Where to get cultured stem cell procedure?

[Grove]

First post here, but I've read through hundreds of threads on this forum in the last months and have gotten great information, so thanks to all.

I have issues with several joints that have become painful in the last year. I've spent huge amounts of time researching, reading academic papers and looking through forums. I've gotten my MRIs and have consulted with many doctors.

I haven't done any treatment yet, so unfortunately I don't have much value I can add to this forum based on actual personal experience. Hopefully soon :-). But I'm now at the point where I at least know that 1) I definitely don't want surgery unless my pain becomes unbearable (many doctors have recommended multiple surgeries) and 2) I want to give stem cells a good try.

Based on the academic research I've read and the experiences of doctors I've spoken to, I'm pretty sure that I want injections of autologous cultured cells. I understand that people have gotten good, sometimes even great, results from same-day MSC procedures. But my reasoning behind wanting cultured as opposed to a same-day style procedure is that the number of cells makes a huge difference in increasing the odds of positive long-term outcome and regeneration potential. It obviously depends on the number of areas to be treated, size of each area, and damage, but as a rough figure I'm looking for at least 25 million for a smallish area and 100 million for a bigger one.

There's been a little research on the dosage size for stem-cell injections. Since this is a knee-focused forum, here are two recent papers I found testing dosage-size in knee injections:

• 2014 Korean study compared 3 differently-sized doses of adipose-derived stem cell injection into osteoarthritic knees: high (100 million cells), mid (50 million) and low (1 million). The study has a small number of patients, but they found that regeneration and long-term pain was significantly better in high dose than low- and mid-, although all doses did have an effect on short-term pain reduction. (https://www.ncbi.nlm.nih.gov/pubmed/24449146)

• 2016 Spanish study compared injection of hyaluronic acid (HA) only vs. injection of 2 differently-sized doses of bone marrow-derived MSCs into OA knees: high (100 million) and low (10 million). More patients than the Korean study, athough still small and not double-blinded. Main conclusion is that the stem cell injections of both sizes outperformed HA-only, but that after 1 year, patients who had the high-dose injections showed significant improvement while the low-dose group did not. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5002157/)

So that's why I'm hoping for cultured cells. If anyone has any thoughts on this, definitely let me know. I'd love to hear any ideas on cultured vs. same-day procedures.

So for now, I'm pretty set on cultured. But I've hit a snag: where to do a cultured cell procedure?

Trials would be the best. They offer great care, well-done legit procedures, headed by both doctors and academic researchers, no need to jump through regulatory hoops as a patient since the trial directors have already done all that. Plus it'd be great to do something to help out science research, especially since I'm relying on these studies so much for planning my own care. And best of all, it's free.

But there are lots of problems with trials, at least in my case. Getting selected for a trial is hard, particulary if you don't live close to where it's being done. As an example, one doctor running a trial told me he got a hundred mails with MRIs from people around the world begging to be accepted, but at the end he only selected locals for both logistical reasons and for follow-up.

Another issue is that you have a good chance - maybe 50% or 66% or 75%, depending on the trial - of not getting the treatment you're hoping for. You get a lesser treatment or you get a sham. In some of the trials, after a year or two, they offer the full, good treatment to the patients who received a sham or lesser treatment. That's nice, of course, but for me that represents a wasted year or two with further degeneration and pain.

Finally, there's time and availability. There are lots of trials on stem cells, but not so many that are specifically doing orthopaedic, cultured stem-cell injections. Even if I get lucky and get into one, it could be a wait of 6 months or more before I finally get started. And if I get the sham treatment, that means I'd be looking at a total wasted time of 2-3 years of further degradation before getting the treatment I want.

So I've been looking at private treatment. The cost will probably wipe out my savings and then some, but I've realized that at some point, quality of life truly is worth more than any amount of money.

So where to do a treatment? I've learned what everyone here knows already: the whole area is a minefield of controversy, with different angles of politics, business, science, and personalities.

In the U.S., cultured cells are definitely not possible after the FDA-Regenexx ruling.

In Europe, I've had problems getting real information about the situation. In general, it seems that culture expanded cells aren't offered EU-wide, but it also seems each country has different loopholes that allow for exceptions. I'd really appreciate any info if anyone knows the real details about this, for the EU in general or any one European country.

I'm willing to go anywhere in the world. I've contacted many clinics and doctors in many countries, but I've only found two legit-seeming places that have confirmed they can definitely offer me cultured treatments on a private, non-trial basis:

- Regenexx, Cayman Islands
- Teknon Medical Center, Barcelona, Spain

I've also found 3 places - one in Thailand, one in China, and one in California of all places - which claim they can offer me culture expanded stem cells, but they don't seem very legit about their procedures, injection process, etc.

So that's the long-winded introduction to my question for the forum:

What clinics and doctors currently offer culture expanded orthopaedic stem cell treatment on a private basis?


Thanks!

[razuzin]

Great question, I'd like to myself know more about available options, both in US and abroad.

Due to a tricky nature of culturing stem cells in US, don't think many clinics would be advertising it openly.
I did have an appointment with a doctor in NYC area who effectively described the above procedure as part of his process via a use of stem cell banks. Can provide details via PM.

Interesting research about duration of improvements.
I can attest from my own experience that the impact of same day stem cells seems to have a limited lifetime. I had a same day MSC injection arthroscopically about 10 months ago. I got great improvement within 3 to 6 months, by now feeling that effect of stems cells is dissipating, some of the symptoms which I had before the injection return.

[Grove]

Razuzin - Your experience ties pretty well with the results from the trials I've seen testing dosage size for injections (no surgery, no scaffold), particularly for bigger areas. Low dosage leads to improvement after a few months, but then fades away after 6 months.

I've spoken to quite a few academic researchers/doctors who have experience with this. They all think that at least currently, there's no technique to get enough stem cells from a same-day, non-expanded procedure which could have a lasting beneficial impact through injection. They say the smaller numbers is clearly helpful as a massive anti-inflammatory, and in some cases maybe that's what's needed, but it doesn't seem to be enough for long-term outcome and regeneration. No one really knows how the stem cells work, but what is clear in the last years is that you need a lot of them. One researcher is so peeved by clinics offering this same-day injection option that he's thought to put together a simple, well-done trial to conclusively show that a same-day treatment, even with the maximum number of cells you can get from it, generally are not enough.

Of course, many clinics, doctors and their patients disagree (most obviously, Regenexx and Dr. Centeno). I'm truly happy for any patient who has gotten great long-term results from same-day procedures. And who knows, it's a wild world of unknowns, every patient's situation is different, and maybe someone has found better techniques than what's already published in the journals and currently experienced by academic researchers. But all the well-done evidence seems to be that you need 25, 50, or even up to 100 million for good effect in an injection procedure.

Regarding your NYC clinic: Personally, I'd be a little suspicious of any doctor in the U.S. who offers a private (non-trial) culture-expanded stem cell treatment. It's definitely possible that there's someone who is very capable, up-to-date on the procedures and research, and has all the equipment, and who disagrees philosophically with the FDA so strongly that s/he will do it in a legit, correct way... but it's a major risk for them, and I think most talented doctors wouldn't cross that line. One clinic kinda-sorta offered it by sneaking it in under an experimental basis, but they got shot down earlier this year as soon as it came to light. And there are a few others I've found in the U.S. who seem to be offering expanded procedures, but after some investigation you find that it's just marketing putting a shine on what turns out to be the standard same-day treatment. I'd be interested what you've found.

Does anyone have any ideas where to go for these culture-expanded treatments? Some places I'm still trying to find out about: Poland (psny..?)? Other countries in Eastern Europe, like Czech Republic, Hungary and Lithuania? Israel (ankle_boneonbone...?)? Taiwan?

[razuzin]

Grove - absolutely agree with you about my NYC clinic, that was the reason I walked away, aside of a high cost. The process of culturing is done remotely, with little knowledge about the facility which does it, also some shipping involved which is not desirable from what I read.
In particular, Regenexx does the full cycle off-shore now as far as I know, as opposed to taking the original sample in US and sending it to Caymans.

It would make perfect sense to me that a large amount of stem cells in a sample should have better results. I'm wondering whether having consecutive same-day injections would have a similar effect over a long term. Also what would be the optimal time interval between two injections?

In my case I first had an adipose same day stem cells procedure which also resulted in a big improvement in pain and inflammation, and then in about eight months the MSC injection. Overall, I'm in much better shape than prior to the first injection, hopefully over fairly long term, it's been about 1.5 years since the first injection.
However, I haven't seen any studies about optimal intervals between the injections if more than one is performed.

I'd expect in Korea and China culturing stem cells is done routinely, possibly in some Eastern European countries - but I don't have any specific info.

[db1984]

Sorry to bump an old thread but I have relevant input. This discussion on the cultured cell data really struck a chord with me. I was dead-set on getting cultured cells based on the data I had seen in the published literature.

I'm currently approaching 5 months post-op for Regenexx-C in the Cayman Islands. My problem is mild-moderate (depending on who reads the MRI) patellofemoral OA with subchondral sclerosis and bone marrow edema. Left knee is worse, combination of post-traumatic OA from a patella dislocation as a teenager and overuse (I just turned 33). I also have patellar and quad tendinosis. I have problems in other body parts as well, such as early lumbar DDD and ligamentous instability in my low back, ligament laxity in my left shoulder, and Achilles tendinosis.

I had my bone marrow aspiration in March of this year. At the same time I had patellar/quad tendon hydrodissections with PRP. This is where they inject PRP to separate the tendons from the fat pad. At the same session I had lumbar ligament and epidural injections in my low back with platelet lysate.

I returned in April to have the cultured cells injected. In each knee they did 10 million MSCs into the trochlear groove and 10 million under the patella... so 20 million total intra-articular. They also drilled into my patellas and did intra-osseous injections of 8 million MSCs into each patella (to treat bone edema and subchondral changes). They injected MANY ligaments throughout my knees with MSCs, such as patellar/quad tendons, MPFLs MCLs, ACLs etc. I also had many lumbar ligaments and shoulder ligaments injected with MSCs. I had my Achilles tendons injected with PRP a couple months later by a Regenexx doctor in the US... which has really helped by the way!

20 million intra-articular is kind of on the low side relative to the published literature for cultured MSC knee OA injections, but at the same time they inject a combination of PRP and platelet lysate, which is actually what they use as their culture expansion medium. So "in theory" there should have been MSC proliferation in-vivo post injection, but that's hard to verify as a fact.

Now that I'm almost 5 months post-op I'm noticing some improvements, but nothing super dramatic yet. I'm moving up and down stairs more quickly and the frequency/intensity of chronic inflammation has reduced. I still have inflammatory flare ups though, which is frustrating. I had functional limitations squatting down, but that is gradually starting to improve. I definitely have a long way to go in terms of recovery. I think I'm going to wait until I'm 12 months out and if I'm not satisfied head to Regenexx headquarters in Colorado for a thorough re-evaluation. Before and after MRIs would be great!

The recent publications by the doctors at the Teknon Barcelona clinic are very impressive. By the way, I recently learned that they setup an operation in Switzerland:

www.medxcell.ch

A clinic in Santiago, Chile (Clinica Las Condes) recently published a couple papers on treating hip OA with cultured BM-MSCs. They didn't mention knees but they would probably do it if the price is right:

www.clinicalascondes.cl

I ultimately chose Regenexx Cayman because they were very helpful communicating with me during the planning phase, and I like their emphasis on biomechanics and treating all the areas of the body that need work, which in my case included not just my patellofemoral cartilage, but also the knee ligaments, bone edema and lumbar spine. I think if I were to just get a straight intra-articular injection in Barcelona it would help my cartilage but I would still have other issues.

www.regenexxcayman.ky

[diesiel]

great post, thanks for the contribution!  i also have a few questions

1.) are all of your injuries as a result of some kind of acute traumas, or do you think you may have some kind of systemic inflammatory condition? 

2.) did they mention how long to wait until full results are realized?

3) were you charged extra for the ancillary ligament/tendon injections?

4) do you mind sharing what the cost was for all of your procedures?

thanks!

[db1984]

Hi diesel:

1. I've pushed my body really hard working out, lots of weightlifting. Heavy squats, deadlifts, etc. That really took it's toll on my knees and back. Aside from my injuries I'm healthy. I've never been diagnosed with a systemic inflammatory issue, but I have had periodontal disease (which is now well managed) and that's an inflammatory condition... so maybe but not sure. My old patella dislocation has resulted in some post-traumatic OA, worse cartilage wear in the left knee vs the right.

2. They gave me some "guidelines" for rehab, activities that are okay at 1 month, 2 months, etc... but it's just an approximation. Frankly I think the guidelines are optimistic. They say that generally patients start to feel better between 1-3 months, but some take 6-9 months before they notice improvements. They explained the inflammation, proliferation, remodeling process and said remodeling usually takes 6-12 months. They make no specific claims on cartilage regeneration but I've read enough of the studies to know that it's real, the question is "how much" do you really get?

3. I was charged extra for the patellar tendon hydrodissections and bone augmentations (intra-osseous patella injections). I was also charged extra for the lumbar spine and shoulder work. Their clinic coordinator is a pretty reasonable guy though and gave me a discount on a few items.

4. Overall I paid about $30k for everything. Keep in mind I had A LOT of work done... they went to town on me! If you had OA in one knee and no other problems the cost would be $17k. I made sure to get a comprehensive cost breakdown before hand and I originally thought it would be $25k, but they modified the treatment plan a bit after my physical exam, which brought the cost up. Financially it was a tough pill to swallow but the Regenexx docs insist on fixing your problems, especially if you have spine issues, which I think is wise in the long run. I think most athletes with worn out bodies have one big problem they're panicking about and a few extra dormant problems they're in denial about... and they know that.

[db1984]

I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

[diesiel]

Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

[psny]

I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before.

[db1984]

I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before.

psny,

Yes, my Achilles tendons have definitely improved after the PRP injections. I had "Regenexx style" PRP with minimal red and white blood cells, 10x platelet concentration.

Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

diesiel,

Check out these studies, they're seeing significant improvements in cartilage after a single injection of culture expanded cells. This kind of data doesn't exist for the BMAC injections that 99% of people are getting:

https://www.ncbi.nlm.nih.gov/pubmed/25822648
https://www.omicsonline.org/open-access/treatment-of-knee-osteoarthritis-with-autologous-expanded-bone-marrow-mesenchymal-stem-cells-50-cases-clinical-and-mri-results-at-one-year-followup-2157-7633-1000285.php?aid=54989
https://www.ncbi.nlm.nih.gov/pubmed/26783191

These are some of the papers published by the Teknon Barcelona doctors mentioned above. One of them (R Soler) also runs the clinic in Switzerland.

[db1984]

Also... Dr. Saw's results are very impressive, but there needs to be a "middle ground" treatment for mild to moderate OA vs. the bone-on-bone lesions Dr. Saw is treating. Cartilage damage is a spectrum disorder, it's not binary. Injections of culture expanded stem cells are the most promising option right now for early to mid-range OA. A few more studies:

http://www.celltherapyjournal.org/article/S1465-3249(14)00064-4/abstract
https://www.ncbi.nlm.nih.gov/pubmed/22724879
https://www.ncbi.nlm.nih.gov/pubmed/26058927
http://www.celltherapyjournal.org/article/S1465-3249(13)00152-7/abstract
https://www.ncbi.nlm.nih.gov/pubmed/18523506
https://www.ncbi.nlm.nih.gov/pubmed/18786777
https://www.ncbi.nlm.nih.gov/pubmed/24430407

[psny]

I should clarify, I live in the US, so all the prices I mentioned are in American dollars.

I spent about a year digging through the published literature and agree with all the comments made here on same-day vs cultured cells. The Spanish doctors at the Teknon Barcelona clinic actually felt it was necessary to point out the false equivalency between same-day and cultured stem cells in one of their recent publications. Their opinion is that BMAC shouldn't really be considered a "true" stem cell procedure.

That being said, a lot of people are getting good results with same day stem cells, although it might have more to do with changing the chemistry of the knee than actually regenerating cartilage and bone. I tried same day cells and it didn't help me at all.

Regenexx is actually running a knee OA trial for Regenexx-SD in Chicago right now, although from what I've read they're using an untreated control group vs a blinded sham injection group. That might have to do with the ethics of performing a sham bone marrow aspiration to ensure blinding... but I'm just speculating.

The evidence for cultured cells is a lot stronger than many realize. I've found 5 randomized controlled trials testing cultured BM MSC's delivered via injection for OA. One was for post-menisectomy and another as an addition to MFX and HTO... the other three trials were just an IA knee injection for OA. But in every single trial the only difference between the groups is one got a cultured cell injection and the other got the placebo, and the cultured cell group always has better clinical outcomes and regeneration seen on imaging. That doesn't mean it's making knees "brand new" but the injections are definitely disease modifying and have regenerative effects. One of the findings of the Teknon doctors is that cultured cells improve cartilage quality... so that even if changes are hard to see on a standard MRI or X-ray there are still regenerative changes taking place. What's also interesting is that many of the studies are showing subchondral bone regeneration as well... not sure if that's improvements in cartilage protecting the bone or the biochemical "crosstalk" between cartilage and bone, or maybe some combination of the two. It's all very fascinating and I'm always on the lookout for new publications. Overall I think a cultured cell injection (especially bone marrow cells) is a wise investment for anyone with mild to moderate OA.

Sorry I'm rambling at this point... can't help it!

Since you cannot yet send private messages due to your post count I will ask here. Has PRP helped your tendon injuries such as your Achilles? I have Achilles and would like to know. I had the Tenex procedure along with PPR done by a very prominent ankle surgeon in Manhattan and I still have pain, intact, its not much if at all better then before.

psny,

Yes, my Achilles tendons have definitely improved after the PRP injections. I had "Regenexx style" PRP with minimal red and white blood cells, 10x platelet concentration.

Another thing to consider is frequency of injections vs yield of each one.  I'd favor frequent treatments over a single potent one.  Although it's hard to weigh in, the data just isn't there yet.  There is a reason dr saw does multiple stemcell doses after his custom MFX.

diesiel,

Check out these studies, they're seeing significant improvements in cartilage after a single injection of culture expanded cells. This kind of data doesn't exist for the BMAC injections that 99% of people are getting:

https://www.ncbi.nlm.nih.gov/pubmed/25822648
https://www.omicsonline.org/open-access/treatment-of-knee-osteoarthritis-with-autologous-expanded-bone-marrow-mesenchymal-stem-cells-50-cases-clinical-and-mri-results-at-one-year-followup-2157-7633-1000285.php?aid=54989
https://www.ncbi.nlm.nih.gov/pubmed/26783191

These are some of the papers published by the Teknon Barcelona doctors mentioned above. One of them (R Soler) also runs the clinic in Switzerland.

How many times did you have PRP on the Achilles? Is it pain free? Can you elaborate on the technique? Was the tendon fenstrated with the needle while injecting to breakup scar tissue and increase damage?

[db1984]

psny,

I had the Achilles PRP injections done in one doctors visit in June, so a little over 3 months ago. It was 4 or 5 injections at multiple spots along each Achilles with ultrasound guidance. I don't think he "fenestrated" it. I would say they improved about 60%, so significant improvement. Most noticable change was a decrease in morning stiffness. They're not perfect though.

The clinic is called Columbia Pain Management, it's in Hood River, Oregon. They're a Regenexx affiliate.

[dex]

Anyone has tried, or knows someone who tried, a cultured cell treatment to an articulation?

Teknon and MedXCell seem quite interesting. I tried googling and searching the forum for testimonials but found none. MedXCell claims that over 700 patients have been treated and would really be interesting to know how it turned out for them.

[db1984]

Anyone has tried, or knows someone who tried, a cultured cell treatment to an articulation?

Teknon and MedXCell seem quite interesting. I tried googling and searching the forum for testimonials but found none. MedXCell claims that over 700 patients have been treated and would really be interesting to know how it turned out for them.

dex,

I think you'll have a hard time finding testimonials for a couple reasons:

-Cultured cells are only available at a few clinics around the world
-Treatment is very expensive, $15k - $20k (US dollars) for an injection

That being said, the Teknon Barcelona doctors have run two randomized controlled trials showing MRI evidence of cartilage regeneration. They've also run a non-randomized study on a larger group of patients with long term follow-up (4 years) also showing MRI evidence of regeneration. I posted links to these studies earlier in this thread.

I'm 5 months post-op for cultured cell injections at Regenexx Cayman. I've noticed some improvement but still have a long way to go in terms of recovery. I'll see if I can get an MRI in a few months.

[db1984]

I forgot to mention, before 2010, when Regenexx was still doing culture expansion in the US, there was a thread on this forum of patients who had the procedure done and they were getting good results. I don't have the link on hand but if you search for it you should be able to find it.

[db1984]

Quick update on my post Regenexx-C status. I had 8 month post-op MRI's of both knees, as well as x-rays of my lumbar spine.

I'll start with the spine:

Previously I had lumbar instability, basically the vertebrae slip sideways a few mm instead of staying in alignment throughout the range of motion. This was most noticeable on extension, and is easily seen on x-ray. I also had early degenerative disc disease on the bottom 2 discs, L5-S1 and L4-L5, which shows up as mild disc narrowing on x-ray. Symptomatically my low back was tight but not super painful. 8 month post-op x-rays show good alignment of the vertebrae and normal disc space... basically no spine abnormalities! I was quite surprised by the results on the lumbar discs, as I haven't found any research indicating disc height can be restored with these procedures. It might be due to the fact that the sloppy vertebrae movement has been corrected, putting less stress on the discs, and that we caught it early. Symptom wise my low back is greatly improved with occasional soreness that might just be a posture or muscle issue. Been doing lots of planks and other core exercises, the back feels strong.

Now the knees:

I have moderate cartilage wear in the trochlear groove of the left knee, and mild damage on the left patella. No cartilage damage in the right knee. Bilateral patellar tendinosis with some partial tearing on the right side. I also had bone marrow lesions (BML's) in the trochlear grooves and patellas of both knees. If you don't know what a BML is, look it up. It's basically arthritic bone degeneration and abnormal remodeling of bone. They cause knee pain and accelerated OA progression.

My 8 month post-op MRI shows ZERO bone marrow lesions in both knees! That was by far the best part. My cartilage wear doesn't look like it's changed much and I still have patellar crepitus, which I'm somewhat disappointed by, but not heartbroken. Patellar tendinosis doesn't seem to have changed much either, which I am surprised by, was expecting more improvement in that area. Symptom wise my pain levels are significantly improved with much less frequent flare-ups. I'm not back to working out hard, but I can squat down comfortably and jog up and down the stairs, although not as fast as I used to.

Overall I would say I'm extremely satisfied with my low back results and partially satisfied with the knees, the most encouraging part being the complete healing of the BMLs. We're all dreaming of cartilage regeneration, but subchondral bone integrity is an extremely important part of OA, so the fact that they healed means the treatment is having a serious impact structurally. I have a follow-up appointment at the Centeno-Schultz clinic next month to discuss next steps. I would like to see how much improvement they would expect with a second injection of cultured cells in the left knee and if they think I would have a reasonable chance of getting some cartilage growth. Also need to get a price quote, these treatments aren't cheap! Also... maybe I just need to give it more time. If I like what I hear I might go back for a second treatment. If not... then I have a lot of thinking to do.

[Brandon123]

Many thanks for the info, please keep us updated on how everything develops!

[db1984]

I previously stated that my knee results from Regenexx-C were moderately good. I need to correct that, the positive results have been nothing short of amazing. I previously based my opinion on the report of the radiologists reading my MRI's, but now that I've taken the effort to line up matched slices back to back, I can see that the results are truly dramatic and that the radiologist was probably too lazy to do a thorough comparison. I've had not only significant healing of bone marrow lesions, but also a substantial amount of cartilage regeneration as well as greatly improved inflammation levels. I just attached a before and after comparison of a sagittal image of my left knee. I have many more, but I'll just include this one for now. Very exciting stuff!

[Brandon123]

Thanks for the update, db1984.

I follow your journey with interest as I also suffer from patellofemoral OA (approx. the same age as well). You seem to have gotten really good results with Regenexx-C! Can I ask if your previous PRP shots did anything for your knees? Also, PRP and injections in general only last a 6-12 months or so, but what about stem cells such as Regenexx-C? Of course, if cartilage healing occurs that is hopefully permanent, but do such stem cell treatments also have anti-inflammatory effects that wear off after a while?

[db1984]

Hi Brandon,

My right knee had some improvement from the PRP injections, but that knee has intact cartilage, so the damage was less severe. Left knee, not so much. My Achilles tendons as well as some tendons in my right hip responded very well to PRP and are much better than before. The stem cells definitely have an anti-inflammatory effect, but it takes a few months to kick in. Before the procedure I had frequent flare ups, but as time progressed after the injections the frequency and intensity of flare ups gradually decreased. I didn't see much improvement until the 3 month mark, then had a bigger boost at 6 months. Now at 9 months I've improved significantly, although I still have some issues. I definitely recommend this, it's just a very big commitment in terms of time and money. I tried the Regenexx-SD procedure before this, but the difference between same day stem cells and cultured cells is like night and day... at least for me! I can't say for sure how long the improvements will last but my research suggests that it should be at least a few years, possibly longer, unless of course I mess up my knees again. If so I can always get more injections.

[Brandon123]

Ok, thanks for the info! Yup, from what I have understood PRP seems to work best for tendons and other soft tissue issues.

Is Regenexx-C the only cultured cells treatment out there?

[db1984]

Ok, thanks for the info! Yup, from what I have understood PRP seems to work best for tendons and other soft tissue issues.

Is Regenexx-C the only cultured cells treatment out there?

No, there are others, it was discussed earlier in this thread. There's the Teknon Medical Center in Barcelona and MedXcell in Switzerland, both run by the same doctors. They've published very good data on their procedures, but I can't say to what extent they're comparable to Regenexx Cayman. To my knowledge the main similarity is that they both use autologous cultured bone marrow MSCs and deliver the cells via injection. At Regenexx Cayman, they use customized blood platelet solutions to optimize cell growth based on lab data collected during the expansion phase, as well as a little dexamethasone to stimulate cartilage growth, so you're getting an optimized injection. I don't know if the Teknon doctors have any techniques to optimize growth. At Regenexx Cayman they also do a full biomechanical assessment and customize the treatment plan to address your specific issues, so it's a bit more involved than just squirting cells into the knee. For example, they do tendon and ligament injections to address instability, as well bone augmentations, platelet lysate injections around nerves to address neuromuscular problems, etc. I'm not sure how a biomechanical evaluation and treatment would look at Teknon or MedXcell. I do know they treat lumbar discs in addition to knees, but I can't say much more than that. There's also Clinica Las Condes in Santiago, Chile, they've published data on using cultured cells to treat hip OA. Depending on what country you're from and whether or not you need a visa, there's the Royan Institute in Iran. They're using cultured cell injections for knees and have published a lot of good data too.

[diesiel]

Theres also : https://www.cellmedicine.com/

he was on the joe rogan podcast recently, apparently the umbilical cord stem cells are extremely potent as well...

[db1984]

Theres also : https://www.cellmedicine.com/

he was on the joe rogan podcast recently, apparently the umbilical cord stem cells are extremely potent as well...

diesiel,

I looked up the Joe Rogan podcast with Dr. Riordian, watched it on YouTube. Very interesting stuff, sounds like Dr. Riordian is getting great results treating a lot of different conditions. My main concern is that I couldn't find any publications on his website specifically addressing umbilical MSCs and OA, although in the podcast he did mention good results treating RA and other joint issues. (Maybe the data is there but I just didn't find it) By comparison, there's a lot of data on the use of cultured bone marrow MSCs to treat OA. Not saying it wouldn't work, just that given the enormous investment one makes to undertake one of these procedures, it should be done with as much supporting evidence as possible. I definitely would NOT have paid as much as I did for cultured BM-MSCs without first seeing some controlled trial data and MRIs of treated joints. I think we've passed that threshold of evidence for cultured BM-MSCs, not sure if the same is true for umbilical MSCs (but I could be wrong). If you know of any publications by all means don't hesitate to post the link. I'll do more research on this myself. If I see some pre and post op MRIs of arthritic joints treated with umbilical MSCs showing regeneration I'll be convinced.

[Brandon123]

Ok, thanks for the info! Yup, from what I have understood PRP seems to work best for tendons and other soft tissue issues.

Is Regenexx-C the only cultured cells treatment out there?

No, there are others, it was discussed earlier in this thread. There's the Teknon Medical Center in Barcelona and MedXcell in Switzerland, both run by the same doctors. They've published very good data on their procedures, but I can't say to what extent they're comparable to Regenexx Cayman. To my knowledge the main similarity is that they both use autologous cultured bone marrow MSCs and deliver the cells via injection. At Regenexx Cayman, they use customized blood platelet solutions to optimize cell growth based on lab data collected during the expansion phase, as well as a little dexamethasone to stimulate cartilage growth, so you're getting an optimized injection. I don't know if the Teknon doctors have any techniques to optimize growth. At Regenexx Cayman they also do a full biomechanical assessment and customize the treatment plan to address your specific issues, so it's a bit more involved than just squirting cells into the knee. For example, they do tendon and ligament injections to address instability, as well bone augmentations, platelet lysate injections around nerves to address neuromuscular problems, etc. I'm not sure how a biomechanical evaluation and treatment would look at Teknon or MedXcell. I do know they treat lumbar discs in addition to knees, but I can't say much more than that. There's also Clinica Las Condes in Santiago, Chile, they've published data on using cultured cells to treat hip OA. Depending on what country you're from and whether or not you need a visa, there's the Royan Institute in Iran. They're using cultured cell injections for knees and have published a lot of good data too.

Thanks for the info!

[db1984]

It's been a while, so time for an update. I'm now over 12 months post-op for Regenexx-C and I'm actually heading back to Grand Cayman this month for a second treatment. It's not because I've declined, but because I want an extra boost to see how far I can take this. I also have a few issues which haven't improved to my satisfaction, in particular my patellar tendons need more work, so that will be a big focus on this trip. I have cells in cryostorage, so no need to do a bone marrow harvest. Currently I have 3 million MSCs in storage, which they'll culture a little more to get a therapeutic dose, but it will most likely be a smaller dose than my first treatment. This treatment will likely use up the rest of my remaining cells, so if I want more after this I have to start the whole process over again. Hopefully that won't be necessary... at least for a while, I'm not getting any younger! They'll likely give me some more platelet lysate injections in my low back while I'm down there. Back is still doing well but I get some occasional stiffness and right leg symptoms that seem like nerve irritation. That might require more maintenance going forward.

Overall I've continued to improve, despite my stubborn patellar tendons. For the last month I've been jogging up and down the stairs at a park near my apartment. It's 188 steps to the top and right now I'm doing 5 laps up and down, which I'm increasing as my fitness improves. It feels great to get an actual workout again. Before the procedure my knees would have been in agony after a workout like that, but lately exercise seems to make them feel better... how it should be. I get a little stiffness in the evenings if I work at my desk for too long, and I do get some occasional pain from the tendons if I'm rising from a squat position, but overall my pain levels are much lower.

I should mention that my Achilles tendons are starting to get stiff again too. The PRP injections gave me big improvements for about 9 months before they started to decline, which isn't bad I think. I've been doing eccentric exercises, which I was very consistent about until I was distracted by traveling last month. Been doing eccentrics for the patellar tendons as well. I will most likely get more PRP for the Achilles sometime this summer, as well as some PRP in my right hip which has some tendinopathy. These areas might need long term maintenance.

Hopefully this 2nd treatment boosts my knees further so that I'm sufficiently satisfied with them. This treatment is going to be $10k for both knees, plus an additional $4k if we do the platelet lysate injections in my low back. If I had to do the whole cycle over again my finances couldn't handle it, so this will be the last cultured cell treatment for a while, unless something crazy happened like one of my hips started to go out, in which case I would scrounge up the money somehow. Fingers crossed that won't happen.

[exrunner1]

It's been a while, so time for an update. I'm now over 12 months post-op for Regenexx-C and I'm actually heading back to Grand Cayman this month for a second treatment. It's not because I've declined, but because I want an extra boost to see how far I can take this. I also have a few issues which haven't improved to my satisfaction, in particular my patellar tendons need more work, so that will be a big focus on this trip. I have cells in cryostorage, so no need to do a bone marrow harvest. Currently I have 3 million MSCs in storage, which they'll culture a little more to get a therapeutic dose, but it will most likely be a smaller dose than my first treatment. This treatment will likely use up the rest of my remaining cells, so if I want more after this I have to start the whole process over again. Hopefully that won't be necessary... at least for a while, I'm not getting any younger! They'll likely give me some more platelet lysate injections in my low back while I'm down there. Back is still doing well but I get some occasional stiffness and right leg symptoms that seem like nerve irritation. That might require more maintenance going forward.

Overall I've continued to improve, despite my stubborn patellar tendons. For the last month I've been jogging up and down the stairs at a park near my apartment. It's 188 steps to the top and right now I'm doing 5 laps up and down, which I'm increasing as my fitness improves. It feels great to get an actual workout again. Before the procedure my knees would have been in agony after a workout like that, but lately exercise seems to make them feel better... how it should be. I get a little stiffness in the evenings if I work at my desk for too long, and I do get some occasional pain from the tendons if I'm rising from a squat position, but overall my pain levels are much lower.

I should mention that my Achilles tendons are starting to get stiff again too. The PRP injections gave me big improvements for about 9 months before they started to decline, which isn't bad I think. I've been doing eccentric exercises, which I was very consistent about until I was distracted by traveling last month. Been doing eccentrics for the patellar tendons as well. I will most likely get more PRP for the Achilles sometime this summer, as well as some PRP in my right hip which has some tendinopathy. These areas might need long term maintenance.

Hopefully this 2nd treatment boosts my knees further so that I'm sufficiently satisfied with them. This treatment is going to be $10k for both knees, plus an additional $4k if we do the platelet lysate injections in my low back. If I had to do the whole cycle over again my finances couldn't handle it, so this will be the last cultured cell treatment for a while, unless something crazy happened like one of my hips started to go out, in which case I would scrounge up the money somehow. Fingers crossed that won't happen.

Good luck with your second treatment. Have to say a big thank you to you for sharing your experience and other information. Also, I think you should start a separate page about your experience. What you are doing is a inspiration for a lot of people like me.I am also looking at stem cells and may get it done in a few months.

Questions: Knee is a water tight joint. So any stem cells injected into the knee might not impact any other joint. Back muscles are not. Considering that, how do they make sure stem cells injected for the back do not impact other parts of the body.

Why did you choose Regenexx-C over SD. Any other reason apart from increased stem cell count and substantially larger impact.

Also, what about side affects from Regenexx-C. Did you do any research on them?

My knee situation is similar to yours. So eagerly following your development.

[db1984]

exrunner1:

Thanks, I'm hoping it goes well too. I guess I could have a separate page, but since this is the cultured cell thread and I'm apparently the only one here who has actually tried it, I think it's appropriate to share my experience here. If anybody else has tried cultured cells they're welcome to share their experience as well! I know they're out there, just not on this little corner of the internet.

I'm not sure if cells injected into the back impact other body parts. If they did somehow migrate out (which is possible but seems unlikely) I don't think they would be harmful. Regenexx tracks their patients in a registry and has published safety data, so if harmful effects were occurring I think that would have come to light by now (after 13 years doing these procedures). When I was in Cayman my next door neighbor at the hotel was also a patient and was getting some discs in his back injected. He was in A LOT of pain afterwards, my recovery was a cake-walk in comparison. I didn't have any discs injected, just muscles, ligaments, facet joints and epidurals.

I actually did try Regenexx-SD first for my left knee and experienced no improvement in my condition. I improved significantly with Regenexx-C, I mean a night and day difference! With culture expansion you get 100-1000 times more stem cells. In addition to that it's a "pure" stem cell injection, as opposed to a bone marrow concentrate injection (ie. SD) which is really many types of cells mixed together, a small percentage of which are stem cells. Many people do improve with SD though, and Regenexx has registry data showing that. The biggest difficulty with C is the cost, 3 times as expensive as an SD procedure. However in my case, I would have actually saved money if I skipped the SD and went straight for C.

Having researched as much as I can, my opinion is that there is more evidence of efficacy for cultured cells, which is consistent with my experience. Most of the studies on cultured cell injections include MRIs that show repair of cartilage and subchondral bone. My own MRIs show dramatic improvements. In addition cultured cell injections have now been tested in at least 7 randomized controlled trials (just for bone marrow, not adipose). I've searched extensively for similar data on bone marrow concentrate injections and haven't found anything comparable. The studies that do show cartilage repair combine BMC with surgery, ie. Dr. Broyles, etc.

Also, cultured cell injections aren't a panacea. Last year I met a fellow patient who was getting his arthritic hip treated. It didn't work... he ended up getting it resurfaced. My own knee, while significantly improved, is definitely not "brand new". I still have damaged cartilage which I'm hoping will further improve with my second treatment.

Before the FDA cracked down and Regenexx was still doing cultured cells in the US (pre-2010) there was a thread with a lot of patients sharing their experiences. A very interesting read. See the link below:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=40048.0

[exrunner1]

exrunner1:

Thanks, I'm hoping it goes well too. I guess I could have a separate page, but since this is the cultured cell thread and I'm apparently the only one here who has actually tried it, I think it's appropriate to share my experience here. If anybody else has tried cultured cells they're welcome to share their experience as well! I know they're out there, just not on this little corner of the internet.

I'm not sure if cells injected into the back impact other body parts. If they did somehow migrate out (which is possible but seems unlikely) I don't think they would be harmful. Regenexx tracks their patients in a registry and has published safety data, so if harmful effects were occurring I think that would have come to light by now (after 13 years doing these procedures). When I was in Cayman my next door neighbor at the hotel was also a patient and was getting some discs in his back injected. He was in A LOT of pain afterwards, my recovery was a cake-walk in comparison. I didn't have any discs injected, just muscles, ligaments, facet joints and epidurals.

I actually did try Regenexx-SD first for my left knee and experienced no improvement in my condition. I improved significantly with Regenexx-C, I mean a night and day difference! With culture expansion you get 100-1000 times more stem cells. In addition to that it's a "pure" stem cell injection, as opposed to a bone marrow concentrate injection (ie. SD) which is really many types of cells mixed together, a small percentage of which are stem cells. Many people do improve with SD though, and Regenexx has registry data showing that. The biggest difficulty with C is the cost, 3 times as expensive as an SD procedure. However in my case, I would have actually saved money if I skipped the SD and went straight for C.

Having researched as much as I can, my opinion is that there is more evidence of efficacy for cultured cells, which is consistent with my experience. Most of the studies on cultured cell injections include MRIs that show repair of cartilage and subchondral bone. My own MRIs show dramatic improvements. In addition cultured cell injections have now been tested in at least 7 randomized controlled trials (just for bone marrow, not adipose). I've searched extensively for similar data on bone marrow concentrate injections and haven't found anything comparable. The studies that do show cartilage repair combine BMC with surgery, ie. Dr. Broyles, etc.

Also, cultured cell injections aren't a panacea. Last year I met a fellow patient who was getting his arthritic hip treated. It didn't work... he ended up getting it resurfaced. My own knee, while significantly improved, is definitely not "brand new". I still have damaged cartilage which I'm hoping will further improve with my second treatment.

Before the FDA cracked down and Regenexx was still doing cultured cells in the US (pre-2010) there was a thread with a lot of patients sharing their experiences. A very interesting read. See the link below:

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=40048.0

Thanks a lot, Mate.

[Vanderbilt1]

Any update on your progress DB? I’m curious, did the procedure reduce crepitus in your knee?

[db1984]

Hi Vanderbilt1,

This is somewhat subjective but I do think the crepitus has improved. What's interesting is that when I bend the knee unloaded it sounds about the same, but when I put a load on it and bend I can hear a difference. At it's worst it sounded like a wet paper bag, now it's more like hard clicks. Seems like the cartilage still isn't perfectly smooth but has firmed up. Take that with a grain of salt of course. My 8 month post-injection MRI showed what looked like improvements in the cartilage on the T2 sequence. Most significant improvement on MRI was that the bone marrow lesions disappeared.

Functionally my knees have improved significantly, but still aren't perfect. I'm doing stair climbing workouts and recently started doing squats and lunges just with my bodyweight, but with very low reps, just to see how they feel. I even did a little jogging a few weeks ago, but am by no means attempting long distance runs or sprints yet.

They still flare up a little if I push them too hard, but not nearly as bad as they did before the injections. I have patellar tendinopathy that I've been rehabbing with single leg eccentric decline squats on a slant board. That seems to be my primary knee issue at the moment.

[exrunner1]

Hi Vanderbilt1,

This is somewhat subjective but I do think the crepitus has improved. What's interesting is that when I bend the knee unloaded it sounds about the same, but when I put a load on it and bend I can hear a difference. At it's worst it sounded like a wet paper bag, now it's more like hard clicks. Seems like the cartilage still isn't perfectly smooth but has firmed up. Take that with a grain of salt of course. My 8 month post-injection MRI showed what looked like improvements in the cartilage on the T2 sequence. Most significant improvement on MRI was that the bone marrow lesions disappeared.

Functionally my knees have improved significantly, but still aren't perfect. I'm doing stair climbing workouts and recently started doing squats and lunges just with my bodyweight, but with very low reps, just to see how they feel. I even did a little jogging a few weeks ago, but am by no means attempting long distance runs or sprints yet.

They still flare up a little if I push them too hard, but not nearly as bad as they did before the injections. I have patellar tendinopathy that I've been rehabbing with single leg eccentric decline squats on a slant board. That seems to be my primary knee issue at the moment.

Good to know you are improving. In one of your previous posts you have mentioned jogging up and down the stairs(188 steps) 4 to 5 times a day. I was assuming you are getting back to your original activity levels. What are your activity levels now and what levels are planning for in the future? Have you seen/known anyone who have returned to long distance running after this procedure?

I am following your progress with great interest. The reason being I am also looking into getting cultured stem cell procedure. After years of exercise, I am doing much better now. I am prepared to spend money on cultured stem cells. But if I cannot run there is no point in spending those dollars.

Please let me know what you think about it.

[ankle_boneonbone]

Hi Guys,

I haven't gotten any treatment yet, due to financial reasons, and while I was +- fine the first two years, I have now definitely deteriorated.

Am now looking into stem cells again.

Anyone knows the cost of treatment at Teknon in spain?

About the hydrogel in Israel, I will get an update and post on the forum for everyone. I know they are now doing phase 2 clinical trials for it.

Thanks!

[db1984]

exrunner1,

Yes, I've been doing the stair workouts for a while, but as of last week decided I'm taking a break for a while to focus more on patellar tendon rehab. The tendinopathy has been much more stubborn than I expected. It's fine once I warm them up but the first few minutes of activity are painful.

People who get this procedure are very few and far between, and I don't really know anybody other than myself who has done it, so I can't comment on people getting back to distance running. I did some running on the beach this summer, but it was only a couple minutes at a time and not something I did regularly.

As for my activity level, I'm noticeably improved but not back to the level I was at before all my injuries. I think this is due to numerous factors, such as the complex nature of my injuries. I think it's likely I'll pursue more treatment at some point in the future, but I can't say exactly when. Might be a few years down the road or maybe sooner depending on my circumstances.

I'm 18 months out from my first cell injections and 5 months out from the second. I would like to get another MRI at some point to see if there have been any more structural changes in my knees. It's definitely not perfectly cartilage repair as I still have crepitus in my left knee, I just want to make sure it's still heading in the right direction.

ankle_boneonbone,

I'm a little leary of the Teknon clinic at this point. I've received three cost estimates from them ranging from 15,000 euros to over 60,000. If you decide to pursue them for treatment make sure you get a straight answer from them regarding price. I would look into the Regenexx Cayman clinic. Just be sure to ask a lot of questions and make sure you get a comprehensive estimate. Also understand this has a good chance of helping your ankle but it won't make it perfect or brand new, especially if it's bone on bone like your name suggests.

-Dane

[exrunner1]

exrunner1,

Yes, I've been doing the stair workouts for a while, but as of last week decided I'm taking a break for a while to focus more on patellar tendon rehab. The tendinopathy has been much more stubborn than I expected. It's fine once I warm them up but the first few minutes of activity are painful.

People who get this procedure are very few and far between, and I don't really know anybody other than myself who has done it, so I can't comment on people getting back to distance running. I did some running on the beach this summer, but it was only a couple minutes at a time and not something I did regularly.

As for my activity level, I'm noticeably improved but not back to the level I was at before all my injuries. I think this is due to numerous factors, such as the complex nature of my injuries. I think it's likely I'll pursue more treatment at some point in the future, but I can't say exactly when. Might be a few years down the road or maybe sooner depending on my circumstances.

I'm 18 months out from my first cell injections and 5 months out from the second. I would like to get another MRI at some point to see if there have been any more structural changes in my knees. It's definitely not perfectly cartilage repair as I still have crepitus in my left knee, I just want to make sure it's still heading in the right direction.

ankle_boneonbone,

I'm a little leary of the Teknon clinic at this point. I've received three cost estimates from them ranging from 15,000 euros to over 60,000. If you decide to pursue them for treatment make sure you get a straight answer from them regarding price. I would look into the Regenexx Cayman clinic. Just be sure to ask a lot of questions and make sure you get a comprehensive estimate. Also understand this has a good chance of helping your ankle but it won't make it perfect or brand new, especially if it's bone on bone like your name suggests.

-Dane

Thanks a lot for the information. How is your progress coming along.

[db1984]

exrunner1,

Recovery is going pretty well. I previously described the stubbornness of my patellar tendons... I've gone through a lot of trial and error with rehabbing them. If you've ever dealt with tendinosis and read up on the rehab protocols, eccentric exercise is the go to approach for the most part, and for patellar tendons in particular, eccentric decline squats on a slant board. I think I was overdoing it because I cut back significantly on the frequency I do the exercises and my pain levels have decreased noticeably. I'm cautiously optimistic about that, as I only made that change a few weeks ago.

I've returned to the stair climbing workouts. It's 188 steps, which I climb repeatedly from 5-7 times per workout. I climb 2 steps at a time to get a decent range of motion that involves the glutes and hamstrings, not just the quads. Right now I'm doing 2 of those workouts per week, usually Wednesday and Saturday. During the workouts I try to focus on pushing a hard pace so my leg muscles are burning and I'm getting winded at the top of the climb. I'm not at my strongest but have a decent strength level in my legs right now... Which is a good sign! Especially since muscle wasting is one of those big problems when your knees go downhill. I would like to get to the point that I can run the stairs 2 steps at a time, but I'm not really confident enough to do it yet. A couple months ago I threw caution to the wind and decided to try sprinting up a single flight of stairs just to see what would happen. I was able to do it and had a little pain, but not much. I'm not convinced that's sustainable right now though.

On the days I'm not doing the stairs I either rest or do core exercises and some upper body work. For my core I do planks and side planks. I also do single leg bridges, which hits the low back, glutes and hamstrings. I've noticed an improvement in my ability to activate my glutes, which I think will be helpful in the long run. For upper body work I'm mainly doing pull ups and push ups, and try to emphasize good form and range of motion over speed and number of reps.

So in the big picture my knees appear to be holding up pretty well. Well enough that I can exercise hard enough to build some fitness without knee pain being a limiting factor. Occasionally if I overwork them they get a little inflamed, but not the intense "knees on fire" feeling when you have active OA and the inflammation is out of control. This is 22 months after my first injections of cultured cells and 9 months after the second round of injections. I haven't completely returned to their pre-injury performance though. I was pretty athletic back then and it's probably asking a lot for knees that have been through hell and back at age 34. I do think my knees will need more work at some point, especially my left knee, in which the trochlea cartilage defect hasn't completely healed. I think for now it's stabilized, in other words not degenerating, but given enough time, maybe several years down the road, it will probably start to degenerate again, at which point I'll probably need more stem cell injections or maybe pursue some other options. I'm also researching additional options for my patellar tendons, assuming they continue to be stubborn. There's an interesting technique called intratissue percutaneous electrolysis (EPI) that some doctors in Spain are using for tendon regeneration, I've been in contact with one of the clinics that does it and may travel there if I really think it's necessary.

My other treated body parts are doing well. My low back is 90% better, it's probably the part that has responded the best. The achilles tendons are still holding up well after my 2nd round of PRP injections last June, as is my iliopsoas tendon. My right ankle, which isn't super painful but has some consistent clicking and popping, will be evaluated pretty soon. I'll probably get some PRP injections for it just to be proactive.

[ChrondoCanuck]

db1984 - thanks a lot for the very informative post. I am 3 years older than you and have had similar issues with my knee, though perhaps not as bad. That pre and post MNRI scans are really something! There is no denying the it - you aren't just in some placebo effect post-op bliss.

When I had stem cells 3 years ago for chrondomalicia under my left patella, we used SVF (fat adispose). I was told at the time it has 100x more stem cells than bone marrow. Do you know Regenexx uses BMAC when SVF is much less invasive?

Suggest you read a blog called "Healing my knees". Low impact, high rep, consistent exercise helped that fellow heal OA knees, without any procedures. It may change your thinking on how you work out, because it sounds like you are putting a lot of pressure and strain on your knees with all those stair exercises. Just food for thought.

All the best!

[exrunner1]

db1984 - thanks a lot for the very informative post. I am 3 years older than you and have had similar issues with my knee, though perhaps not as bad. That pre and post MNRI scans are really something! There is no denying the it - you aren't just in some placebo effect post-op bliss.

When I had stem cells 3 years ago for chrondomalicia under my left patella, we used SVF (fat adispose). I was told at the time it has 100x more stem cells than bone marrow. Do you know Regenexx uses BMAC when SVF is much less invasive?

Suggest you read a blog called "Healing my knees". Low impact, high rep, consistent exercise helped that fellow heal OA knees, without any procedures. It may change your thinking on how you work out, because it sounds like you are putting a lot of pressure and strain on your knees with all those stair exercises. Just food for thought.

All the best!

Can you please provide the link to that blog?

[vickster]

db1984 - thanks a lot for the very informative post. I am 3 years older than you and have had similar issues with my knee, though perhaps not as bad. That pre and post MNRI scans are really something! There is no denying the it - you aren't just in some placebo effect post-op bliss.

When I had stem cells 3 years ago for chrondomalicia under my left patella, we used SVF (fat adispose). I was told at the time it has 100x more stem cells than bone marrow. Do you know Regenexx uses BMAC when SVF is much less invasive?

Suggest you read a blog called "Healing my knees". Low impact, high rep, consistent exercise helped that fellow heal OA knees, without any procedures. It may change your thinking on how you work out, because it sounds like you are putting a lot of pressure and strain on your knees with all those stair exercises. Just food for thought.

All the best!

Can you please provide the link to that blog?

He might mean Richard Bedard's Saving my knees blog/book (a recognised source for PFS management)

http://savingmyknees.blogspot.com

[Caliguy]

Grove, just curious if you have any updates from this 2017 post (or anyone else for that matter) for cultured injections. Any new information is appreciated!

[db1984]

It's been a while and I thought I should give an update. I feel pretty good for the most part and I'm still very active, but a recent MRI has shown the cartilage damage in my left trochlea is progressing and I've started developing bone marrow edema under the defect again. I'm not happy about this at all. Considering that I've had two treatments at Regenexx Cayman in the last 3 years and the progression is already sliding backwards I've decided I won't be getting anymore knee treatments there. I've started researching my cartilage surgery options. Since summer is approaching and I'm really not in much pain right now I think I might just back off the activity to avoid doing more damage and get surgery in the fall so I can get the hard part of recovery over with during the winter. Or I might get surgery earlier. I haven't decided yet. I have a lot of thinking to do.

4/1/2020: I've done more thinking since posting this a few weeks ago and decided Regenexx still could be a good option. I don't want to be a reactionary jumping into surgery. I'll definitely have a consultation with a surgeon and see what he has to say about my options. I benefitted greatly from the cultured cell injections but clearly it doesn't make my knee invincible. There's a learning curve to climb with this and I'm still figuring things out. After scrutinizing my MRI's a little harder the cartilage defect looks like it's the same size as before with a little fissuring seen on one of the MRI slides. So considering how hard I've been pushing it the last couple years the progression in terms of cartilage damage isn't very significant. The biggest change is the BML, which is definitely significant and I need to get that under control. However the BML isn't nearly as severe as they were back when I was at my worst in 2016, and pain wise I have a little soreness and discomfort but am still functional. I spoke with my Regenexx Cayman doctor (Dr. John Pitts) and he thinks there's a chance the BML could heal if I take it easy for a couple months, so I'll be getting another follow-up MRI in May or June depending on how the coronavirus situation pans out. I may just stick it out with another Regenexx C... But since we're all on lock down from coronavirus I can't do anything about it right now anyways, which gives me several months to think about this. If I do decide to get another injection of cultured cells I think I need to have a serious talk with them about the factors that could lead to improved cartilage repair. They have a lot of freedom to get creative at the Cayman clinic so maybe they have some tricks up their sleeve, or maybe I just need to modify the rehab protocol. We'll see.

[db1984]

Thought I'd give a quick update. The Regenexx Cayman clinic is closed until at least November 2020, possibly longer, and last I heard scheduling priority will be given to patients who had to cancel their procedures due to Covid-19. So I anticipate that it will be at least until spring 2021 until I have the opportunity to get another cultured cell treatment, but that's not confirmed.

In the meantime I've been taking it easy on my knee and doing a lot of research. My first course of action is a minor knee surgery with Dr. Ethan Kellum in Tennessee. He's a Regenexx doctor who is also an orthopedic surgeon. He's going to do an arthroscopy to remove some loose bone fragments from my left knee, which are leftover from my patella dislocation 20 years ago. After that he'll inject PRP into my knee both intra-articular, as well as intra-osseous to treat the bone marrow lesion. I'm actually pretty interested to see how my knee responds to this. Since my knee will be completely flushed out in the arthroscopy, there won't be any fluid in my knee to dilute the PRP, so it will be super concentrated. As for the intra-osseous injection, there have been several studies showing that injecting both the joint and the bone makes PRP a lot more effective than the usual method of just injecting the joint. I'm feeling pretty optimistic about this overall. I might get another PRP injection a couple months after that.

I've taken a renewed interest in methods to stimulate cartilage non-invasively. I bought a CPM machine after I read a lot of studies showing it enhances cartilage repair. I know all the surgeons use it in their patients but Regenexx doesn't. I decided I would rather have one available to use after my next procedure.

I've also been doing a lot of research on the use of ultrasound to stimulate cartilage. I don't think I've mentioned this before but I'm an engineer at a company that makes medical ultrasound scanners, so I have a lot of background in this. I found a bunch of studies by a research group at the University of Nebraska that have done simulations to model the way cartilage cells and MSCs vibrate in response to ultrasound. They've found that there's a vibrational resonance frequency that maximizes the gene expression of the cells to enhance cartilage repair. I studied their ultrasound setup and am going to replicate it myself. I ordered some ultrasound probes on eBay and they're en route. This could be a way to enhance cartilage repair non-invasively and I'm pretty excited about it. The nice thing about the trochlea is that with the knee in full extension the cartilage is only covered by soft tissue, which makes it easy to access with ultrasound. I know because I've used the ultrasound scanners at my job to visualize my cartilage and it makes a very clear image.

On top of all this I ordered an electrical stimulator to target my VMO, which should be arriving sometime next week. My left VMO has always been a little weaker than my right, so I'm going to try correcting that to improve my patellar tracking. I've read a lot of physical therapy blogs about how isolating the VMO with exercise is a waste of time but that electrical stimulation works pretty well. I found a few studies to back that up so I'm excited to get started with it.

Basically I've decided that I'm still on board with the Regenexx approach but I think there are a lot of parameters that can be better optimized in my recovery to get a better cartilage repair response. In the short term I'll manage with PRP, but sometime next year I anticipate I'll get another injection of cultured cells, then apply my modified recovery plan to see how much more improvement I get.

[mang0954]

Thought I'd give a quick update. The Regenexx Cayman clinic is closed until at least November 2020, possibly longer, and last I heard scheduling priority will be given to patients who had to cancel their procedures due to Covid-19. So I anticipate that it will be at least until spring 2021 until I have the opportunity to get another cultured cell treatment, but that's not confirmed.

In the meantime I've been taking it easy on my knee and doing a lot of research. My first course of action is a minor knee surgery with Dr. Ethan Kellum in Tennessee. He's a Regenexx doctor who is also an orthopedic surgeon. He's going to do an arthroscopy to remove some loose bone fragments from my left knee, which are leftover from my patella dislocation 20 years ago. After that he'll inject PRP into my knee both intra-articular, as well as intra-osseous to treat the bone marrow lesion. I'm actually pretty interested to see how my knee responds to this. Since my knee will be completely flushed out in the arthroscopy, there won't be any fluid in my knee to dilute the PRP, so it will be super concentrated. As for the intra-osseous injection, there have been several studies showing that injecting both the joint and the bone makes PRP a lot more effective than the usual method of just injecting the joint. I'm feeling pretty optimistic about this overall. I might get another PRP injection a couple months after that.

I've taken a renewed interest in methods to stimulate cartilage non-invasively. I bought a CPM machine after I read a lot of studies showing it enhances cartilage repair. I know all the surgeons use it in their patients but Regenexx doesn't. I decided I would rather have one available to use after my next procedure.

I've also been doing a lot of research on the use of ultrasound to stimulate cartilage. I don't think I've mentioned this before but I'm an engineer at a company that makes medical ultrasound scanners, so I have a lot of background in this. I found a bunch of studies by a research group at the University of Nebraska that have done simulations to model the way cartilage cells and MSCs vibrate in response to ultrasound. They've found that there's a vibrational resonance frequency that maximizes the gene expression of the cells to enhance cartilage repair. I studied their ultrasound setup and am going to replicate it myself. I ordered some ultrasound probes on eBay and they're en route. This could be a way to enhance cartilage repair non-invasively and I'm pretty excited about it. The nice thing about the trochlea is that with the knee in full extension the cartilage is only covered by soft tissue, which makes it easy to access with ultrasound. I know because I've used the ultrasound scanners at my job to visualize my cartilage and it makes a very clear image.

On top of all this I ordered an electrical stimulator to target my VMO, which should be arriving sometime next week. My left VMO has always been a little weaker than my right, so I'm going to try correcting that to improve my patellar tracking. I've read a lot of physical therapy blogs about how isolating the VMO with exercise is a waste of time but that electrical stimulation works pretty well. I found a few studies to back that up so I'm excited to get started with it.

Basically I've decided that I'm still on board with the Regenexx approach but I think there are a lot of parameters that can be better optimized in my recovery to get a better cartilage repair response. In the short term I'll manage with PRP, but sometime next year I anticipate I'll get another injection of cultured cells, then apply my modified recovery plan to see how much more improvement I get.

Hi db1984,
Do you mind sharing the electrical stimulator device and ultrasound device that you purchased and the vibrational resonance frequency that you mentioned?

And thank you for sharing your experience and information your gathered, I learn a lot after reading through all your posts. I am about the same age as you (1983 here), I too developed moderate cartilage damage due to running and powerlifting. I feel we are exactily the same that once we see some improvement we jump into weight room to lift heavy again.... After injecting PRP, pentosan polysulfate and some peptides, I recently get a little better and kind of figure out what movement pattens that bothers my knee -- lowbar squats is safe, but deadlift and lunge are big no-no, even RDL gets my knee swelling for 2 days.

if cultured stem cell can get most of my cartiliage back, I'll be all in without hesitation. But after reading your posts, it seems no where near fully restore. Someone lately told me that Korea has a clinical trial using umbilical cord blood stem cell which has the most cell count for knee cartilage regeneration. If this trial is successful, I will fly there to recevie treatment (I live in south Florida).

Also I am not sure if Dr Saw's multi injections of peripheral stem cell without surgery will work or not. If it works, I am willing to stay in Malaysia for several weeks to receive treatment

[db1984]

Hi mang0954,

The electrical stimulator is a Compex Edge. I've been using it for a few weeks and so far I'm impressed:

https://www.compex.com/compex-edge-2-0-muscle-stimulator-kit-with-tens

I decided to get it after reading multiple articles about how it's impossible to isolate the VMO through exercise alone, but that electrical stimulation can effectively isolate it. The goal of this is to improve my patellar tracking as much as possible:

http://www.viviangrisogono.com/knee/ems-for-vmo
https://spinalflowyoga.com/exercise-wont-selectively-activate-the-vmo-but-electric-stimulation-will/
https://www.academia.edu/38834008/The_Effect_of_Exercise_and_Electrical_Muscle_Stimulation_on_the_Architecture_of_the_Vastus_Medialis_Oblique_-The_Empi_Electrotherapy_System
https://www.researchgate.net/publication/280236807_Effects_of_electrical_stimulation_of_vastus_medialis_obliquus_muscle_in_patients_with_patellofemoral_pain_syndrome_An_electromyographic_analysis

My idea to try ultrasound is based on the studies listed below. These are from a research group at the University of Nebraska that derived a resonant frequency for chondrocytes and MSCs at 5 MHz. I should clarify that these aren't human trials but purely scientific studies in the lab. In my opinion, the most convincing work they've done is repairing cartilage fissures in osteochondral explants, just by applying ultrasound. They've also shown that they can use ultrasound to enhance chondrogenic gene expression in MSCs, so "in theory" you could enhance the outcome of a stem cell injection with ultrasound. This is very impressive in my opinion and the basic science makes sense, but how well this will translate to an actual knee hasn't been demonstrated in human trials.

This is definitely a grey area that I'm willing to try myself but wouldn't recommend to others. For my day job I'm an engineer at a company that makes medical ultrasound probes. I know how to fine tune them to keep the power levels safe, in fact that's what I do at my job. The probes that they're using in these studies aren't medical grade probes but are normally used in industrial applications. They should be safe if the power output is kept low. There are no FDA approved therapeutic ultrasound systems that I'm aware of that put out the same frequency and power levels used in these studies, hence my need to do my own experimentation. While I consider using ultrasound probes on my knee to be low risk, It is possible to hurt yourself with these probes if you don't know what you're doing. This is why I can't specifically recommend this to anybody else, although I'm willing to share what I'm experimenting with. Anyways, here's the studies I mentioned. They give a detailed description of the ultrasound setup they used:

https://pubmed.ncbi.nlm.nih.gov/31054572/
https://pubmed.ncbi.nlm.nih.gov/31190618/
https://stemcellres.biomedcentral.com/articles/10.1186/s13287-019-1532-2
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684760/

I would definitely recommend trying Regenexx-C. It's very safe, non-invasive, has a lot of efficacy and doesn't burn any bridges. They have demonstrated repair of cartilage defects with their injection technique, although it seems to work best in small defects and not in all patients. I think with enough optimization I can get better results with cartilage repair, which is why I'm researching all this stuff. I'm not quite ready to give up on it yet, so when the time comes I'm going to try again, probably some time in 2021.

By the way, if you want to try Dr. Saw's procedure I'm pretty sure it will be a lot more than a few weeks in Malaysia. Isn't it multiple injections spread out over months? I know that's how Dr. Broyles is doing it in the US, although I could be mistaken.

[Nici_j]

Hi there - I've been reading your posts with interest as I seem to have similar knee issues - small 3 mm diameter full thickness lesion in trochlear groove with subchondral oedema. It's a trauma injury from 6 months ago when I had to jump a fence to escape some young cows running towards me and I caught my foot in the fence as I jumped down and twisted my leg. I've only just got the diagnosis from MRI and looking into what I can do next. I'm pretty sure that the pain I am getting is from the oedema. I'm also concerned that if I don't manage to find a way to heal the lesion, that I'm always going to be susceptible to oedema. I'm probably going to try stem cells but I am also looking at extracorporeal shockwave therapy for the oedema and wondered if you had looked into that or considered it at all? It seems to be quite successful.

https://pubmed.ncbi.nlm.nih.gov/29384878/

[db1984]

Nici_J,

Sorry I didn't reply sooner, I haven't been on the site in a while. Check out my recent reply in the "Any recent stem cell experience" thread:

https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=78021.0

3 mm is pretty small but the edema is more concerning, it's important to treat that to prevent further cartilage loss. You might try getting an intra-osseous injection of PRP or BMAC. It's way cheaper than cultured cells, plus all the clinics that do cultured cells are closed right now anyways because of Covid. Do a little research on intra-osseous PRP and bone marrow concentrate, the studies by Philippe Hernigou and Mikel Sanchez are pretty impressive. And yes there is evidence that bone injection can improve cartilage repair, so for a small lesion like that it might take care of both

I've read about ESWT and it sounds like it works well for bone but is pretty rough on cartilage, just too much energy. I've done a little research on bone stimulators that use electromagnetic energy to accelerate bone healing. They're commonly used to accelerate healing following spinal fusion. I don't have the studies on hand right this second but maybe I'll post some links later.