Autologous Blood Injections for patella tendonitis/tendonosis

[n285south]

 

Case history: patella tendonosis in both knees diagnosed earlier 2003 after years of running injured (stupid) and military training. Surgery to cut out cyst, scar tissue and dead tendon (left knee) in Oct. Tendonitis recurred - lateral release, debridement and patella "shaved" in April. Tendonitis recurred whilst still in rehab. Havenet started on right knee yet.

JUST ACCEPTED PLACE ON AUTOLOGOUS BLOOD INJECTION TRIAL for tendonitis AT THE WIMBLEDON KNEE CLINIC, PARKSIDE HOSPITAL, LONDON.

This is a new treatment that is not widely used. If anyone out there has received this treatment, please let me know your thoughts. If it has been suggested to you by your consultant/surgeon, you might want to keep on eye on this post.   

The trial starts on 21 Oct 05.

[The KNEEguru]

Thanks for that. I wonder how it differs from this study -

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15756611&itool=iconabstr&query_hl=5

[IanT]

Case history: patella tendonosis in both knees diagnosed earlier 2003 after years of running injured (stupid) and military training. Surgery to cut out cyst, scar tissue and dead tendon (left knee) in Oct. Tendonitis recurred - lateral release, debridement and patella "shaved" in April. Tendonitis recurred whilst still in rehab. Havenet started on right knee yet.

JUST ACCEPTED PLACE ON AUTOLOGOUS BLOOD INJECTION TRIAL for tendonitis AT THE WIMBLEDON KNEE CLINIC, PARKSIDE HOSPITAL, LONDON.

This is a new treatment that is not widely used. If anyone out there has received this treatment, please let me know your thoughts. If it has been suggested to you by your consultant/surgeon, you might want to keep on eye on this post.   

The trial starts on 21 Oct 05.

The internet is a wonderful thing!

I suspect that the blood injections will be targetting the tendinosis.

I have just started physio / rehab after receiving two sets of autologous blood injections for bilateral patellar tendinosis. My treatment was at Parkside as yours will be. Some early thoughts;

1) Not sure if there is etiquette / convention here regarding naming medical professionals, so will proceed with caution. However, I'm sure you'll be seeing the same guy as me. He is truly excellent. Conspicuous confidence and skill allied to a no BS manner. Exactly what I would hope to find. Patient before me was a well known former England cricket captain btw.

2) The injections (or more accurately the local anaesthetic that precedes) are quite exquisitely painful. I managed to have both knees done each time - better I thought to have two visits than four!

3) Expect a few sore / painful days afterwards. I was really only able to hobble about until day 3/4. Plan accordingly work / driving wise.

4) The physio / rehab, I understand, is critically important. Again, if you are seeing the same team as me then you'll find yourself in excellent hands. I've just started the program. First time back in a gym for over 12 months. Every other day, limited at present to 20mins on ex bike, level < 10, with lots of quad stretching etc.

I will be reporting in on my experiences here, and hopefully finding others following the same program. Keep posting!

Ian

[The KNEEguru]

What is the philosophy behind this treatment?

[IanT]

What is the philosophy behind this treatment?

I'm a patient not a medical professional, but here's my (probably over-simplistic) understanding:


- Tendinosis is a degradation of the fabric and therefore function of the tendon caused by a cycle of injury (possibly minor tear) - poor quality repair by the body - increased likelihood of further injury etc. - poor quality repair etc.

- Over time the tendon loses its structure and functionality as the poorly repaired material becomes prevalent.

- Ultrasound scan is the best / only way to confirm that this is occurring

- Blood is taken (from the arm as in a normal blood test) and injected, under local anaesthetic guided by ultrasound, into the affected area. Not fun!

- The blood injections may need to be repeated several times

- The blood facilitates (or increases the likelihood of) regeneration & repair of the dysfunctional area of tendon when combined with a carefully constructed physio / rehab exercise protocol pursued over a period of several months

- The exercise protocol comprises stretching intended to promote the alignment of regenerated fibres in the tendon along with increasing loading over time through dips etc.


I'm just starting the exercise program - 10 days in at the time of posting - and will post here about my experiences in the hope that others may do likewise....

[IanT]

My carefully calibrated rehab programme seems to be going ok. I have now added short spells of jogging to my treadmill sessions, and am more comfortable doing dips than before. Still can't do a one legged dip with my left leg however...

As I seem to be making some progress, I'd be interested to hear from others who have had the autologous blood treatment. How is it going for you?

[old_runner]

Does anyone know if this procedure is being used in the United States?

[mee]

When I googled it, there was a U.S. study done for the injection to treat tennis elbow.  Here's the link.

http://www.davidlnelson.md/LateralEpicondylitisBloodInjection.htm

It's not a patellar tendon, but it might be worth an email to them to find out if they are aware of anyone trying it out on knees.

[IanT]

--- Posted today on a cycling forum ---

I'm feeling rather smugly self satisfied after a nice ride around the Surrey Hills this morning. I did 40 or so miles in about 2hr 40mins, including the hill up to Newlands Corner in both directions - eg on the way out and on the way back. I used my granny ring but managed to stay in the saddle and spin my way up the climb without stopping.

Not impressive for many on here I know, but 9 months ago I thought I'd come to the end of my sporting life at the age of 37. With both knees crippled through Patellar Tendinosis I was barely able to walk. I knew that things had become desperate when I was unable to break into a trot fast enough to catch my 3 year old niece as she ran merrily toward a busy road. On a weekend trip to Venice last July my left knee gave way and buckled under me several times causing to me fall in such pain that passers by thought I was having a heart attack.

By the end of last summer I had lost so much muscle from my left quad that I could encircle my thigh with 2 hands, thumbs and fingers touching. I remember walking around a hosepipe lying flat on the lawn rather than trying to step over it.

In September I joined a clinical trial involving multiple 'autologous blood injections' directly into the fabric of both tendons below the knee cap, repeated over a 2 month period. Yes, this is/was as excruciatingly painful as it sounds! The treatment included a detailed 6 month rehab protocol which - if followed to the letter - gave a small chance of avoiding further injections. No more incentive needed believe me.

At the beginning of November I went back to the gym for the first time in 18 months. My first target was to complete 10 mins on an exercise bike set to minimum resistance. This was not a sure thing! Over time, the program gradually upped the loading on my tendons accompanied with a lot of stretching to cause the (hopefully) regenerating fibres to align themselves effectively and with the appropriate elasticity.

By the end of March I had recovered enough that my gym sessions looked like exercise not rehab, and I had begun to regain some aerobic fitness and lose some of the weight I'd inevitably added.

In April I was told that cycling (spinning not grinding) was a good low impact exercise to help me regain quad condition and fitness. So I went and bought myself a nice bike - Specialized Roubaix Expert Triple - with a granny ring. I hadn't owned / ridden a bike for about 15 years so this was all new to me.

After 6 or 7 weeks of shorter (upto 20m) flattish rides, I decided today to try a longer route and to include the nearest thing to a hill locally - Newlands corner.

Hence I am a slightly self satisified smug thing this morning!

I've posted this because there have been a few posts recently from people taking up cycling to lose weight or to recover from injuries. I thought that my story might offer some encouragement - specifically that real progress is possible within a timescale of months not years if you are determined.

Next goal for me is to complete a century ride by the end of this summer....

[djay]

Hi,

Have never looked in this thread as I dont suffer from overuse, I broke my patella and tore the patella tendon in a football tackle back in Dec 05 and havent made the progress I would have liked.

Anyway, I have been referred to a bloke at Parkside and was told they would hopefully do autologous blood injections which are painful but may help strengthen the tendon.  Main problem is the tendon is shorter and thicker since the op.  Dont want to make things worse but anything is worth a try providing I dont end up further back than I am now.

So i searched on here for the word and came to this thread, just wanting a bit of an update from those who have had the before as to whether its worth the pain and money ?

thanks

dan

[IanT]

Hi,

Have never looked in this thread as I dont suffer from overuse, I broke my patella and tore the patella tendon in a football tackle back in Dec 05 and havent made the progress I would have liked.

Anyway, I have been referred to a bloke at Parkside and was told they would hopefully do autologous blood injections which are painful but may help strengthen the tendon.  Main problem is the tendon is shorter and thicker since the op.  Dont want to make things worse but anything is worth a try providing I dont end up further back than I am now.

So i searched on here for the word and came to this thread, just wanting a bit of an update from those who have had the before as to whether its worth the pain and money ?

thanks

dan

If you've read my posts above you know that I will say it is definitely worth the (serious) pain and the money - IF YOU DO ALL OF THE REHAB EXERCISES.

Alongside the guy your seeing at Parkside (probably the same one as me), I'd guess that you are going to see a physio for the rehab protocol. It's really important to do as they say - I am 100% convinced that following their regime is the main reason that I'm back playing sport this summer after not being able to walk around this time last year.

Go for it, but expect to have to put in time and effort to make it work.

[Clive369]

For IanT!

Hi Ian, you've posted some very interesting stuff on a new treatment for patellar tendinosis and I'm wondering how it's going following the autologous blood injections you had. Last we heard you were tearing up the Surrey countryside on your bicycle? What news?

I'm new to this forum but have had patellar tendinosis in both knees for a few years now and am trying to gather as much info on it as possible with a view to getting treatment. My problems started when I began road cycling in '98. It's now at a stage (and I know there are many whose suffering is worse than mine) where I have great difficulty standing still for any length of time without significant pain. Needless to say cycling is a complete no-no which is the one sport I loved.

Thanks,
Clive

[perseus]

I don't know if this is the same treatment as my new thread 

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=35273.msg269283

[IanT]

For IanT!

Hi Ian, you've posted some very interesting stuff on a new treatment for patellar tendinosis and I'm wondering how it's going following the autologous blood injections you had. Last we heard you were tearing up the Surrey countryside on your bicycle? What news?

I'm new to this forum but have had patellar tendinosis in both knees for a few years now and am trying to gather as much info on it as possible with a view to getting treatment. My problems started when I began road cycling in '98. It's now at a stage (and I know there are many whose suffering is worse than mine) where I have great difficulty standing still for any length of time without significant pain. Needless to say cycling is a complete no-no which is the one sport I loved.

Thanks,
Clive

Hello Clive.

The fact that I don't visit here often tells my story!

My knees continue to improve as I rebuild strength in my quads and hamstrings through cycling. On March 24th, I participated in the "Surrey Legs of Steel" - a tough 90km morning out in and around the Surrey Hills, starting and finishing at the top of Box Hill. Over 1500m of climbing including a 21% section so no picnic. I didn't quite have the strength required to climb the two longest / steepest hills without stopping. That said, I didn't have to get off and join those who were walking either. On April 29th, I'll be doing the "White Horse Challenge" which is 140km event around Swindon.

Anyway, autologous blood injections + strict adherence to rehab protocol + a return to a sporty lifestyle has worked for me.

Stay positive. I'm sure you'll find your answer also.

Ian

[shipitin]

I write for the first time on KneeGuru, having been a member for six months with a right knee Patellar Tendonopathy (PT ) since October 2005.

History:  Age 46.  Previously adequately fit; running twice a week etc, lapsed for a month due to minor illness and probably caused tendonopathy whilst out running when trying to get fit again.  Perhaps underestimated problem and went on previously booked skiing holiday Dec 05 and blocked problem with lots of Brufen anti-inflammatories.  Tried rest and denial until private orthopaedic knee surgeon No1 in May 06 recommended arthroscopy procedure. 
MRI scan, report as follows: 
“Moderately severe tendonopathy and a small deep surface partial thickness tear of the proximal third of the patellar tendon.  Less marked tendonopathy in the medial fibres of the mid and distal thirds  of patellar tendon.  Associated adjacent inflammation.  Mild chondromalacia on medial facet of patella.  No menisular tear.  Mild subluxation of patella.”

The PT generally allows me to walk reasonable distance and do such things as cycle gently.  It is only a problem when ‘loaded’ and going up or down (hill or stairs) or given acute shock pressure (i.e. jumping down from height).  Life is tolerable but keeping adequately fit is very difficult and sports such as tennis and skiing are out of the question.

I decided not to have the arthroscopy operation, but tried Physio, (mostly ITB stretching and patellar realignment) and Orthotic shoe in-plants.  Still no resolution so tried private orthopaedic knee surgeon No2 in Sept 06, who did not recommend operating for PT, (‘No evidence that it works’), but suggested KneeGuru and Autologous Blood Injections, (ABI).  I had two ABI procedures Nov & Dec 06 at Wimbledon with same chap mentioned above(?).   Unfortunately I did not follow up with the physio for various other reasons and am now starting again, three months late.  This physio is much the same as before but there is some suggestion to address bad ‘core body strength’ which ricochets around the body.

It is clear that the ABI procedure on its own does not work, and it is imperative to do the physio.  I totally understand and accept the principle at play but still wonder if it really works!  What influence has the placebo effect or even the renewed discipline on physio on success stories elsewhere? 

My PT is now still as bad as ever and I am beginning to think I might have to live with this for the rest of my life and have to forgo fitness and sports.  As I am not medically insured, the process is proving somewhat expensive  and I am getting increasingly reluctant to throw good money after bad!  It does seem as if a lot of people have the problem for a long time.  I wonder what age other contributors and patients are and if age affects the speed and possibility of recovery?

I haven’t contributed until now, but thought it might be useful to others and it might lead to some helpful advice for me.

Paddy

[australia]

In response to your question, I believe one's age does affect the length of recovery.  The older one is the longer the recovery.  I am 42 now, and developed patellar tendinitis 3 years ago (related to too much bicycling.)  While I continue to have symptoms, these are some of the keys points of the past three years:

-- The level of pain has decreased each year.  (I actually wrote down daily pain scores for 2 years, and now still keep a diary of key events.)  I hope and expect my pain to further diminish each year over the next few years.

-- The amount of pain during a typical day has decreased.  The pain used to be all day; later I had pain mostly in the afternoons and evening; now I have pain on and off.  The pain used to be such that it was difficult to concentrate on anything else.

-- I had a 2-3 month period with substantially low pain a number of months ago.  It was the most normal I've felt in the past 3 years.  Pain has increased somewhat since then, but it is still lower than each of the past couple of years.

-- I stretch 30 minutes every day.  (15 minutes in the morning; 15 minutes in the evening)  I started this 2 years ago.  I believe this has helped.  I stretch my quadricepts; hamstrings; hip flexors; calfs; IT-band, etc... I also use a foam roller for the IT band.

-- I can reduce my pain to zero when I wear a patellar strap.  I wore this for a year or so.

-- I had done "eccentric exercises" for a number of months in the Fall of 2006.  There is a lot of positive research on these exercises for patellar tendinitis.  You just need to know how to do them, and make sure you ramp up very slowly and not over-do it.  Unfortunately, not many people are aware of how to do these.

I was advised not to do any surgery by 3 different orthopedists after my MRI, which showed patellar tendinitis.

I have never seen any serious scientific research on autologous blood treatments, so I am distrustful of it at this point.  I have generally kept up to date on the medical literature relating to patellar tendinitis.  Eccentric exercises seem to be evolving as the "gold standard" for treating longstanding patellar tendinitis.

[Clive369]

Hi Paddy,

Thanks for sharing your experience which is interesting. I'm sure I'm stating the blindingly obvious when I say you may never know quite how bleak OR bright the future may be until you do the whole programme, physio + ABI? Good luck.

IanT - thanks for sharing your update. You're right about staying positive - one of the hardest issues is simply continuing to believe that the problem can get better and not losing hope. This isn't made any easier by fact that, in truth, most people including front line GPs + physios know jack about the condition. 

Clive

[ALRunner]

Ian and the original poster, and others, how are you doing now?

I have had what must be patellar tendinosis (despite MRIs and physician consults, the first term I heard the term was by surfing the net on it) for over two years now after ramping up for a marathon. My symptoms are mild tightness (used to be quite severe but in the last several months has toned down to generally mild, but definitely worse first thing in the morning), mild or no pain (which turns into moderate pain if I exercise too much) and a clicking knee (scar tissue on the tendon?). MRIs are mostly clean, the last one indicating a possible minor or mild patellar tendon tear.

I've been doing eccentric work for a couple of months now. I feel better, but it's hard to say if that's because of the eccentric or a continued downturn in training (I like to do short triathlons and have gotten through mild training for them the last two summers, but this summer I will not do it unless I can lick this problem).

BTW, the reason I have this is I'm quite sure a hip/pelvic imbalance from a muscle and flexibility standpoint. I stretch everything now.

I'd like to know how others are doing. I have found a guy online who cured (for 2.5 years until a recent relapse, which I think he attributes to basically having forgotten about the treatment he did) a 4 month long bout of patellar tendinosis in 6 weeks of doing eccentric work 3-5 times/week, 10-15 reps for 3 sets with a slow negative and then both legs for the positive. He goes relatively deep into the pain zone when training and training to tendon pain with eccentrics is supported in at least one study, though others will say that it's overdoing it and slowing recovery. He is a PT and prescriptions of this to his clients have netted positive results. He likes to feel no pain during the eccentric rep, but that moment of transition to concentric there is a twinge of pain. I've noted in most areas that the advice is to use a 25 degree decline board and do not bend beyond 90 degrees. A decline board, btw, can be made out of ply and strongly gluing some sand paper to it (that's what I do).

[greyhound]

I have also appreciated your insights and hearing your stories.  I know this is quite an old post.  However, if any of you who were treated at the Wimbeldon clinic happen to check in, I would be interested in knowing the doctor who performed the autologous blood injections.  I am looking for a doctor in the UK for this type of treatment.  You can send me a message privately.  Many thanks!

[shipitin]

@greyhound
I had mine done at Wimbledon but cannot remember the name of the surgeon/doc? I might remember if you give me some names to remember.

MEANWHILE, I have torn and had replaced the Anterior Cruciate on the other knee whilst skiing, and had a Patellar tendon graft.  Interestingly the tendon from which the graft is extracted causes me the most ongoing problems, similar to the original tendonitis in the other knee.

I am back to skiing now but wear a brace on my left (damaged ACL) knee.  My right knee (patella tendonitis) seems to have made a full recovery.

My lesson from all this is; keep as fit as you need to be for the level of sport you want to participate in.  Strength dissipates with age and one cannot expect to maintain the strength of someone in their 20s or 30s when over 40! One can recover when older, but probably never back to as good as before.  But it certainly takes application and discipline with the physiotherapy.

[Jimbob2]

Hey guys I’m new to this forum and although I don’t have any knee problems I am suffering with the same tendonosis problem described in this post but in both my elbows, lateral epicondylitis a.k.a Tennis elbow.
It was good reading this post and I really agree with what clive said about staying positive.  Some day’s I just find myself going mad and in total despair, it can be very depressing to suddenly have to quit doing all the activity’s you enjoy. 
I was just posting for the same reason greyhound was, wondering if anyone has had autologous blood injection in the UK.  Is this the same thing as Platelet rich plasma injection? (PRP ) Where they take out your own blood and separate the platelets in a centrifuge  then re inject them into the affected tendon to speed up the bodys natural healing process.
I have been looking into it and so far only found of one private clinic in London mentioned in this article, but it also mentions there are a few NHS hospitals performing it here is the link : http://www.dailyexpress.co.uk/features/view/135016/I-was-cured-by-my-own-blood#

My story:
I have been suffering with lateral epicondylitis in both arms for around 4 months now, although the problem has been manifesting for quite some time.  The first time I ever experienced the pain in and around my forearms was during weight training about 18 months ago.  It started very mild and was felt only during training but progressively worsened over a couple of weeks or so.  I would end up having to take a week off all training which I used to do periodically anyway.  After this I would be back to normal and ready to continue training, or so I thought.  This happened about 3 times over roughly a year entill recently sometime near the end of January which has now become a real problem and will not heal. 

 After stopping training with weights and using the doctor’s advice of resting, taking a course of NSAID's and applying ice there was no improvement. This is when I started to research all about tendinapathy and read all about tendonitis and tendonosis.  I bought an E book called “Target tendonitis” and found that what I had was almost defiantly tedonosis, which has little to do with immflamation and is in fact degeneration of the tendon from repeated failure to heal.

 The book contained physiotherapy exercises to do, basically just eccentric light weight isolation Exercises to be done frequently along with nutritional advice, supplements worth getting ect, so I started implementing the techniques.  I explained this to the doctor and although he didn't seem to of ever heard of the condition tendonosis he agreed with me that this is what I have.  After pressing on my forearm and near the elbow he said I had lateral epicondylitis a.k.a tennis elbow.  He agreed I was taking the correct cause of action and to be patient as these injury's are renowned for taking a long time to heal.

A few weeks after this my condition began to worsen gradually as a result of my Job being repetitive on my arms,  So I ended up signed off from work.  I am now only on SSP and getting only half my normal wage, which is leaving me very short on money to support myself and my partner.  This is becoming a serious disability to me and is completely ruining my quality of life.  I am no longer able to and have been for quite some time to enjoy an active life style.  I am desperate to get back to work and to my hobbies and sports which I love such as Surfing, Playing my drums and computer gaming.

I was referred to an NHS physiotherapist who again seemed to know less about this problem than me. She tried to tell me tendonitis and tendonosis where the same thing.  She did however tell me that the eccentric exercises I was using where the correct cause of action, and that I should continue to do them 3 times a day for 15 reps and to also do some stretches.

After 6 weeks off work and still not much better with only a slight improvement I returned to work to see how I got on as I was running out of full Sick pay.  Only for the pain start to relapse and again worsen so am now again signed off.