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Author Topic: UK runner researching cartilage options & hoping to meet other runners too...  (Read 8686 times)

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Offline willp

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Hi everyone,

It's been a very long time (nearly a decade) since I've posted on this board. I've been lucky enough to count myself as one of the success stories here.

This post is quite long, as a way (re) introducing myself and giving some context.

My whole story is on a thread in the arthrofibrosis section. But to summarise - back in 2006 I was living in NYC. I was 37/8.  I've always been a keen runner, and did my first marathon in 2005. But I over trained for it and had some unexpected aches and pains in my RHK. In hindsight these were minor, and an MRI only showed a very small area of cartilage change in my MFC (grade 1 or 2).

A friend recommended that I see an ortho that he'd had a good experience with for his shoulder. Silly me - I didn't know at that stage that a surgeon who operates on every joint in the body is a jack of all trades and a master of none. This man told me that MRI's don't show everything, and he recommended exploratory surgery. No PT to follow, because I was 'fit'. I told him I'd need to be on my feet for 14 hrs a day for  5 days for my work three weeks later. That - apparently  - was going to be fine, as was my doing a triathlon three months later. And perhaps most crucially, he assured me that no, a knee surgery was not going to put me at greater risk of arthritis. Liar.

He removed my plica, which he said was impinging on my cartilage, trimmed what he said was a "small" radial tear of my meniscus, and debrided an 8mm grade 2  lesion on my MFC where the plica had been.

I subsequently discovered that he lied about his credentials, had a $12.5 mill award against him for permanently paralysing a woman's arm during shoulder surgery, and committed insurance fraud on my surgery. (I'm not going to mention his name here, but will happily share it in a PM with anyone).

Things went badly wrong. My knee froze up, pain levels increased exponentially, and my quad vanished. The surgeon washed his hands of me. By the time I saw a PT my knee couldn't move beyond a certain ROM without my screaming.

After several months, I took myself to the Steadman Clinic in Vail. The best decision I could have made. Dr Steadman diagnosed arthofibrosis (and more or less said that I never needed the first surgery.) he operated in December 2006, and I spent a couple of weeks in Vail doing PT with their amazing team. For the next year, I was absolutely rigorous with my PT, and slowly I worked my way back.

Dr Steadman told me not to run any more marathons (I haven't). He also said that "if you weren't a runner I would say don't run, but you are so I'm going to say cross train". With that, I've had good intentions, and have subsequently entered triathlons, but my running mileage has, over the years crept up.

Last year I ran 1,100 miles (thank you Dr Steadman and the team), and I race over half marathon and shorter distances. I've been doing around 4/5 halves a year, as well as a couple of tris(sprint and Olympic) over the summer. I have also been skiing 3 or 4 times, and some short hiking etc.

I'm now back in London, and running is an incredibly important part of both my fitness and my social life. It is - in short - the sport I love.

I've been very, very lucky -  I know this. My knee has always felt a bit different, and there's been a fairly constant trace swelling, but pain has been minimal, and to all intents and purposes I've led a completely normal life.

So, why am I posting here? Because, around about last October, Nov, things began to change slightly. I started to get increased pain in my medial joint line. It would be particularly bad if I slept on a plane. I could still run, but sometimes there would be tenderness around the joint line when I walked. Sometimes the ache would bother me at night - other times I felt almost completely fine. If I caught stairs oddly on the way down there were/are twinges.

I saw a sports Dr here in February  who gave me an MRI. The findings showed a "9mm focus of the abnormal cartilage over the lateral margin of the MFC. This shows swelling and marked abnormal signal with a tiny focus of subcortical bone marrow oedema." I had an 8mm defect grade 2 defect when Dr Steadman operated, and wanted to find out if this was a deteriotation to grade 3 or worse, but the sports Dr couldn't really tell me.

I also have a very small radial tear in the anteromedial corner of the medial meniscus, and "a small focus of chondral damage of the lateral facet of the patella, towards the inferior pole where there is a focal chondral defect of the 2mm surrounded by some minor chrondomalacia".

This last defect  - and the meniscal tear  - was new.

My goal seeing the sports Dr was to compare my knee of 10 years ago with my knee now. Is it holding up well given my levels of activity? Should I be cutting back.

But I couldn't get the answers I wanted. He referred me to physio.  And in the meantime, I've been slowly noticing increased issues with my knee (recently, I've had a couple of stabbing pains in the side of my patella after runs - this is totally new).

So, in two weeks time I have a trip scheduled to Colorado, and I decided that I would make a detour and return to Vail to get an opinion from them, and a 10 year post op check up with them. Dr Steadman is long since retired, but I'm seeing Dr LaPrade, who I've heard great things about.

I'm hoping that he will say that overall the knee is holding up well, but I have to be prepared for him to say that further degenerative changes have begun. I know that the bone marrow edema is not a good sign. i'm also concerned about the long term effects of my partial menisectomy. Though (I think) it's very small, it'll still have an impact.

My goal is to explore all options that will - long term - keep arthritis at bay and keep me active and hopefully running, even if that means simply doing 10ks or trail runs rather than 1/2 marathons.

I want to be able to ask Dr LaPrade about viable cartilage regeneration procedures that have proven efficacy, but might not be permitted in the US under current FDA rules. I know about Dr Saw in Malaysia, but I'm course keen to avoid surgery. It also seems that there are  promising stem cell injections in Barcelona, but these may be for full arthritis, not chondral defects. The Stone Clinic in SF seems to have some amazing results, but it's hard to distinguish their actual success rates from their PR.

And does anyone know of any UK based Drs who are offering biologic treatments? That would be ideal.

I'm very new to this world, and want to be as educated and informed as possible. Hopefully, Dr LaPrade will give me relatively good news about the state of my knee, but I can definitely feel things changing and want to explore every sensible and well researched option to stay active long term that I can  - and I hope help others through an exchange of info.

If you read this far - thank you! And I hope you're all doing well.

Will




Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline jnestor1299

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Hi There! I've seen both Dr. Saw and Dr. Stone in person. I don't know the specific questions you have. I will tell you they have completely different goals and success rate. Saw is grow new cartilage, where Stone is buy time 2 to 10 years with paste grafting and meniscus repair/transplants. I'm curious about the stem cells in Spain. Please let me know if you have a link etc.... Thanks

Offline willp

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Hi jnestor1299 - thanks for your very quick reply.

Here is is Barcelona link. It looks reputable, though still on a trial basis:

http://www.itrt.es/en/stem-cells-treatments/adult-stem-cells/treatment-osteoarthritis-knee-stem-cells

Obviously, anything that involves injections rather than surgery is preferable. However, it mat not be suitable for Focal defects because there doesn't seem any way of targeting the cells.

What do you know about the different success rates of Stone/Saw?

Can I ask what the issues you're dealing with are?

Cheers, Will
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline vickster

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  • Neelie knee!
Eastern Europe seems to be a popular destination for stem cell and PRP injections and rather cheaper than the US. Look for posts by PSNY

Little seems to be happening in uk outside a few (trial) centres in cartilage repair
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline willp

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Thanks Vickster - I'll check out PSNY's posts.

I drew a bit of a blank when I was researching the UK too.
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline vickster

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  • Neelie knee!
If prepared to go the surgical route, could try Anan Shetty in Kent and his Cartifill product. Do you have private healthcare or reliant on NHS? These treatments are considered experimental so difficult to access unless have deep pockets for self pay
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Offline willp

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Hi Vickster - Right now, I'm not planning on any surgery, as I still have fairly high function (though, as I mentioned, I can feel that things are turning, hence my being back on the board!) Also, I've done extensive rehab before and don't want to go through that again.

So ideally, I'd like to avoid any sort of surgery, but if I do need that to stay active and avoid pain and premature global arthritis then I'd consider it. But I'd want a procedure that has the best possible chance of regenerating stable hyaline cartilage.

I don't have private health insurance, but would pay out of pocket (and go into debt if needbe) to secure the best chance of a functioning knee for the next few decades. (I'm 48 now).

But anyway, I'll see what Dr LaPrade says how he feels my knee has changed over the last ten years when I see him in 2 weeks. I hope that will make everything clearer  - my previous experience in Vail means I have a huge amount of trust in their expertise.
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline dal_knee

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For nonsurgical option, look at Invossa due out in a year:
http://www.koreaherald.com/view.php?ud=20160712000693

Also look at posts from "skierboy" who posted his experience with it.
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 willp

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Thanks Dal_knee. This is the first I've head of Invossa.

It sounds like a fascinating product and I can't wait to find out more. Though - sadly - it does seem as if there is always a 'miracle' product in the pipeline which doesn't end up living up expectations.

But I'm hoping it comes onto the market in Korea soon, and then a lot more will hopefully become clear.
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline IMF73

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If prepared to go the surgical route, could try Anan Shetty in Kent and his Cartifill product. Do you have private healthcare or reliant on NHS? These treatments are considered experimental so difficult to access unless have deep pockets for self pay
I had surgery by Professor Shetty back in Oct last year. As I have said on a few other posts on here, so far so good and starting to become pretty active again.

Offline jnestor1299

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I have grade 3 damage in medial compartment, along with meniscus tears. Stone success rate is 2 to 12 year at about 80%.He uses paste grafting( watch youtube video Stone paste grafting). Saw on the other hand is at 90% or better with full thickness cartilage that is approaching 95% of your native cartilage (watch youtube video dr saw knee search). I was impressed with both drs.

Offline willp

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Thanks IMF and Jnestor. I suspect (but won't know for sure until I meet Dr LaPrade), that my MFC defect is now grade 3 (it was a 2 ten years ago).

I'll read more about Professor Shetty and consider an appointment with him once I know more from Vail.

It seems (I hope! ) that with drugs like Invossa and stem cells there are some genuinely encouraging prospects for cartilage growth. I obviously want to ensure that any repair method I try aims to replicate as much hyaline cartilage as possible, rather than an inferior substitute.

Anyway, lots of research to do. I'll report back after I have my appointment in Vail in two weeks.

Best wishes to all.....
Medial plica removal 4/12/06. Not referred to PT. Increasing pain and quad weakness. Diagnosed with scar tissue by Dr Steadman 10/12/06, LOA and AIR in Vail 12/15/06. Returned to high level activities 4 14 years.
2020 - flare up with medial joint line pain and occasional collapse. Currently baffled

Offline psny

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Thanks IMF and Jnestor. I suspect (but won't know for sure until I meet Dr LaPrade), that my MFC defect is now grade 3 (it was a 2 ten years ago).

I'll read more about Professor Shetty and consider an appointment with him once I know more from Vail.

It seems (I hope! ) that with drugs like Invossa and stem cells there are some genuinely encouraging prospects for cartilage growth. I obviously want to ensure that any repair method I try aims to replicate as much hyaline cartilage as possible, rather than an inferior substitute.

Anyway, lots of research to do. I'll report back after I have my appointment in Vail in two weeks.

Best wishes to all.....

I've been on these forums for a few years and closely follow all of the latest studies, press releases, and general news about implants and techniques around cartilage regeneration. Additionally, I have done two rounds of SVF followed by 3 PRP injections along with HGH into both knees. You can read more about it in my thread called "My Stem Cell Journey - Lodz".

Anyhow, this is just my opinion based on what I've read and experienced, injections will not regrow cartilage without a vascular channel into the bone. They may delay symptoms of arthritis and generally change the chemistry of the joint by lowering inflammation, but cartilage regrowth in my opinion is not possible.

If I were to choose any method for regenerating cartilage I would choose Dr. Saw. His research and method has shown consistently good results and has actual scientific data collected from biopsies to back it up.

As for Dr. Shetty, his method is very basic and in my opinion nothing special in comparison to what is currently available. To my knowledge he is just mixing BMAC with a injectable collagen fibrin scaffold. The end is result is slightly better then microfracture. The majority of currently available scaffold products are focusing on improving results from microfracture by fully filling the defect. The main issue is the tissue is still not close to hyaline cartilage. The reason for the recent influx is such devices are highly profitable for the device manufactures. Once approved they can be used in the hundreds of thousands of microfracture surgeries per year. They're covered by insurance, easy to use, and offer benefit over standard microfracture.
Large medical device manufactures license these products and push them to their existing base of doctors, such as Arthrex with BioCartilage and Cartiform, both of which are originally produced by another manufacture.

If Dr. Saw were not available for whatever reason I would look at Cartiform. There are a few other methods that do not have much data right now such as CartiONE in the EU that I would also keep a close eye on. CartiONE is different then Caritform, but shows promising results. These methods achieve around 80-85% hyaline cartilage, versus 3-7% hyaline in standard microfracture. They're also covered by insurance and several forum members here have had good experiences with Cartiform.

Offline IMF73

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Psny, what is Dr Saw doing differently to Shetty? In laymans terms please. I have as you probably have seen had surgery by Shetty and am pleased so far. But I'd be interested to understand what Dr Saw is doing differently and potentially better.
Thanks

Offline psny

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Psny, what is Dr Saw doing differently to Shetty? In laymans terms please. I have as you probably have seen had surgery by Shetty and am pleased so far. But I'd be interested to understand what Dr Saw is doing differently and potentially better.
Thanks

First off,  I just want to say I am not recommending any specific methods. I simply stated my preference if I had to go down the surgical route. I am pleased in hearing about anyones success regardless of method that they used to attain a pain free repair.

To answer your question, Dr. Shetty is performing standard microfracture with the addition of a collagen scaffold product called Cartifil. The term "standard microfracture" refers to the original method developed in the 1980's that involves drilling of the subchondral bone. This creates access to marrow elements in the bone that go onto create a clot, followed by revascularization, that then produces fibrocartilage. Dr. Shetty layers on top of this by injecting a collagen gel scaffold called Cartifil into the defect followed drilling. Cartifil hardens instantly unlike other products so it is suitable for patellar defects, which is a plus as the patella is always difficult to repair due to its position.

As for Dr. Saw, he modified the microfracture technique significantly by creating more drill holes that are closer together and deeper. One member here gave the analogy of the defect looking like a mine field post drilling. He does not use any implantable or gel scaffolds following drilling. After drilling, he injects PBSC (peripheral blood stem cells) and hyaluronic acid for a number of weeks into the joint. 

To compare the two methods one must understand the two issues with all current cartilage repair methods. The first is fibrocartilage, almost all repair methods involve microfracture. Microfracture alone produces around 5% hyaline cartilage with the rest being fibrocartilage. This is the single most reason microfracture fails. The second is the defect does not fully fill in with fibrocartilage, thus causing uneven loading and premature failure. Scaffold products are aiming to make repairs that utilize microfracture more consistent by securing the clot thus filling in the defect completely. There are many on the market. Some are just scaffolds while others such as Anthrax's BioCartilage contain growth factors and dehydrated allograft cartilage.

Dr. Saw has demonstrated several times that his drilling method creates a better repair even without PBSC. His original trials were done without PBSC and HA only. He has also documented around 90%+ hyaline cartilage via biopsies in the PBSC treated patients. The are a number of theories as to why his method is superior, but if I had to guess I'd say it is likely a combination of the following: The drilling is more aggressive thus giving an increased number of channels into the bone. This produces a more even clot that better fills the defect and allows for better integration with the surrounding cartilage. The addition of concentrated cells for a set number of weeks afterwards allows for even more differentiation into cartilage, also known as chondrogenesis. Hyaluronic acid acts as a scaffold and plays a large role in joint health where it surrounds each chondrocyte. 
« Last Edit: July 15, 2016, 06:52:49 AM by psny »















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