees, and he ended up, you know, he did okay. But 10 years later, he got a hip infection.

Hmm.

From probably his teeth, his mouth, you know, that once you put metal and plastic in someone, there's always a chance it can get infected however many years down the road. And, you know, so long and short of it is he, you know, that ended up leading to his demise in the long run. And so I think that, yeah, I had the trigger point 35 years ago, but when that happened with my dad, then I'm like, I'm going to, you know, I'm going to really— it's time to do something about this.

And how long ago was that? How long ago did that happen to your dad?

That happened in 2015. Well, 2013 was when he had the hip infection.

Okay.

But it lasted a good, you know, I mean, it was a disaster, multiple surgeries and they never were able to put the hip back in. It was just a disaster. So I had been dabbling in some of these things I learned during my fellowship, et cetera, PRP, early PRP, laser therapy, non-invasive things. And then, you know, then I started learning more about this stuff and the stem cells and all that thing, all that stuff. And in 2020 hit, COVID hit, and I put it all together. So that's kind of my evolution.

Okay, nice. So I think, I think you just mentioned something very important, and this is what we've come to understand is that in any therapeutic response, there's the components and then there's a sequencing of those components. And so in your world, why don't you explain the components that you are on the shelf that you can draw on and then how you choose which components and how you sequence them in, in a particular situation, but Maybe we can do that.

Yeah, I mean, components and sequencing is huge. And as we get— I just got back from the IOF and the TOBI conference, which are orthobiologic conferences, regenerative medicine. And I think the more we learn, the less we know. You know how that goes.

Yep.

And so cells know what to do, and now we're talking about exosomes and nanoparticles and peptides and all these other things. And the sequencing, like you said, that's the hard part. Like, we don't really know that, but cells kind of— cells know how to do that stuff. That's inherent them. But as far as the sequencing and the tools that I have, I'll kind of break it down. I'm a gardener. And so I like to use the gardening analogy with my, with my patients. So I like to let them know that inflammation is kind of like weeds in the garden. You know, it's going to choke— weeds choke out all the good plants and weeds eat up all the nutrients so the good plants can't grow. So same thing. Inflammation is not just some— it's cells. It's it's factors, it's cytokines, it's, it's all these different chemicals, but it's also cells. So they choke out all your, all your, all your good things and prevent your good, your body from healing itself. Or if you take stem cells from your, your bone marrow and you try to implant them somewhere there, if your body is systemically inflamed, it's not gonna work as well. It's not, it's not a good environment. It's just like in a garden, you're gonna get rid of the weeds, you're gonna put topsoil down. So the topsoil is kind of like, your nutrition. And the way we figure that out is we use a genetic-based swab, and we figure out what people's diet is best based on their genetics. It's not as simple as that because there's epigenetics and everything, but figure out what the best nutrients are— real nutrients, real food that you can go to the store or go to the— or go to a restaurant and order so that you're on the most anti-inflammatory, most nutritious diet. Those are the building blocks. And then getting rid of the inflammation— A, the diet, but B, we also use red light laser for that. We have a 635-nanometer red light laser that, you know, to make matter simple, it opens up the pores on the fat cells. The fat drains into your lymphatics, and then you eliminate it naturally. And fat is very inflammatory, so the more fat you can get rid of, the better. And the more visceral fat, even better, as you know.

Mm-hmm.

But if people just— I always tell people, you know, you may lose 2 or 3 or 4 inches of fat on one treatment, but if you go home and drink beer and eat Twinkies, you're gonna fill those fat cells back up. So that's where the diet comes in. So we try to get the inflammation down and we try to get the nutrients right. So we call that preparing the fields, kind of getting the fields ready to plant. Then, you know, you're not going to grow plants by just putting fertilizer down or just watering, right? You need, or just having sunlight, you need seeds. And so cells do the work, as I always say, and you can get stem cells or, you know, there's other cells that help the stem cells, the bone marrow. I like to use the bone marrow, but fat has those in it. Every area of our body has some stem cells in it, but the best places to get them are obviously our fat and our bone marrow. And I prefer the bone marrow. And so those are the cells and they're going to be like the seeds. If we have an area that needs to be repaired, like a knee, then we're going to use those in that area and implant those into the area where we think that it needs to be to heal the bone, especially because that's really where most of the pain comes from with arthritis, but also the tendons, the ligaments, the soft tissues, the muscles. And those are this kind of like this, the seeds, and those are going to grow and spread and do all the work and, and, and help the area heal. But then I also like to use fertilizer in the garden to help those plants grow stronger. So we use platelet-rich plasma, PRP. We take the blood, spin it down. I'm sure a lot of your users know about it, or even, or listeners have heard about it or used it. But it basically, platelets are those things that when you cut yourself, you form a scab, you stop the bleeding so you don't bleed to death, but they have growth factors and they release those growth factors and that stimulates new blood vessels and cells to come in the area. So It's kind of like the fertilizer. And then we use laser. It's kind of like sunlight. I mean, you can grow a garden in the shade, but it's not going to grow as well as if it's in the sunlight. And the same thing, studies have shown and our registry has shown that if you use laser, certain healing lasers with these treatments, that it will work synergistically and you will get better results. And then you need someone to tend to the garden. And that's our total body fitness people. You know, if someone has a knee problem, chances are there's a back issue, a hip issue. An ankle issue, we look at people from head to toe and we try to figure out there's, there's some mechanical issue that usually that's causing or imbalance or thing like that. So our total body fitness people are all medical and they're all strength and conditioning and they're going to evaluate people from head to toe. Now there's other things, you know, there's hormones, there's peptides, there's all those other things, but mostly those are kind of that, that's kind of the garden analogy that I like to use. And honestly, that pretty much applies to everybody. Diet and exercise applies to everybody. Maybe you don't need cells sometimes. Maybe you don't need PRP, laser. If you're in pain, I mean, it's great. No needles, no shots, no side effects. But those are the components. And then the biggest thing I think is figuring out what's wrong with someone. So we call that a clarity day. And that's where we spend, we'll spend 4 or 5 hours with someone figuring out what's wrong with them first before we even decide what we're going to do. So we use those general principles, but we tailor it to each person's goals and needs, if that makes sense.

Yeah, it makes perfect sense. You know, it's interesting. We do some regenerative procedures here. We're not orthopedists, but we're, but we, you know, We get involved with some things, knees and shoulders and things like that. And basically it's, what's interesting is to hear the parallels. Our approach is to actually decrease inflammation first. And one of the ways we do that is with diet, with some supplements we know that will decrease inflammation, SPMs and special pro-resolving mediators, as well as, you know, omega-3s, adequate vitamin D levels, all those things. And then in addition, we'll do total plasma exchange. So we do plasmapheresis. To actually get rid of the inflammation.

Yeah, tremendous.

Right, with albumin and saline. And then, right, and then we bring them in and we'll use laser-activated PRP, put it in there along with cord blood and placental rejuvenation factors. And then we put in some hyaluronic acid and we put in some ozone at times as well.

Yeah.

And then support that with ongoing peptides.

Tremendous.

Yeah, so it's kind of a sequence. And sometimes people need, you know, more than one procedure to get where they want to go, which is okay too. But it's interesting that we've kind of landed on similar components and also a similar sequence.

Parallel evolution, right?

Yeah, exactly right.

Well, it's basic stuff though. It's, I mean, it's nothing new. The ancient Greeks knew this stuff, right? I mean, the diet, the ex— let food be their medicine, medicine be their food. We've known exercise is important. We have more advanced ways of maybe testing things and figuring things out, or, or maybe speeding things up, hacking things, whatever you want to call it. But it still does come down to, you know, you can inject all the cells into somebody, you can inject the PRP, but if you don't have a good host or the inflammation's not down or they're not going to maintain themselves, it's going to, it's going to break down. Even the greatest car, the greatest airplane or spaceship is going to break down if you don't maintain it. We're more complicated than any of those things.

So tell us a little bit about the genetic testing you do relative to food. We do, you know, food sensitivity testing and gut testing and things like this to look for signs of inflammation, more occult signs of inflammation, if you will, which of course has an impact on the brain, but also on the systemically in the joints as well. And we use genetics to give us an idea of food intolerances and histamine release and, you know, things like this. But it sounds like you're doing something analogous but maybe a little bit different. So I'd be curious to hear about that.

So it's a cheek swab and it goes to the lab and it's about a 32-page report. Mine's around here somewhere. But we have a health coach who is very specialized in diet and she will go over that and we do have other doctors who can interpret that if need be and/or ourselves, but she really handles most of that. But basically the bottom line is it's about a 30-page report and it comes back with, you know, the macros first. So what percent, you know, what percent proteins, carbohydrates, fats. And a lot of people I think are surprised that they need to eat more good fat. Like they always think they don't need to eat fat. And actually a lot of people come back where their percentage should. And of course that's going to create, you know, a fullness feeling, satiety. That's right. And people don't realize that. So once they realize that, you know, get rid of the seed oils and eat the good fats, it's pretty amazing. So that's kind of one part of it. Then there's the micronutrients and what form of micronutrients. Then there's sensitivities, there's allergies, and also there's exercise, which is interesting. So my report came back that I am an endurance athlete. Well, I didn't know that, but, you know, I used to play soccer, which is, I guess it's kind of, it's sprinting and it's endurance, but Once I went to college, I didn't play soccer and I, I roomed with a lot of cross-country and track athletes. So I started taking up just running and running. And I got, you know, the more stress that you have and the more you went through medical school and the farther, the longer and longer I would run. And I've run 7 marathons and a bunch of other long runs over my years. And it turns out I followed my genetics. Not everybody does. Some people try to be an endurance athlete and they just can't be. They can't, they're not meant to. So I think that helps us with our Vmotion Fit people as well, can help them tailored the right exercise program. It doesn't mean you can't— I mean, human body's amazing, right? Even your diet, what it says on the genetics doesn't guarantee that's what actually you're presenting with, what your epigenetics is, what you— how you actually present. Like, I'm supposed to not like bitter food, but I love dark coffee, you know, I love black coffee and I love red wine. So your genetics is one thing. You can't just go by only your genetics. You have to interview the patient and introduce things slowly.. And that's what our health, you know, our nutrition health coach says. She's really awesome doing that over 3 months with these people and getting them on the right diet that they tolerate the best, that, that matches their genetics. But it doesn't always match the genetics 100%. Like, I'm supposedly lactose intolerant, but I just ate yogurt. I, I tend not to have any issues with— I'm allergic to cats, but we had cats growing up. So you're— how you express your genes, it can be different. And can actually change based on your diet, your exercise, everything, as you know.

Yeah, I think in a lot of respects we do quite a bit of genetic testing here, and for, for me, it's like your genes are not your destiny. For the most part, it's really a set of proclivities, and then it's the environment in which you, you know, bathe those genes, if you will, that determine how they're expressed. So we're looking to, you know, optimize expression.

Absolutely. That's a great, it's a great expression— optimize expression. That's exactly what you're trying to do.

Yeah, exactly. No, that's, that's very, very cool. You know, you made a really interesting point about seed oils, and I think that these are now coming into the mainstream as people starting to understand that how inflammatory they are and how they really are ubiquitous almost when it comes to any kind of packaged product. There's— I've only found maybe one or two things in a grocery store like Whole Foods that doesn't contain seed oils. But even in a quote-unquote healthy kind of approach, these things show up over and over again, and they're, they're so inflammatory. So it's, uh, it's really very interesting that you mentioned those.

I have a question for you on that as well. Do you think that it's more how they're prepared and extracted? Yes. Yeah, right? I mean, I think if they're—

the damage that's done in that, in the extraction process and the heating and—

yeah, totally. I mean, that's not 100%, but that's a big part of it, I think.

That's right. I think that's right. I mean, you could take linoleic acid, right? So I mean, if that's, you know, exogenous, then that's pretty inflammatory, but your body you know, make some of it, right? So you're going to have some, and there it's not. So again, I think it's, it's how these things are processed. It's the idea of processed foods and processed oils, you know, soybean, sesame oils, you know, all these different ones. So what are you excited about when you think about sort of next steps? What's on the horizon for you when you think about, well, I've learned how to be a gardener, and we're pretty good gardeners, uh, but we can always be better gardeners. So what are you thinking about as next steps?

Well, I mean, our mission, first of all, is to end the need for knee replacements for basically on those two stories. One, the story how, you know, I was kind of embarrassed and it happened to be a knee replacement I was watching. And my dad's was a hip replacement that got infected. So you can kind of translate that. Obviously, if we can end the need for knee replacements, we can probably end the need for hip replacements and other joint replacements. But that's our overall mission. And that does excite me. And it's nice to have something that you really believe in and you really want to do. And so our mission is really to be knee replacement-free by 2043. And the reason it's 2043 43 is because we kind of started that in 2023. It also rhymes, so I kind of like that. But if we, you know, if we could put a man on the moon and bring him back in the '60s, there's no reason we can't end the need for joint replacements. Now, how are we going to do it? Right now, we're treating people too late, in my opinion. I think you're on the right track trying to prevent people from getting to the bad point in the first place because that's the most important thing. So right now, there's a ton of things that we can do to help joints that are already pretty far damaged. And that includes the stem cells and that includes the PRP. And, you know, I was just at this conference, you know, exosomes are a hot topic. There's pluses and minuses to that. Using other people's cells, using other animal cells, using mew cells. And there's all these different things out there. And some of them we don't even have close to access in the US yet. I was in Dubai before all the conflict. And there's a lot of doctors doing a lot of different things. But that's all treating after the fact. So, number one, getting the word out. Like, I wrote a book, Repair Not Replace. Hopefully you got a copy of it. If not, we'll send one. But it, I go through kind of at the end. The first step is getting the word out. And thank you for letting me get the word out. But a lot of patients, I mean, 90% of patients or more, probably more, have no idea that there's another option. They're just told, yep, you gotta have a knee replacement or suck it up and pain till you need a knee replacement. So the first step is just getting people. I get excited about telling people that there's a third option. They get excited about it. It's like, wow. There actually is an option where we can repair things. Yeah. So me getting the word out first, and we're partnering with the Arthritis Foundation to try to raise $1 million to get the, the word out there. Then yes, we are advancing with all these new gardening techniques and things that we can use, all these other cells and things that I was talking about. But really it's still gonna come down to a little bit more simpler thing. It's gonna come down to prevention and being proactive. So, you know, the diet and the exercise and all that stuff, getting, that's the hardest thing is the prevention and all that stuff and the proactive. But I can tell you one thing we can prevent. We can prevent ACL tears. You know, the ACL is the main ligament inside the knee that stabilizes as people are running and cutting and pivoting. And once somebody tears their ACL, even if you go in there and you reconstruct it and make a new ligament, they still have a high risk of arthritis. It's, it just pushes it off 12 to 15 years.

Mm-hmm.

So two things. One, there's, there's simple programs, 6-week preventive programs that teach people, especially females, because it's 5 to 10 times more common in females.

Right.

Teach people how to run, cut, jump in the appropriate way, use the right muscles in the appropriate balance, train the muscles in the appropriate balance, and lessens the risk of tearing that ACL by 50 to 75%.

Yeah, that's massive.

Yeah, because most of those injuries are non-contact. The person's not even getting hit.

Right. They're twisting or turning, right, in a run, or, or they twist an ankle or something like that.

And their knee is too extended or too valgus to knock lead, or the muscles aren't balanced to and those are all preventable. And so preventing, just doing that can prevent a lot of arthritis.

So what would be an example of those exercises? What kind of exercise would you do to kind of, to me it's a little bit about proprioception. In other words, keeping the joint aligned properly as you're knowing where you are in space, right? That's a piece of it. And then the other is it's going to be some tendon and ligament strength and some muscular strength to kind of keep the knee aligned so that it has resilience when it does take some sort of a hit or unexpected twists, right?

So part of it, so that's, and, and that's kind of the plyometrics, proprioceptive type things, uh, in therapy while someone's standing on, you know, a balancing thing, throwing a ball at them and talking to them, you know, those things are really higher level things. But some of this other stuff is even a little simpler. You just have them jump off of a box and you watch their knees. If their knees expand and you take video of it, and if their knees become knock-knee valgus, It's simple. You train them hip over knee over ankle every time they land, every time they land. And then females especially, but even males, you— when you land, you want to bend your knees. You want to flex more. The more flexion, the less chance of injury. Just like if you're skiing and you're going to fall and you know you're going to bite it, bend your knees and wipe out. You're not going to probably tear anything. If you extend your leg to try to stay up, you're gonna— that's when they tear. So those two things are really simple, and you can videotape and you can show the athlete. And then it just, it's just become, it is kind of proprioceptive getting your reps in, landing the correct way, flexing enough correctly, then how you cut and you pivot. But also females, interestingly, when you pull the tibia forward, the shin bone forward, their quad fires first, most of them.

Interesting.

Which pulls it even more forward versus the hamstrings, which are protective and flex the knee and are protective of your ACL. So just retraining them to fire their hamstring first instead of their quad is a huge thing. So yes, all the things you mentioned are part of it, but it's even, it's like when you look at the program, most of it's pretty simple. Now you can get really high level and even be more proprioceptive, plyometric, you know, strengthening, videotaping, balance, all those things are big, but it's really, they're not the most difficult exercises in the world. There's even like a warm-up, but you can do a dynamic warm-up program for 5 minutes before each practice, and that will— it won't cut the risk as dramatically as going through a full 6-week program, but it will significantly still cut the risk. So most, most athletic trainers nowadays know to at least do a dynamic warm-up program versus your static stretching like used to be done, right?

Yeah, I know, that's a really good point. You know, what we find too is that because everybody sits so much these days that the glutes stop firing, and when the glutes stop firing, then the quads got to kick in and take over, right? And the the back has to kick in. And so a lot of back pain, you know, and you're talking about quads firing first, if you can train the glutes, then all of a sudden you can bring everything back into balance between your back, hamstrings. Yeah.

The glutes are definitely part of it. That whole, that whole lower extremity. I mean, even, even your core, it, it starts the whole body. Definitely that kinetic chain of your extremities, including your core, but even the upper body plays a factor in the lower body.

I've seen some interesting studies that they've done on plyometrics. And for the audience, what plyometrics are, basically jumping up and down is probably an easy way to understand it. Hopping on one foot, hopping on two feet, jumping up on a box, jumping down off a box, you know. So basically it's, um, it's jumping around.

Yeah, it's kind of an explosive movement after— it's kind of like you jump down and then you jump up. It's so— and different versions of it, but it's kind of an explosive movement. After a less explosive movement, but it's a kind of a jump type movement.

And even skipping can be sort of a plyometric kind of scenario to some extent, just so people can relate to that.

I think you mentioned something important as well. You said two legs and one leg. So you want to master the two legs first before you go to the one leg. And then when you master the one leg, then you start getting into the more advanced things. So, because so many people are so weak, they are They're so weak on one leg, but they try to go to one leg before they're even good on two legs.

That's right.

So you gotta start with two, master that, go to one before you start. So people think you do two and then you can go on the field and play. No, you go two to one, because when you're running, you're mostly on one leg. So absolutely what you said was gold right there.

Yeah, no, that's right. And the interesting thing about it in the studies was that you can actually build up a higher concentration of fast-twitch muscle fibers, which, you know, fast-twitch muscle fibers are going to be more power-based, more speed-based things like that. And we tend to lose those over time through the aging process. And also because we're not, we're not doing plyometrics. When we were kids, we were running around, jumping off stuff, you know, all that. And then adults were walking and were maybe jogging. And all of that is basically reinforcing slow-switch muscle fibers. So it's very important not only to improve proprioception with like balance boards and Swiss balls and things like that, but it's also important to do some jumping, hopping, skipping, two legs, one leg, up on a box, down off a box, because you're, you're not only making yourself more resilient, you're actually making yourself quicker. And when you have quickness and you have balance, now you can start to develop agility, right? And so that's really, I think when people are agile, they can run down the stairs, right? Then they've actually developed something that's, you know, youthful and that's—

Or they can avoid falling when they're, when they're, you know, when they're knocked off balance because they're agile. Which is, you know, you fall and break your hip, those people, one-third of those people die within a year. One-third.

I know it's, it's shocking. Yeah. We stress balance here so much and have for years and years and years. We do this little thing that I learned from a guy, Justin Franson, who's in Orange County. He's an ath— he wrote a book called Athleticism and he trains people to be ambidextrous. But one way he does that is to have them walk in a figure 8 with their eyes open, their arms out, just a figure 8, right? Then close your eyes and walk the figure 8, right? Then open your eyes and now walk it backwards. And close your eyes and walk it backwards. It's really, it's really good. I mean, if you want to become a good dancer, oh my gosh, if you do that, if you do that, I need to do that then. Okay. All right. If you do that, I swear, here's the challenge.

If you do that, my son's getting married in 6 weeks. I'm going to start doing the 8, the figure of 8. Figure 8.

Yes. I swear. Yeah. You'll have to shoot me a text to let me know how the dancing goes, but you will be stunned if you do that for a week or 2. Yeah, it'll be like, oh my gosh, you know where you are, your feet are moving. It's just like, it's beautiful. Yeah. So all of this is regainable.

How large of a surface area do you need?

Yes. So that's a great question. So you can do it in a bigger space. Like you can do it in the space of a, let's call it a parking space, right? You could do it inside that parking space or a little bigger, or if you're in a hotel room, you can actually do it almost in microspace.

Right. Perfect. Yeah, absolutely. Hotel room is perfect to do that in, and in a parking space, people probably think there's this crazy guy out there doing that, but, you know, I'm starting to try.

I'm over that, you know, they don't know what they don't know, so it's okay. I really don't care what other people think.

Well, that's smart. That keeps your stress level down, that's for sure.

Yeah, for sure. Well, that's cool. So tell us a little bit about ACL repair because I know that you have been involved with this BEAR procedure and maybe you can talk a little bit about how this is different from replacement or some other things and who might be a candidate for it and some things like that.

Well, it ties right into what we were just talking about. So ideally we prevent the injury but, you know, you know that if someone plays soccer or football or whatever, someone's going to collide with them and you can't prevent the collision ACLs and you probably can't prevent some of the non-collision ACLs. So people who play sports or active or in the military or whatever, ski, some people are still going to tear that ACL. So when that ACL tears, it kind of, it's like a rope, it kind of breaks apart and it's kind of all shredded and the ends are all shredded and the inside of the knee is filled with fluid. So those ends can never meld back together. Even if you sew them back together, what happens is our knees hate having blood inside our knee because when you tear something, it bleeds, right? And usually it bleeds because it forms a clot in between the two torn ends and that acts like a bridge for your blood vessels, your cells, your nerves to grow across so it heals. But inside the knee that doesn't happen because it's fluid and so that fluid's floating around and there's enzymes in there that dissolve the, the blood. And so even if in the old days even the Greeks tried to sew the ACL back together and it usually doesn't heal because you don't have that bridge gets dissolved unless it's torn right off the bone and that's a different exception. So, We went from trying to repair them in the '50s, '60s to doctors like Dr. Clancy was one of the guys who trained me, who developed reconstruction. So we take a strip of tendon from the kneecap or the quad tendon or the hamstring tendon, or even a donated tendon, cadaver tendon, those aren't as good, at least at this time, and drill a bunch, drill some holes, shave away all the old torn ligament, drill some holes and put a new ligament in there. And then it has to kind of revascularize and remodel, and it takes, it takes a good year to 18 months to kind of really get back. But it does do a very good job of stabilizing the knee. So people can get back playing very high-level sports, professional sports, after they tear their ACL, even a couple times sometimes. But the problem is you tear your ACL, you got about 50% chance of getting arthritis within 4 or 5 years. If you tear your ACL and you undergo a reconstruction, you'll get back to sports, but it doesn't lower your risk of getting arthritis. It just pushes it out, you know, 10, 15, 20 years. So if you're a 14-year-old and you tear your ACL, 15 years from now you're only 29 and you got a really high risk of arthritis.

Right.

So the BEAR surgery, Bridge Enhanced ACL Restoration or Repair, Dr. Martha Murray, I did not, I do not take credit for developing this. Dr. Martha Murray at Boston Children's, she came up with a collagen implant that is soaked in your own blood and sewn in between the two torn ends and it won't dissolve right away. The body will slowly dissolve it, but it takes 8 weeks. So during that 8 weeks, that's enough time for your new blood vessels and cells and nerves to grow back across and heal that ACL. So now you keep your own parts. And importantly, like you said, you keep the proprioceptive nerve fibers, your position nerve fibers. So I think that's one of the reasons why if you don't have good proprioception, maybe that knee is going to degenerate, or maybe you're going to put more stress on your other knee. And people who have an ACL reconstruction are just as likely to tear their other knee as they are to retear the first knee.

Yeah.

Yeah. Whereas if you do the BEAR, number one, animal studies shows that it prevents arthritis. And now the FDA has come out after the human studies and human, it's out there in humans for long enough that it does lessen the risk of post-traumatic arthritis significantly. So my first one I did was in 2021. I was not able to be in the study group, but I was able to be the first one to do one outside the studies. It was FDA approved back in 2021. So I have a lot of experience with it. And yes. It's a lot less risk of arthritis. You can still tear it again just like an ACL reconstruction. So that's why that rehab and everything is still important but it does significantly lessen the risk of arthritis. It feels more normal. You have less risk of tearing your other ACL. And if you do tear it, it's kind of like you're starting from an ACL recon— primary reconstruction which usually does well. Whereas if you do a reconstruction right off the bat and you tear that and you need a revision, those results aren't as good. So it's kind of like starting a step ahead, even God forbid if you're, you know, one of those 10 or 15% who retears it, because even with a reconstruction and you go back playing sports, you could reinjure it.

So it's a collagen, it's a, it's basically collagen, which is protein.

Yeah.

Okay. Bovine collagen. So it's, so collagen's kind of tough. And then when, when you make that bridge, is it that you are overlapping it with the healthy portions of the tendon to create the bridge? Do you, and how far do you overlap it? Do you overlap it all the way down? Down to the insertion of the tendons or? Good question.

Yeah, so it's interesting. You'd think when you look at this thing, it looks like a packing peanut and it's pretty big. It's a couple inches long by, you know, I don't know, a centimeter and a half wide. And it's very porous and it's very hydrophilic, meaning it absorbs fluid and absorbs blood very easily. So once you put the blood in it, what you actually do is you sew some stitches in the stump of the ACL and you put a couple stitches through the implant and a couple stitches through that. And all you have to do is get that implant in between the ends. You don't have to pull it really tight. The body knows what to do. So as long as you get that implant in between, it almost forms a hydrogel. So it almost kind of coats the— you know, it actually doesn't stay solid, which is interesting. You think, oh, it needs to stay solid, it stays in there. It forms a hydrogel and it kind of coats everything, and that allows the, the body to heal through it.

So it knows Yeah, so you're not overlapping it a ton, you're overlapping it enough for, for structure.

It doesn't, the ends don't always even touch at this point because—

Okay. Oh, interesting. So you can have, I get it, it can be a true bridge. It can actually be a bridge. Okay.

It's a bridge.

Interesting. And they'll, and it'll grow, everything will grow back together across the bridge. And the blood that you're putting into it, do you ever put PRP into it or things like that?

Okay. Now, that's off-label. So, but the answer is—

that's where we live, off-label.

Yeah, of course. As long as something has an indication, you can use it off-label as long as you let the patients know. And so there's tons of examples of that, as you know. But so interestingly, in the studies, they looked at PRP, soaking it in PRP, soaking it in blood. There was no difference.

Okay.

But what they didn't look at was using bone marrow concentrate, which is— so I enjoy— I love putting cells in there, bone marrow concentrate.

Nice.

And PRP and blood. I do all 3, which is again, that's off-label. But I mean, knock on wood, we haven't had anybody retear who we've done that on. So, you know, I'm sure that'll happen at some point, but we, it seems like they recover faster anecdotally and that we have not had anybody who we've done that on retear, including like MMA fighters and skiers and people like that. So I love using that.

You know, I would suggest if you're not doing it to consider the peptides here. You know, the BPC, the GHKCU, and the TB-500, because we've had such good success in helping people recover from virtually any surgery in half the time that it may help those people recover that much faster from the surgery and may even make the integrity of the, of the graft, if you will, or the repair that much greater. I don't know, but it's a thought.

Well, I definitely, people are using BPC-157 for sure for that. And there are, I'm definitely not the expert at peptides.. But I do like the direction that hopefully things are going in the next, uh, you know, month or so here. And I certainly believe in them and would love to talk about where you source yours from and all that stuff too. But, uh, I, I do, I am a, I'm a believer in that. And, you know, even certain types of hormone therapy and things like that.

Yeah, for sure. Hormones are very important.

Yeah. Even laser works for that too. So it's, it's pretty amazing.

Yeah, no, that's cool. When you do the laser for your knees and things like that, do you, is it a course? In other words, we, we tend to use the laser, this particular laser that we use here in the office, the day prior to the procedure to kind of prime the area. Then we do it the day of the procedure. And then we use a different laser kind of after that can kind of continue the healing process. And people can even take that home and use it for a while. So I'm just curious kind of what your what your scenario is.

Preparing the fields is big. So if, I mean, everybody's different, right? Some people need to get it done right away, et cetera. But the ideal scenario is we do, they do maybe get, you know, if you're going to talk about just specifically laser, ideally it'd be nice to get 1 to 3 treatments before any procedure or surgery. If you do a surgery, I do not, this is how powerful lasers are. This is how I, one of the reasons I know they work. If you perform a surgery on somebody and you do the laser the next day, You will see a massive amount more bruising because there's all those, you know, there's all the raw blood vessels in there that all of a sudden you're— before they're completely clotted up and sealed over, you're adding laser, which is increasing blood flow, and those people will bruise like crazy. So I usually wait 3 days after a surgery. I had been chicken to start laser till 3 days after Regenerative Procedures, but now we've been doing that and we don't have any issues with like, if you're doing an injection, we'll start it the next day. We will photobiomodulate our PRP as well. And I, we personally don't laser the same exact day, but there's no reason not to either before or after. I know people who do both. We'll even do BFR, blood flow restriction, on a bike for 10. Yeah, we'll do that on a bike for 10 minutes before we draw their blood or draw their bone marrow because obviously that increases some of the growth factors for, you know, maybe an hour or so and, and even the growth hormone goes up. So, you know, is there any studies that definitively prove that's gonna help? No, but it's certainly not gonna hurt. And you're, you know, BFR is great. We love it. So we use that a lot too.

Yeah, that's, that's really interesting. The blood flow restriction. We like blood flow restriction, but we haven't done it just prior to a procedure, but I don't see a downside to it at all. In fact, I, to your point, I think it could be good. We know it's actually gonna boost growth hormone release endogenously, and you can augment that with a little CJC-1295 and ipamorelin. So yeah, that's a cool piece. Yeah, there you go. We have a bike and we also have a Vasper. Expert here, which is blood flow restriction exercise.

So yeah, love it.

All right, cool. So where can people learn more about you? I know you've got a book out there, Repair Not Replace.

Yeah, so go to Amazon, just type in Repair Not Replace, and that's one thing. All our contact info is in there, but victoryinmotion.com, victoryinmotion.com, Dr. Mark Petropoli on any of the socials, or Victory in Motion 1 on any of the socials, all the socials we're on. And 315-685-7544. 315-685-7544.

Okay, cool. And you're located where in New York?

We are located in Skinny Atlas, New York, which is near Syracuse, up in the Finger Lakes. It's a beautiful region, especially this time of year. Great place to, to come. Skinny Atlas, look it up. S-K-A-N-E-A-T-E-L-E-S. It's really beautiful.

Okay, people flying to Syracuse, I guess, to get you.

Yes. Yeah, there's a small— I mean, some people— we had a farmer come from Michigan recently and flew into right to the Skinny Atlas. Okay. But it's a smaller plane there, that's for sure.

Beautiful. Well, it's been a pleasure chatting with you. Appreciate you taking the time.

I appreciate you having me on. And thanks to all your listeners.

How do we live young for a lifetime? How do we make 100 the new 30? The answers are out there and we're bringing them to you every episode. Make sure you're subscribed. Check out more episodes right here and follow us on social media so you never miss a breakthrough. Thanks for listening.