Banner - Hide this banner




Recent Posts

Pages: 1 ... 8 9 [10]
91
I updated my initial post to include microfracture as it does grow scar tissue.  Fibrocartilage is essentially scar tissue.
92
Oh yes and microrafture/nanofractuere regrows some cartilage like substance. With amic they claim results are much better (so fracture plus scaffold) and it seems to be superior to no scaffold for sure.
There would need to be a comparative study Vs maci (in Europe i think currently only novocart inject plus still available/sold) and autocart.
Quite likely the financing will be hard to attain as there is no interest my Maci providers to finance such a study against much cheaper alternatives if they aren't sure it will come out clearly superior while it will be hard for a cheap solution to pay the maci costs... Amic Vs autocart on the other hand could be much more likely to be included in a blind study as costs are comparable (if you do a double blind study you can only charge patients with the costs of the cheapest treatment in the study).
93
This cartilage paste/paste graft seems to be very similar to minced cartilage (arthrex autocart). Arthrex autocart simply is more standardized and I would think has more research into it because it is used by a lot more doctors.
Essentially both mince the cartilage to about the same size and use Fibrin glue. There is a reason why it's called 2nd generation minced cartilage. I guess other big players could jump in and propose solutions too based on minced cartilage, but then those tools likely aren't much expensive and the centrifuge is the same as for prp or similar... Unlike aci/maci it's quite low tech.

Note that at least on the website some problems are still present with cartilage paste graft. By now it's clear that you should not use chondrocytes from non load bearing parts it possible due to lower quality. As long as you can with autocart it's recommended to just use the cartilage gathered while debriding/cleaning up the defect. It could be a the stone and co. Also adapted their techniques. I think the biggest pitfall is that they didn't think of a way to market it. So lack money for further research and the problems that arthrex solved by providing an easy to follow surgery method including all tools aren't solved. With autocart and I guess over 100 doctors using it by now much more feedback and data will have been gathered to further improve it. There are clearly differences now and Vs it's introduction 5-7 years ago. The principle is the same but it's refined. Essentially both is building up on much earlier minced cartilage trials.
94
Hi,
I too live in Aus....was wondering how it went with Dr Roger Paterson? I too have arthrofibrosis and am facing a 3rd surgery..... and was wondering if there are any specialist in Australia?
Cheers,
Fran.
95
I know of only two technologies clinically proven to regrow cartilage in bone on bone arthritis.

They are:

1.  ACI/MACI (Carticel has been discontinued and replaced by MACI)
2.  Arthrex Autocart

Tigenix discontinued its product as far as I know.
https://www.evaluate.com/vantage/articles/news/after-us-approval-vericels-headache-begins

Dr. Stone makes a cartilage paste, but does it work as well as MACI and Autocart?

The following products are NOT clinically proven to regrow cartilage in bone on bone arthritis:
1.  Dr. Dunn's IAGH (I think this is a scam to be honest)
2.  Regenexx or any other mesenchymal stem cell product
3.  ACP/PRP
4.  So called umbilical cord stem cells (not only a scam, but dangerous and illegal)

Microfracture has been well demonstrated to regrow fibrocartilage (scar tissue).

So that's it--only two products on the market that I know of that regrow cartilage.  Are there any others?
96
https://www.arthrex.com/resources/presentation/rUo5Ks8_I0GsXwGAlXySqQ/autocart-procedure-vs-autologous-chondrocyte-implantation-aci

The doctor obviously favors Autocart.

Rather than comparing Autocart to MACI, they really should be highlighting that Autocart and MACI are two technologies that actually regrow cartilage in bone on bone arthritis and that 99% of clinics claiming to regrow cartilage with stem cells/prp are scammers.  In the USA, the FDA simply can't shut the scammers down fast enough.

How many knee patients have even heard of MACI and/or Autocart?  I'd say very few.  Prospective patients are overwhelmed every day by fraudulent marketing from dishonest clinics and the honest technologies like MACI and Autocart are harder to find in all the noise.
97
However before I would do a treatment regiment like Dr. Dunn which couples HGH injections with 6 weeks of non weight bearing, and further restrictions for 6 months - I would get a proper knee cartilage surgery. The pain may be less but the restrictions are similar - and there is no evidence of stage 4 cartilage regrowth simply with HGH and a 6 months rehab protocol.

Well said.  Dr. Dunn had me on crutches for many months following IAGH and it didn't regrow any cartilage.  He claimed it did, but MRIs and follow up scopes showed otherwise.  I wasted all this time on crutches for a worthless IAGH procedure.  I flew to Florida many times for worthless follow up IAGH injections.  I think IAGH is a total scam, but that's only my opinion.  Now if Dr. Dunn had said IAGH only works on grade 2 damage we would be having an entirely different conversation.  He promised IAGH works for grade 4 damage like I had.
98
Actually I would be very sceptical about Regenexx taking stem cells and same day reimplantation. That sounds like snake oil if ACI/MACI needs 3-4 weeks for lab growth of the cells. Most of Regenexx is nothing else than PRP really overpriced. The fact that they make secrets over what they are doing is typical for snake oil procedures.

I can explain this and same day stem cells isn't anything to be skeptical about.  MACI is a two part procedure.  The first arthroscopy removes a tic tac size piece of cartilage from your knee.  This cartilage sample is used to create millions of cartilage cells on a matrix.  That matrix is glued with fibrin into the defect with a second surgery (usually an arthrotomy).

Regenexx stem cells are obtained from your hip.  They are mesenchymal stem cells.  They are spun in a centrifuge and injected into your joint.  There is no need to make millions more of them because your knees can only take so many at once.  If you want your stem cells multiplied to use them later you can go to Regenexx Cayman Islands.

The two procedures are quite different.  Regenexx isn't capable of regrowing cartilage in bone on bone arthritis because no one has figured out how to make stem cells do that yet.
99
So, Felix complained about Regenexx costing too much but if Vericel charges $60,000 that makes Regenexx charges, ~$8K, look like chump change.

Not a fair comparison.  If your insurance covers 100% of MACI and zero percent of Regenexx then MACI is the far better deal.
Insurance will cover MACI because it had an FDA trial and MACI actually grows real cartilage in bone on bone arthritis.

Quote
Also, the MACI site says to stay off your knee for eight weeks! I had trouble enough staying off mine for three days! ::) So, add another $10K for a rehab facility. ;D

Good argument.  MACI recovery is brutal, but it does actually regrow cartilage for bone on bone arthritis and Regenexx does not.
Dr. Dunn had me on crutches for many months following IAGH and it didn't regrow any cartilage.  He claimed it did, but MRIs and follow up scopes showed otherwise.  I wasted all this time on crutches for a worthless IAGH procedure.  Eight weeks on crutches is rough, but doable.
Dr. Centeno has regularly stated that there is no evidence IAGH regrows cartilage.

Quote
I was willing to take the risk to learn first-hand whether stem cells work. So far, the jury is out of course, but Dr. Carlo Tremolada of LIPOGEMS told me it could take as long as nine months before you see real results.

What is your definition of "works"?  Stem cells won't regrow cartilage in bone on bone arthritis.  Perhaps stem cells will strengthen existing cartilage and tendons.
100
So, Felix complained about Regenexx costing too much but if Vericel charges $60,000 that makes Regenexx charges, ~$8K, look like chump change.

Also, the MACI site says to stay off your knee for eight weeks! I had trouble enough staying off mine for three days! ::) So, add another $10K for a rehab facility. ;D

I was willing to take the risk to learn first-hand whether stem cells work. So far, the jury is out of course, but Dr. Carlo Tremolada of LIPOGEMS told me it could take as long as nine months before you see real results.


In Europe for 8K you can easily get Autocart without any insurance. However from what I would gather about those stem cell injections - I guess if you cannot reduce your weight bearing for 2-3 weeks - there is no chance for the cells to grow (not too likely they grow into anything useful even if you don't do any weight bearing for that time).
With Autocart you are kinda in for a really tough 4-5 weeks (the bigger your difficulties pre surgery - the harder those weeks) - you have 25% weight bearing two weeks, then 50% in the third week - and from the 4. week it's 75% or even 100% depending on the doctor and what your pain level allows you. If you only have grade 3 damage you most likely can be off crutches in the 5. week already.

From week 5 you can be back on a trainer bicycle. Week 6 back on a real bike and if possible no more crutches. Maci is the same most surgeons really shortened those guidelines.
Yes - the first 8 weeks will be much harder - the 3. and 4. month still a bit harder - but the effect will be much bigger and it's proven success. And those times are from severe grade 4 damage - if it's grade 3-4 it will be much faster. For grade 2 cartilage damage you don't need any surgery - build muscle - loose weight - should be your main priority. I was painfree for at least 6 years with grade 4 damage - because of good muscles and enough sport. Should have had surgery earlier but then good I didn't because MACI would not have been covered by my insurance - while NFX/MFX likely only would have caused bigger damage. I do think with some advances in MACI (like the new liquid scaffolds which seem superior in blind studies vs older scaffolds) MACI is on par with Autocart concerning success, maybe even superior (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137299/ - those numbers are really great in this study!)? But then it's  surgeries instead of a single one and it's way more expensive.

The biggest change you realized in your other thread - do sports every day! But don't do sports that hurt your knee. That's the best way to keep your knee working. Cartilage needs to be nurtured - but not stressed. That's why very early return to swimming / cycling is great. Return to hiking as soon as possible. Walk up and down stairs every day for 20 floors if it doesn't cause you pain. And grow back your muscles as quickly as possible - BFR training is a way to achieve that even if kinda everything causes you pain. Usually after surgeries proprioception is more important than muscle mass/power - with cartilage damage and the ability to do BFR training I think this approach should be changed. First get back the muscle mass then the proprioception. Usually if you first grow back mass the danger is you will do damage while other structures aren't back yet. If you are still in pain that's not a worry - so BFR to get back muscle to really high levels - then this will allow you to add proprioception quicker too.

MACi is around 25K in Europe vs 60K in US , but that's mainly due to lab costs which are prohibitive. Autocart should be possible to find for 8K in US - it would be the same price as ACL surgery because it's about the same difficulty (and yes ACL surgeries can be found for 8K USD - even if some clinics will charge way more and rip you of in US). And  it can be done with ligament surgeries together in the same surgery (Same for Maci of course). If you have grown up - there simply seems no way to actually regrow cartilage without surgery. Without surgery the best that can be achieved is stopping degradation - which is good enough IF you are not down to the bone yet (or only small area). And anyhow most insurances will pay for it - unlike Regenexx.


Actually I would be very sceptical about Regenexx taking stem cells and same day reimplantation. That sounds like snake oil if ACI/MACI needs 3-4 weeks for lab growth of the cells. Most of Regenexx is nothing else than PRP really overpriced. The fact that they make secrets over what they are doing is typical for snake oil procedures.
Pages: 1 ... 8 9 [10]