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Author Topic: Out of surgery with Broyles  (Read 19559 times)

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Offline psny

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Re: Out of surgery with Broyles
« Reply #15 on: July 02, 2016, 06:43:19 AM »
Thank you plaidwandering,
yes, that what I estimated about costs too.

Psny,  I'm planning to have an arthroscopic procedure mainly to assess the defect, and also do some clean up. It'll be combined with BMAC stem cells which would be placed exactly at the site of defects, in trochlear groove and meniscus, mixed with fibrin glue. The glue will have the cells in place. There are studies showing a slightly better outcome if fibrin glue is used.

I see, very interesting! Did you receive any more relief from the SVF / PRP / HGH injections? I'm beginning to really wonder if injectable stem cells therapies have any regeneration capability without actual trauma for chondral defects. For arthritic patients they seem to offer anti-inflammatory benefits and potentially slow progression while controlling symptoms. Standard intraarticular injections don't seem to be able to really regrow any cartilage or even regenerate softened cartilage seen in mild chondromalacia. If there is some regrowth it is usually very minor. At least from what I've seen on these forums. I am not far along in my quest yet with SVF / PRP to know if anything has changed.

All of the studies around cartilage regeneration involve marrow stimulation (microfracture), a scaffold, or fibrin glue. Standard microfracture creates a poor repair due to the repair tissue not filling the defect completely in addition to healing mostly as fibrocartilage. This is likely due to there being too few drill holes in the area of damage, thus forming less vascular channels from the bone to allow cells present in bone marrow to create new cartilage. Although, I guess in theory if something is done to hold the cells in the place of damage then even without microfracture they can begin healing the area. This is being researched now for tendon injuries. Creating a scaffold that can hold growth factors in place long enough for tissue to heal.

Dr. Saw's drilling method isn't even comparable to what is typically done during microfracture. He, as the original poster of this thread mentioned, creates what appears to be a minefield. The drill holes are very close together and deep. He doesn't use scaffolds or fibrin glue and aides healing by injecting cells and hyaluronic acid for a set number of weeks after. The modified microfracture technique with the additional cells seems to take healing and defect filing to the next level. You can see in his videos that the repairs later on are almost indistinguishable from a undamaged knee.

Video of Dr. Saw's drilling technique:
https://www.youtube.com/watch?v=v8TAbBEBqsA
« Last Edit: July 02, 2016, 06:45:40 AM by psny »

Offline jnestor1299

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Re: Out of surgery with Broyles
« Reply #16 on: July 03, 2016, 06:19:41 PM »
I really hope all goes well for you. I'm flying to San Fran on Wed to meet Dr. Saw and see what he has to say about my knees. Please continue to post updates. Take Care

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #17 on: July 06, 2016, 02:55:22 PM »
Planning to update for a long long time, they just won't be as frequent

PT continues, gaining back rom quickly, I only had a few degrees lost prior though so. cPM has been on 120 for days, it's max. The leg will go to 160 on its own, but the cpm Broyles said is more for giving it some pressure to stimulate and not for flexibility


I am trying to venture out to the world a bit more, but the arms exhaust quickly on the crutches.

I guess I should look up a grocery delivery service to restock the fridge in room.

Offline razuzin

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Re: Out of surgery with Broyles
« Reply #18 on: July 06, 2016, 07:46:56 PM »
Thank you plaidwandering,
yes, that what I estimated about costs too.

Psny,  I'm planning to have an arthroscopic procedure mainly to assess the defect, and also do some clean up. It'll be combined with BMAC stem cells which would be placed exactly at the site of defects, in trochlear groove and meniscus, mixed with fibrin glue. The glue will have the cells in place. There are studies showing a slightly better outcome if fibrin glue is used.

I see, very interesting! Did you receive any more relief from the SVF / PRP / HGH injections? I'm beginning to really wonder if injectable stem cells therapies have any regeneration capability without actual trauma for chondral defects. For arthritic patients they seem to offer anti-inflammatory benefits and potentially slow progression while controlling symptoms. Standard intraarticular injections don't seem to be able to really regrow any cartilage or even regenerate softened cartilage seen in mild chondromalacia. If there is some regrowth it is usually very minor. At least from what I've seen on these forums. I am not far along in my quest yet with SVF / PRP to know if anything has changed.

All of the studies around cartilage regeneration involve marrow stimulation (microfracture), a scaffold, or fibrin glue. Standard microfracture creates a poor repair due to the repair tissue not filling the defect completely in addition to healing mostly as fibrocartilage. This is likely due to there being too few drill holes in the area of damage, thus forming less vascular channels from the bone to allow cells present in bone marrow to create new cartilage. Although, I guess in theory if something is done to hold the cells in the place of damage then even without microfracture they can begin healing the area. This is being researched now for tendon injuries. Creating a scaffold that can hold growth factors in place long enough for tissue to heal.

Dr. Saw's drilling method isn't even comparable to what is typically done during microfracture. He, as the original poster of this thread mentioned, creates what appears to be a minefield. The drill holes are very close together and deep. He doesn't use scaffolds or fibrin glue and aides healing by injecting cells and hyaluronic acid for a set number of weeks after. The modified microfracture technique with the additional cells seems to take healing and defect filing to the next level. You can see in his videos that the repairs later on are almost indistinguishable from a undamaged knee.

Video of Dr. Saw's drilling technique:
https://www.youtube.com/watch?v=v8TAbBEBqsA
psny,
this is exactly the question I'm trying to answer for myself. I've done SVF/PRP/HGH over 9 months, and it's hard to attribute my progress to any of these treatments. Day-to-day progress wasn't very visible either, however I've had a tremendous improvement since 9 months ago.

Last long weekend I played tennis three days in a row. I felt quite sore afterwards and had to take a couple of NSAIDs but overall not too bad. I'd say I'm at 70%-80% of my pre-injury level.  Nine months ago I had pain from walking for 5 minutes, couldn't do stationary bike at a medium resistance. So in terms of pain, inflammation, function I had a huge improvement.

At the same time it's possible that my defect in terms of cartilage deterioration haven't changed much. A big part of assessing the condition of it will be the arthroscopic surgery combined with BMAC.
Scaffold and exact placement will definitely help. However, not sure whether the healing effect will be comparable with the procedure combined with microfracture - no MF will be done in my case. Clearly drs. Saw and Broyle showed a success of MF+ stem cells approach.

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #19 on: July 07, 2016, 05:34:18 PM »
Another injection done, and weight bearing increased to 30%( from 20)

Offline psny

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Re: Out of surgery with Broyles
« Reply #20 on: July 07, 2016, 10:00:37 PM »
Another injection done, and weight bearing increased to 30%( from 20)

Do you know what sort of separation equipment Dr. Broyles uses for PRP and BMAC? Also, what brand of Hyaluronic Acid does he use?

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #21 on: July 08, 2016, 04:17:31 PM »
I don't know what equipment they use for that.

Here is what it looked like after drilling on day of surgery

Offline dal_knee

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Re: Out of surgery with Broyles
« Reply #22 on: July 08, 2016, 06:39:13 PM »
vomit..... :o
2007 - partial medial meniscectomy
2010 - full thickness chondral defect & adjacent subchondral edema MFC.   Direct result of stupid partial mensicectomy from 2007.
2014 - Subchondroplasty, chondroplasty, unauthorized 2nd partial medial meniscectomy.
2015 - partial failure of subchondroplasty.

Offline psny

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Re: Out of surgery with Broyles
« Reply #23 on: July 08, 2016, 06:54:11 PM »
I don't know what equipment they use for that.

Here is what it looked like after drilling on day of surgery

Looks almost identical to the video I posted above from Dr. Saw. Great updates to this thread by the way!

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #24 on: July 14, 2016, 08:55:23 PM »
no change in weight bearing, 4th injection went fine today. It's a piece of cake after the first awake one heh.

Offline jnestor1299

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Re: Out of surgery with Broyles
« Reply #25 on: July 14, 2016, 11:52:15 PM »
How's your knee feeling...are you still in a lot of pain killers? Was your damage in the weight bear area?

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #26 on: July 15, 2016, 01:43:10 AM »
I haven't taken a pain killer since the first night after surgery. Pain is mostly a 1 if any, very occasional 2 or 3

damage was in weight bearing portion of MFC, I go up to 40% in a week.

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #27 on: July 21, 2016, 05:36:22 PM »
PT had new things for the start of week five. Some patella loading, stationary bike, and one leg gait motions on treadmill with partial weight. No trouble with this or progressing to 40% weight bearing

Injection #5 though got me riled up though, for some reason really sore this time. It seems to be tapering off at least, but it was an unhappy first fifteen minutes. As compared to the prior ones being forgettable after thirty seconds.

Offline jnestor1299

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Re: Out of surgery with Broyles
« Reply #28 on: July 22, 2016, 01:11:35 AM »
Thanks for the updates, please keep them coming. I'm curious you indicated you had damage in the MFC, did you also have meniscus damage? If so did Broyles do injections into the meniscus? Thanks

Offline plaidwandering

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Re: Out of surgery with Broyles
« Reply #29 on: July 22, 2016, 01:22:23 AM »
Nope,  healthy meniscus in this knee















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