The BIOS Orthopedic Institute

Alberto J. Panero, D.O.

Regenerative Orthopedics Specialist & Sports Medicine Specialist located in Sacramento, CA

While the cartilage at articular surface of the joint has always been the primary focus of arthritis treatments, recent studies continue to highlight the importance of treating the bone underneath. This area, referred as the “subchondral bone”, bone underneath the cartilage can become inflamed and diseased. This bone inflammation is called subchondral edema, and because it increases the pressure inside of the bone, it can be quite painful. Furthermore, it sets a negative inflammatory cycle with the cartilage below it, leading to further breakdown of the joint.

With the advent of orthobiologics and interventional orthopedics, we can now treat the subchondral bone by performing intraosseous injections of PRP or BMC. Sometimes we have to use a bioactive scaffold like demineralized bone matrix (DBM) to help the bone heal.

There are now multiple studies that show that by treating the subchondral bone along with the cartilage can slow down the progression of arthritis, and prevent the need for joint replacement.

Our protocol at B.I.O.S is to do a series of treatments. For instance, in the case of knee arthritis that has subchondral edema or bony changes, we perform a series of 3 injections including PRP or BMC into the joint. At one of the visit, we will also perform an intra-osseous injection in to the site of bony pathology under x-ray guidance.

This injection can be painful while its happening, but quickly resolves after the injection is over. We protect the area by modifying your weight bearing for 5-7 days afterwards, and typically recommend using a compartment unloader brace for 4-6 weeks after the injection to help with healing.

Dr. Panero is extremely professional and takes the time to explain in detail his diagnosis and opinion. He is also willing to listen to your concerns and needs.(Some orthopedic doctors I’ve meet with have not been as open minded.) I really like his approach to rehab and regeneration. It is refreshing to not have a Dr. want to immediately operate or medicate you. Nice courteous staff, reasonable wait time and the office is very accessible with a parking garage. Parking fee, I paid $1 for 30 mins, cash only.

Ronald Z.

Initial consultation went well. Looking forward to the next few appts to get back to total health.

Andy W.

I just had my first visit with Dr. Panero and found him to be knowledgeable and personable. I appreciate the fact that he was straightforward with my options for treatment, which are limited due to the nature of my orthopedic problem. I will continue with his recommended injections.

Karen L.

Dr. Panero is an amazing physician who truly cares about the wellbeing of his patients. His entire team is dedicated, thorough, and professional who makes sure all appointments go smoothly even with the ongoing pandemic. Dr. Panero recommended PRP for my elbow tendinitis and truly advocated for me to get the treatment I needed to improve my chronic pain. I am so grateful to be one of Dr. Panero’s patients!

Rena S.

Very personable and knowledgeable presenting options for the problem and then going forward from the choice made. I would definitely recommend him to friends and family! Office staff is fabulous as well.

Jim M.