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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!
Quote from: db1984 on September 16, 2017, 07:27:37 AMI 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.
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.
Quote from: psny on September 19, 2017, 12:40:58 AMQuote from: db1984 on September 16, 2017, 07:27:37 AMI 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.Quote from: diesiel on September 17, 2017, 05:54:21 AMAnother 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/25822648https://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=54989https://www.ncbi.nlm.nih.gov/pubmed/26783191These are some of the papers published by the Teknon Barcelona doctors mentioned above. One of them (R Soler) also runs the clinic in Switzerland.
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.
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?
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...
Quote from: Brandon123 on January 19, 2018, 08:54:17 AMOk, 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.
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: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
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,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
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!
Quote from: ChrondoCanuck on March 04, 2019, 06:15:34 PMdb1984 - 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?
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.