Research & Publications

Dr. Panero maintains a true passion for research and the advancement of sports medicine. He is currently working with the UC Davis Center for Regenerative Cures in Sacramento, CA on stem cell research.  One project is looking at the role of mesenchymal stem cells in patellar tendinopathy, while the other is trying to decipher whether amniotic tissue actually contains viable stem cells ant their clinical relevance. 

In addition, he is faculty for various musculoskeletal ultrasound courses and is an associate editor of the Sports Review Journal. He continues highly involved with his academic role at UC Davis, through the department of Physical Medicine & Rehab.

Dr. Panero has published multiple journal articles in his specialty, including topics such as platelet rich plasma (PRP), musculoskeletal ultrasound, and concussion. 

Check out some of the Highlights Below!

A Guide to Ultrasound of the Shoulder, Part 3: Interventional and Procedural Uses

Am J Orthop. 2016 November;45(7):440-445. Author(s): Alan M. Hirahara, MD, FRCS(C)

Alberto J. Panero, DO

Ultrasound is an extremely useful diagnostic tool for physicians, but recent advances have found that ultrasound’s greatest utility is in interventional and procedural uses. Numerous studies have demonstrated a significant improvement in outcome and patient satisfaction when using ultrasound guidance for injections. Newer techniques are emerging to use ultrasound as an aid to surgery and interventional procedures. This allows the physician to use smaller incisions and less invasive methods, which are also easier to use for the practitioner and more cost-effective.

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 Platelet-Rich Plasma or Hyaluronic Acid Intra-Articular Knee Injections for Early OA, Which is Better?

Sport Rev J. 2016;1(6). Author(s): Raghunanandan A, Panero AJ

Recent literature has supported the use of platelet-rich plasma (PRP) in clinical practice as a minimally invasive intra-articular injection option over the more commonly used hyaluronic acid (HA) for knee joint osteoarthritis (OA). PRP has been shown to have many positive effects on the joint micro-environment, however, the varying strength level of its evidence makes its use controversial. In view of this, Giuseppe Filardo et al. completed a level 1 double-blind randomized controlled trial to evaluate the effectiveness of PRP on early stages of joint degeneration and hypothesized that PRP would show a superior result compared to HA at a 12-month follow-up.

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A Guide to Ultrasound of the Shoulder, Part 2: The Diagnostic evaluation.

Am J Orthop. 2016 May-Jun; 45(4):233-8. Author(s): Hirahara AM, Panero AJ.

Ultrasound is becoming an increasingly accessible modality for its easy and accurate evaluation of shoulder pathology. In Part 1 of our series (Am J Orthop. 2016;45(3):176-182), we showed how musculoskeletal ultrasound can be properly coded and reimbursed and can be as effective in evaluating the shoulder as magnetic resonance imaging, yet more economical. With more physicians beginning to incorporate this technology into their practice, we describe the physics of ultrasound and our methods for evaluating the shoulder with ultrasound. In the coming year, new certifications are emerging that may be required to perform and bill for these services. Staying abreast with the current guidelines and protocols being introduced by the American Institute of Ultrasound in Medicine and the American Registry for Diagnostic Medical Sonography will be essential.

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How a Seemingly Minimal Physical Exam Finding Unveiled a More Serious Condition: A Case Report

J Med Cases. 2015; 6 (6):240-24. Author(s): Rothenberg J, Ross K, Harrington A, Panero A

Cerebral contusion following a concussion is a severely debilitating and possibly life-threatening condition that is not readily uncovered in American football players. We describe the case of a 16-year-old high school male who presented to a university-based concussion clinic 5 days post helmet-to-helmet collision with symptoms of nighttime headaches, dizziness, and difficulties with concentration and word finding. Neurocognitive evaluation demonstrated decreased visual and verbal memory, along with a very high concussion symptom score on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT®). Physical examination findings revealed lower extremity hyperreflexia with pathologic spread to bilateral knees and Achilles tendons. These focal neurologic signs prompted obtention of brain and cervical spine imaging, which demonstrated a right temporal lobe contusion and multiple cervical disc herniations. This case emphasizes the importance of a thorough neurologic examination. Failure to recognize these critical signs could have resulted in premature or unsafe return to play, ultimately exposing the athlete to the risk of additional trauma. Concussion is primarily diagnosed clinically and therefore imaging is not routinely obtained. Thus, fastidious upper motor neuron testing should be a fundamental component of the standard neurologic examination when evaluating players suspected of having a concussion.

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A Guide to Ultrasound of the Shoulder, Part 1: Coding and Reimbursement.

Am J Orthop. 2016 Mar; 45(3):176-82. Author(s): Hirahara AM, Panero AJ.

Ultrasound is an inexpensive, easy, mobile, dynamic study that has many advantages over other imaging modalities. Several studies have shown the need for an ultrasound during procedures, with significantly improved outcomes and patient satisfaction. Other studies have also shown that ultrasound has medical and economic advantages over magnetic resonance imaging. With the increased use of ultrasound in the office, operating room, and during athletic competitions, the need for accurate coding is essential. Reimbursement is viable for both radiologists and non-radiologists. In the coming year, “appropriate use criteria” will be introduced and implemented. Physicians need to be prepared and informed of all the necessary requirements and coming changes regarding the use and billing of ultrasound procedures.

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The Emerging Use of Platelet-Rich Plasma in Musculoskeletal Medicine.

JAOA. 2015 Jan; 115(1): 24-31.Author(s): Bashir J, Panero A, Sherman A.

Platelet-rich plasma (PRP) is one of many new developments within the expanding field of regenerative medicine. Specialists in areas such as orthopedics, physical medicine and rehabilitation, and rheumatology have been exploring the benefits of this novel therapy. Although PRP therapy remains controversial and has minimal clinical trial support, the use of orthobiologics such as PRP continues to advance as patients seek nonsurgical approaches to acute and chronic musculoskeletal injury and disease. However, academic acceptance, as well as insurance reimbursement, remain reliant on solid and repeatable positive results from large clinical trials. The authors summarize the evolution of PRP therapy and report on its status.

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Surrogate decision making in the case of a pregnant woman newly disabled with brain injury.

PMR. 2013 Jan; 5(1): 57-65. Author(s) Fins JJ, Hammond C, Tarsney PS, Panero A.

Brain injuries are never planned. Brain injuries also disproportionately affect young adults who are busy with young adult tasks such as school, selecting careers, dating, choosing whom to marry, and whether to become parents. Young adults have rarely spent much time thinking about advance directives or wills, and almost never have left guidance for decision making in the event of brain injury. Thus, brain injuries often pose some of the most difficult dilemmas in medicine and certainly for those who must make decisions on behalf of the person with brain injury, specifically, the family and healthcare team.

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Dr. Alberto Panero, DO

Regenerative Orthopedics Services

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Sacramento, CA 95816
Phone: 916-846-9990
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