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Author Topic: UK runner researching cartilage options & hoping to meet other runners too...  (Read 8707 times)

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Offline jnestor1299

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Psny bring up some interesting points regarding Dr. Saw's technique and why it so effective. The drilling is key. The cartilage builds from the bone up, which add more integrity to the repair, not only in the cartilage quality, but the cartilage attachment to the subchondral bone.  This is his word during our meeting ( the cartilage he creates  will out last the surround cartilage in the knee period). He was very admit about it not break down.

Offline IMF73

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PSNY, thanks and very interesting. It does sound like the methods are slightly different and Dr Shetty did say they were different methods when I asked him.
However he did use stem cells with my surgery, it wasn't micro fracture and cartifill alone. I'm sure he also said that the drilling is different to microfracture whereas he ensures he doesn't create blood to clot i.e. doesn't drill as deep - although I may have that bit slightly wrong.
Dr Saw then injects stem cells, but so does Dr Shetty.
Don't get me wrong I am not saying which is better or worse etc I am not knowledgeable enough, Im just trying to understand the differences but I am 100% certain he uses stem cells mixed with this cartilfill. Its not microfracture and cartifill alone. To me it sounds very similar to Dr Saw.  If you google him you can even see videos of him discussing it.

Offline willp

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Hi PSNY,

Thanks for all your very informative and clear posts. It makes a lot of sense to me that a simple injection is less likely to regrow cartilage without a vascular channel.

However, i'm curious if you've looked into the research from Barcelona?

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

There are some interesting patient profiles, and the clinic itself seems reputable and grounded in serious peer reviewed science.

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 psny

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PSNY, thanks and very interesting. It does sound like the methods are slightly different and Dr Shetty did say they were different methods when I asked him.
However he did use stem cells with my surgery, it wasn't micro fracture and cartifill alone. I'm sure he also said that the drilling is different to microfracture whereas he ensures he doesn't create blood to clot i.e. doesn't drill as deep - although I may have that bit slightly wrong.
Dr Saw then injects stem cells, but so does Dr Shetty.
Don't get me wrong I am not saying which is better or worse etc I am not knowledgeable enough, Im just trying to understand the differences but I am 100% certain he uses stem cells mixed with this cartilfill. Its not microfracture and cartifill alone. To me it sounds very similar to Dr Saw.  If you google him you can even see videos of him discussing it.

I am not specifically sure what Dr. Shetty did in your case, but I did not see any mention of Cartifill being combined with any biologics such as PRP or BMAC. Microfracture is standard procedure, any surgeon performing microfracture would drill deep enough in order to get access to the underlaying marrow. This marrow as with all blood creates a clot. Cartifill assists the procedure by acting as a scaffold that this clot seeds. There is no doubt that Cartifill is miles ahead of standard microfracture. It allows the defect to fully fill in and specifically allows patellar defects to fill in since it instantly hardens.

Offline PuneKnee

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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.

Hi psny,

Do you think Dr Saw's method is suitable for focal patellae defects like Chondromalacia Patella?

Offline vickster

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I believe that's what the aim of his method is, to fix severe cartilage defects. However, that's not the same as chondromalacia patella which means the cartilage is softened, not necessarily through to the bone
« Last Edit: March 06, 2018, 08:10:51 AM by Vickster »
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 badleftknee1

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WillP, In my mind you need to figure out if you have full or near full thickness defects or not. If you do (which is very possible given your subchondral bone edema), than in my experience with visiting cartilage transplant specialists here in the US; OATS is now preferred given that you are giving someone back mature, hyaline cartilage (despite microfracture still being most common- any joe schmoe can do this with an awl). OATS can be autologous (taken from your own non-weight bearing areas) or allograft (taken from cadaver)- Allografts much preferred for larger lesions, but are even becoming popular for small lesions as well as the ease of finding and processing transplants improves.

Keep in mind that most cartilage specialists now look for the reason for damage too (e.g. limb alignment requiring DFO/HTO, meniscal deficiency requiring meniscal transplantation)- these are all much larger procedures that would likely not return you to your desired level of activity anyways.

Unfortunately, returning to sport and distance running is challenging after all of these procedures- you may find testimonials of people returning after small lesions corrected by microfracture (more testimonials as its so much more common)- but there are just as many folks who dont return- its very individualized. What you are doing is creating a better joint surface which will last longer in general, putting off eventual knee replacement. Either way- surgical or non-surgical, activity levels end up needing modification to differing degrees.

As for cartilage specialists, I think you are on the right track with Dr. Laprade. Also, there are some nice papers published (used in the US) and blogs on this site speaking highly of Dr. Tim Spalding in the UK.
« Last Edit: April 01, 2018, 03:35:00 PM by badleftknee1 »















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