PRP injections are regenerating my knee cartilage & ligaments

[gb]

ok. Given the joint disease epidemic gripping our nations and its people, my topic heading is a powerful statement to make and is sure to be of special interest to fellow citizens who all share the same joint degeneration disease i do, which is why I want to share my findings with everyone on this board.

So what is my story ?  16 or 17 years ago I had reconstructive surgery on my ACL and PCL. Both ligaments had been completely torn. Also, during the surgery, my surgeon uncovered damage to my lateral meniscus. So he removed that part of the meniscus damaged. I was fine afterwards. BUT........over the ensuing 15 years, due to an active lifestyle of sport, my knee began to degenerate to the point where my lateral meniscus was 60% gone (it had further degenerated) gradual increase in ligament laxity (causing lots of pain) and articular cartilage badly damaged. my MRI last year showed something the doctor explained as "a cratered moon" lots of holes . about 5 years away from bone on bone.

Imagine, only 36 years old, and I can't play/run with my dog or bike uphill. I was desperate.

In September 2008, my research into degenerative arthritis lead me to founding out about prolotherapy and Platelet Rich Plasma. PRP is the acronym, and means, and i quote from a source per definition "blood plasma with concentrated platelets. The concentrated platelets found in PRP include growth factors among the huge reservoirs of bioactive proteins that are vital to initiate and accelerate tissue repair and regeneration. These bioactive proteins increase stem cell production to initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels and stimulate the wound healing process."

As most people suffering from joint disease already know....joints are avascular....meaning there is very little blood circulating in our joints to trigger healing when damage to our ligament, or tendon or cartilage is made due to sport or accident.

So how does PRP work ? This is how I've experienced it each time I visit my MD. Using a syringe, the nurse withdraws something like 30 -60 cc of blood from your arm, then is placed in a centrifuge. The centrifuge spins and separates the plasma from the blood producing the PRP. This increases the concentration of platelets and growth factors up to 500%. When PRP is injected into the damaged area it stimulates the tendon or ligament causing mild inflammation that triggers the healing cascade. As a result new collagen begins to develop. As this collagen matures it begins to shrink causing the tightening and strengthening of the tendons and ligaments of the damaged area.

My first treatment for PRP injections came in September 2008. I found the most prominent doctor with the longest and best track record around, and made sure he was an MD. There is not just one injection, but up to 30 small injections all around the knee...he covers the entire area. Knee swells for 2 days and healing begins immediately.

I've had 5 injections in 5 months, spaced 4-6 weeks apart. The results have been very good to date. I began to notice pain begin to creap away after 2-3 weeks of my first injection. after my second injection, I could play around with my dog, and maneuver side to side with sharp cuts in and around the playground. That was a sure sign I was on to something good.

the order in which progress occurred....
1. pain begins to diminish and go away while walking (injection 1 and injection 2, 3, 4)
2. ligament feels tighter and stronger (same as above)
3. crunching begins to diminish. (this only occurred until after my 5th injection) it varies from patient to patient i would assume)

To me, the diminished crunching in my knee might is indicative of the PRP regenerating the cartilage....but I won't really know until i have a second MRI...either way the knee is feeling good and i'm happy.

I'm due for my 6th set of injection in a few weeks, and i'll keep the board up to date on my progress.

I plan on having a second set of MRI taken at the end of my PRP treatments...to compare with the initial set of MRI done before treatment began 6 months ago. This will tell me if the cartilage grew back.   

Hope I've added something meaningful to the forum.


George Bazos

[Saverio]

Hi George,

Your post is interesting.  It is somewhat similar to regenexx but without the stem cells processing.  I was hoping more people would comment on your post.  Anybody out there have similar experiences with PRP?

Saverio

[sp7]

...........

My first treatment for PRP injections came in September 2008. I found the most prominent doctor with the longest and best track record around, and made sure he was an MD.

George, this is intriguing. What kind of MD does this? An orthopedist or some other kind of MD? How many MDs know about this and do this? Is there some central website or outfit that helps people find such qualified MDs who do this?


Thanks

[gb]

SP7 - I gathered a list of locations that do Prolotherapy in the U.S, researched their websites and called them up. Maybe 2 or 3 had MD that do the injectionss. I chose caringmedical in Chicago, it's MD appears to have the best track record, most experience with Prolotherapy/{R{ injections. Apprently the number of injections per session and placement of the injections is critical to progress.

Prior to choosing PRP treatments or even having heard of it, I saw 2 surgeons, one was the head knee guy for an NHL team, I won't name names,  and the other was the head knee guy for an MLB team. The first doctor recommended an osteotemy ( a big knee procedure cutting into my bone) and the other said my best option was to buy a knee brace and use glucosemin and MSM and just "deal" with my Osteoarthritis. Neither was an option for me as i wanted to continue an active life style.

My understanding is most MD's won't recommend prolotherapy nor PRP injections due to the fact there's nothing for pharmaceuticals to patent and no big money to be made. It's unclear to me if this plays a factor in what surgeons recommend. I'll let you decide.

[Dr. Centeno]

Wow!  I'm always amazed at how the internet is such a great discussion generating tool.  It's been a few months since I checked this site.  Just to clarify a few points:

1.  I was surprised to see Lee Bucker posting here.  I know Lee owns a commercial cell therapy industry blog and I have communicated with Lee as he relayed.  My comments to his concerns are posted at http://celltherapyblog.blogspot.com/2009/02/regenexx-vs-fda-2009.html?showComment=1234374420000#c5662649568093779579

2.  We have used prolotherapy for years and still use this technique.  Prolo is what I call Regenerative Medicine 1.0.  It's the injection of a substance to prompt an inflammatory healing response.  It works great on ligaments and chronic tendon enthesopathies.  It brings the patients own growth factors and cellular mechanisms to bear.  The upside of prolo is that it's very inexpensive and simple to deploy.  The downside is that because there is big biologic variability in growth factor quality, blood supply, and healing potential of patients, it has a reasonably high failure rate.  However, because of it's low expense and ease of use with limited downside, it's a great technique to try. 

3.  PRP and BMAC have also been discussed here.  PRP uses a bedside centrifuge to spin down platelets and concentrate them.  Platelets have all kinds of great growth factors including PDGF, TGF-beta, IGF, FGF, etc...  This type of technology is great for helping to heal things that are close to healing on their own.  Hence it's been used by many athletes to get them back into the game more quickly.

BMAC is what Dr. Lee does.  It uses a bedside centrifuge to spin down the nucleated cell fraction of a bone marrow aspirate.  About 1 in 50,000-500,000 of those cells is a stem cell capable of orthopedic repair.  We used BMAC in 2005-2006 and even published one interesting case report.  See http://www.ncbi.nlm.nih.gov/pubmed/16886034?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum  The problem we experienced was that BMAC didn't have enough stem cells in it to help most patients.  After we used it for a year and treated 10 patients or so with pre/post MRI's, we abandoned it in favor of what the research community has done for years, which is to grow mesenchymal stem cells in culture to much larger numbers.  There is a post on this issue here: http://www.regenexx.com/2009/02/bone-marrow-nucleated-cell-concentrate-bmac-is-it-concentrated-enough/ 

I would call these centrifuge based treatments (PRP and BMAC) that concentrate autologous (the patient's own) blood products "Regenerative Medicine 2.0". 

4.  I would call what we do "Regenerative Medicine 3.0".  This is what has gotten big pharma and it's representatives so upset.  In our medical practice, we isolate and then culture expand mesenchymal stem cells in our state of the art cGTP lab in Colorado.  This allows us to deploy thousands of times more stem cells capable of orthopedic repair than could be mustered with the 2.0 techniques (BMAC).  We didn't start seeing reliable results with patients until we started using this procedure to grow stem cells for short periods of time in culture.  While using a centrifuge and doing this at the bedside is easier, you just can get enough orthopedic repair cells in my opinion. 

Hope this helps.  Thanks for the kind words!

Chris Centeno, M.D.

[gb]

This just out....

PRP NYTimes article - dated February 17, 2009

http://www.nytimes.com/2009/02/17/sports/17blood.html?_r=1&scp=1&sq=PRP&st=cse

Quote from Hines Ward of the Pittsburg Steelers:
"The technique played its most glaring role with Mr. Ward, a receiver who left that Baltimore game in the first quarter with a sprain of the medial collateral ligament in his right knee. The next day, he was injected with a form of PRP therapy called autologous conditioned plasma, which features different proportions of platelets and other cells. Along with strenuous rehabilitation and hyperbaric oxygen therapy, Ward recovered enough to make two catches in the Super Bowl, in which the Steelers beat the Arizona Cardinals.

“I was next in line, the next guinea pig,” Mr. Ward said, referring to Mr. Polamalu’s experience with platelet-rich plasma. “I think it really helped me. The injury that I had was a severe injury, maybe a four- or six-week injury. In order for me to go out there and play in two weeks, I don’t think anyone with a grade-2 M.C.L. sprain gets back that fast.”"

gb

[gb]

I received my 6th series of PRP and prolotherapy injections 2 weeks ago at CaringMedical in Chicago and here is the update:

Following the treatment, I  waited a bit longer this time around before returning to my exercise routine. I rested a week following the injections to give time for swelling, usual bruising to disappear and for the full range of motion to return. Typically 2-3 days is good enough, just being extra cautious.

during the second week following injection however I upped my activity level to 4 workouts in 7 days. 2 days on the stationary bike, at an intense level for a full 90 minutes, maintaining RPM as high as I could. and 2 days on the Elliptical, which mimics the running motion and I'm told is a good indicator of whether i'll be able to  return to outdoor jogging.

Prognosis....my knee is feeling great. It is more stable than ever and feels at its strongest isince i began treatment 6 months ago.

Remember, I could NOT ride a stationary bike nor walk without experiencing significant pain in the knee joint prior to starting PRP treatment. Today, i feel no pain at all while biking or strenuously riding the elliptical. I feel some strain around the knee cap during heavy riding uphill when the difficulty level jumps to its highest level, but it's minimal and I feel no pain in and around the area of the lateral meniscus which was torn in the rear of my right knee and where last years  x-rays show almost 75% deterioration of my cartilage.

Yesterday also marked my 6 month anniversary since I began PRP treatment on my knee.

I will be returning for a 7th series of injections in 6-8 weeks because i do still have crunching in the knee. The crunching appears to have diminished and that is encouragement enough to continue with the treatment. I think i might wait another 3 months afterwards before having another MRI and x-rays done to evaluate the knee and compare with last years photos.

In my opinion, recovery has not been as fast as I had hoped, meaning the knee seemed to just slightly improve after each visit to the doc, but collectively, from month 1 to month 6, the knee has improved by overall 80%. Patience and commitment. I sense that my ligaments responded very quickly at the beginning and very well to PRP, but there was a lot more damage in my knee than just the ligaments. there is the meniscus, and articular cartilage to heal, and I sense that they are repairing itself. otherwise why is the range of motion improving, crunching diminishing and pain disappearing. Could it be from just he ligament improving...don't really know.  Anyways, hopefully the x-rays will show the improvement to the cartilage, I'll be sure to share the results to the general community here when available.

[irentat]

I am sooo glad somone else had success with prolo.  I am currently undergoing it with my ankle and can't rave enough about it.  It has been 4 months since I started. 

Was the ozone generated by a machine?   My prolotherapist is very open to new ideas and tries different methods on me.  I would like to suggest the ozone as I have read a bit about it but haven't pushed the doc for it.

Ben

I had a subluxed fibular head injury from a fall.

Prolotherapy is effectively stabilizing the area at the distal and proximal ends. My physician is using a combination of dextrose and ozone.  He also injected Ozone into my knee joint. It is painfree after articular cart damage and a meniscuc tear from same fall. I am VERY pleased with the results so far -- 7 months since first series-- I expect complete healing. (My progress is hampered by a secondary issue) Even if I have to go for "tune -ups," so to speak, that's still better than the alternative.

This has been a real blessing and sure beats the surgical options, which didn't sound pleasant no matter how the options were worded. Not to mention the PT required afterwards.

I am SOOO thankful for prolotherapy.

[irentat]

In my opinion, recovery has not been as fast as I had hoped, meaning the knee seemed to just slightly improve after each visit to the doc, but collectively, from month 1 to month 6, the knee has improved by overall 80%. Patience and commitment. I sense that my ligaments responded very quickly at the beginning and very well to PRP, but there was a lot more damage in my knee than just the ligaments. there is the meniscus, and articular cartilage to heal, and I sense that they are repairing itself. otherwise why is the range of motion improving, crunching diminishing and pain disappearing. Could it be from just he ligament improving...don't really know.  Anyways, hopefully the x-rays will show the improvement to the cartilage, I'll be sure to share the results to the general community here when available.

My doc indicated that in such cases of degraded cartilage and ligaments (similar to mine in my ankle) that FULL recovery will take over a year or even 18 months.  I too am 7 months into my recovery.  Thank god for Prolotherapy and PRP.  However, I started with HGH injections to rebuild the cartilage and moved to PRP because they were cheaper and my doc suggested different modalities to keep the body from "getting used" to just HGH shots.  Maybe you should try a few HGH shots?

[gb]

irentat - thanks for the post. you brought up some interesting points which led me to ask questions of my doctor.

After some investigation and advice from nurses and doctors, I've decided to switch from PRP over tot HGH treatment and Gluscosamine shots combined with prolotherapy to address the additional crunching in my knee and to hopefully regenerate some or all of the articular cartilage in my knee.  The PRP treatment rid me of the pain i was feeling in my knee, likely resolving the ligament laxity pervasive in the knee. But it seemed to not really do much for the cartilage. Lots HGH documentation supporting cartilage regrowth on the Web, and doctors recommending it, this suggest I should do HGH injections next. 

So to recap, PRP resolved the pain in my knee, strengthening the ligament laxity over a period of 6 injections over a 6 month window, and now I'm switching over to HGH to resolve the Crunching and hopefully regenerate the cartilage.

BTW Irentat, i made some inquiries and I was informed by the medical community that the body does not get "used to" PRP as your platelets are not a drug and tolerance will not develop.

gb

[irentat]

irentat - thanks for the post. you brought up some interesting points which led me to ask questions of my doctor.

After some investigation and advice from nurses and doctors, I've decided to switch from PRP over tot HGH treatment and Gluscosamine shots combined with prolotherapy to address the additional crunching in my knee and to hopefully regenerate some or all of the articular cartilage in my knee.  The PRP treatment rid me of the pain i was feeling in my knee, likely resolving the ligament laxity pervasive in the knee. But it seemed to not really do much for the cartilage. Lots HGH documentation supporting cartilage regrowth on the Web, and doctors recommending it, this suggest I should do HGH injections next. 

So to recap, PRP resolved the pain in my knee, strengthening the ligament laxity over a period of 6 injections over a 6 month window, and now I'm switching over to HGH to resolve the Crunching and hopefully regenerate the cartilage.

BTW Irentat, i made some inquiries and I was informed by the medical community that the body does not get "used to" PRP as your platelets are not a drug and tolerance will not develop.

gb

I reread all your posts and now realize you never did receive intra-articular PRP.  Am I correct?  My use of PRP was intra-articlular only.  I have not heard of PRP being used as a ligament rebuilder, a ligament healer but not rebuilder as the common dextrose solution in Prolotherapy is designed to do.  I have only done dextrose and the like directly applied to my ligaments but not intra-articular.  I have been through 4 cycles of dextrose based Prolotherapy since November.  I will ask my Prolotherapist about using PRP in the ligaments.  He is open to new stuff.

As for the PRP and the HGH and body tolerance, I can see where PRP would not apply.  However, I am not sure if HGH might cause the body to get lazy after having many shots.  I am no expert but it would seem to me to be the case.  Please do it, if only to see if there is a difference between the two modalities.  You starting PRP first and going to HGH would be the opposite of me starting HGH (7 shots) and then going to PRP (2 shots so far).  We can compare as I had my first shot of HGH mid August 08 after my surgery.

How much HGH were you intending to use per shot and how often?  I ask because of my direct experience with Dr. Dunn and what he accomplished with my ankle and the cartilage I rebuilt.  The knee requires much more per shot than most people realize.

Good luck,
Ben

[gb]

Irentat - I received a PRP injection into the knee. THey withdrew about 50-60 cc of blood from my arm, spun it in a centrifuge to isolate the growth factors (platelets) and re-injected ~ 4 cc of isolated Platelets directly into the damaged knee joint.  My understanding is that PRP will NOT work if you have a completely torn ligament. PRP has shown to be useful in cases where there is a partial tear or strain of a ligament, or ligament laxity in joints.

gb

[irentat]

GB,

You mentioned in your first post up to 30 injections.  This is more of a prolotherapy ligament procedure compared to an intra-articular injections which would normally be 2 or so.  I am very interested and want to be specific here because my PRP injections have only been intra-articular and not related to injections into the surrounding ligaments. 

This is important to me because you still talk of "crunching" and you also say that you had swelling after the procedure.  This indicates you were being treated at the ligaments and not intra-articular (in the joint).  Interesting that you still have "crunching" after 7 months. 

My main interest is to truly understand your success to determine if my own PRP or my HGH shots did me the most good in my recovery.  I can't tell at this time since I started with HGH and went from 0 to over 3 MM cartilage with the HGH but cannot comment directly on the success of PRP and was hoping you could shed some light for me.  Bottom line, no more pain in my joint after 7 HGH and 2 PRP injections.  The ligaments still hurt like a bad sprain after 4 months but I can tell the difference between interior joint pain and ligament pain.  My ligaments still have rebuilding to do and doing the prolotherapy to accomplish that portion.

Ben

[gb]

irentat - in my previous post I bundled together all the shots. I'll clarify and break it down for you.

 In one visit, for my right knee joint,  I had 1 shot of PRP, about 4cc worth. as well as 20-30 shots of prolotheray all around the joint (a fish extract of sodium mohrrite ? not sure of the spelling).

The swelling was likely caused by the prolotherapy. I can't comment if the PRP caused some of the swelling too as all the shots were administered during the same visit to the doc.

Normally i think the nurses withdraw about 20cc's worth of blood to be centrifuged if you only do 1 PRP injection, and about 50-60 cc's if you need 2 PRP injections.

My pain is gone, and most importantly, my stability is WAY better than before. But the Crunching is still there. So the question for me is.....should i go with  PRP or HGH on my next visit ? After 6 visits and 6 shots of PRP, as I mentioned my ligaments are way improved, but I still have crunching that is very bothersome, and others have told me that HGH is more documented for healing cartilage. Thus my decision to convert over to HGH on my next visit.

Another big question I have is, does the healing continue over the next 3-6 months ? No one really seems to know. Although it was suggested to me that the ligaments and tendons admnistered with PRP will continue to heal over an ensuing 3 months.

[irentat]

In one visit, for my right knee joint,  I had 1 shot of PRP, about 4cc worth. as well as 20-30 shots of prolotheray all around the joint (a fish extract of sodium mohrrite ? not sure of the spelling).

The swelling was likely caused by the prolotherapy. I can't comment if the PRP caused some of the swelling too as all the shots were administered during the same visit to the doc.

Normally i think the nurses withdraw about 20cc's worth of blood to be centrifuged if you only do 1 PRP injection, and about 50-60 cc's if you need 2 PRP injections.

My pain is gone, and most importantly, my stability is WAY better than before. But the Crunching is still there. So the question for me is.....should i go with  PRP or HGH on my next visit ? After 6 visits and 6 shots of PRP, as I mentioned my ligaments are way improved, but I still have crunching that is very bothersome, and others have told me that HGH is more documented for healing cartilage. Thus my decision to convert over to HGH on my next visit.

Another big question I have is, does the healing continue over the next 3-6 months ? No one really seems to know. Although it was suggested to me that the ligaments and tendons admnistered with PRP will continue to heal over an ensuing 3 months.

OK, now that makes sense.  I have had both the fish oil and dextrose prolotherapy done on my ligaments and both cause the pain and swelling.  My Prolotherapist does either modality with B-12 added in to increase the healing speed.  Further, he has also tried Zinc with the dextrose. Zinc and the fish oil he said would not work.  DAMN that zinc hurts for 24 hours but it heals even faster. 

From all my research on prolotherapy in the ligaments, the healing does continue for many months after the shots stop.  Specifically, with dextrose, it is an osmotic agent that explodes the surrounding cells and forces the body to come in and rebuild the ligaments to their correct alignment.  From the time I have gotten them in November, I have had this nagging "sprain" feeling in my ankle ligaments from this procedure.  I look forward to the day that it goes away  but I think I have at least 2 more cycles to go.  I understand my ligaments were pretty screwed up.  They had to be to let my ankle move so much to lose all of my cartilage.

Regarding HGH, I would definitely go for it.  As you stated not only has it been documented but I have personally seen the cartilage reappear through the x-rays taken monthly over a period of 5 months since I started the injections.  At 5 months I was over 3 MM growth in all areas except one area I was only at 3 MM with normal being 4 MM or so.  This was from a starting point of 0 MM cartilage since I had surgery to remove the dead bone.  Dr. Dunn did this to give the cartilage a solid place to rebuild.  You don't sound NEARLY as far off as I and absolutely won't need the surgery part.  You will do great. 

Of course, the best thing to do would be offloading the knee but that is not realistic and so just realize you will need to go in for a few more shots than someone who was off of their knee for a period of a month or more.  That new cartilage is fragile and crushes easily.