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Author Topic: Any recent stem cell (BMAC, Fat)experience for cartilage damage?  (Read 328 times)

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Offline mang0954

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Hi,
I have grade 3 chondromalacia on medial facet and apex of patella, grade 3 chondromalacia on trochlea  of femur, and grade 1 on chondromalacia on medial and lateral tibiofemoral joint spaces.

Just had an appointment with Dr. Joseph Purita, here is the summary of what he said:

1) Given my situation, the best option is to do just one injection of bone marrow+fat aspirate+PRP (with about 3 follow-up laser or patch treatments), it will change chemistry of knee (like laying a new interface) to make symptom free. He claimed that 85% of his patients have 70+% improvement. Considering that I am 37, he does not think I need second PRP. The goal is to buy me 10 years of time till higher concentration of stem cell available

2) He doesn't think lipogems is cost efficient and had stopped doing it though he is the first guy who used it. The "fat" he does will do the same job.

3) No surgery is suitable for me including Dr. Saw's procedure (drilling+stem cell for cartilage regeneration) as Dr. Saw's drilling is in femur or tibia but NOT for patella cartilage (He said he met Dr. Saw several times and know his procedure)

Can any guru here kindly provide some comment? Thank you!


=========================== Update on 7/20/2020 ===========================
Just finished a meeting with Dr Adam Anz, the doctor who brought Dr. Saw's procedure to U.S. and just finished a 5-year clinical trials in U.S. He said result of cartilage regeneration is very good, and he expects FDA to approve it so he can perform the procedure in U.S. again. Here is the summary

-- 70% of patients in his trail (or Dr Saw's procedure) are for patellofemoral join issue, thus Dr Purita's statement of Dr. Saw's procedure is only for tibiofemoral joint is wrong

-- If I need this procedure now, I can go to Malaysia, not sure how long we have to wait in U.S., may be a few years

-- The peripheral stem cell (higher cell count) used in the trail and by Dr. Saw is not available U.S.

-- They tested or someone just published (I didn't catch it very well) bone marrow v.s. PRP and fat aspirate v.s. PRP, it turns out that neither bone marrow nor fat aspirate has any difference than PRP alone, it is just doctors that want to make money including cytokines. He commends doing 3 PRP injections in 3 consecutive weeks which has study to prove better result over single injection.
May be this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029538/

-- He said there is no publication to prove that debridement leads to early osteoarthritis. He recommends me to do 3 PRP and debridement. Any existing cartilage restoration surgery or osteotomy are all big operations and should be last option. If Dr. Saw's procedure is approved here, he would choose this procedure over any other procedures for my injury.
« Last Edit: July 24, 2020, 02:45:46 PM by mang0954 »

Offline Gretchen2000

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Re: Any recent stem cell experience for cartilage regeneration?
« Reply #1 on: July 15, 2020, 02:39:49 AM »
Hi! Iím not going to be exactly helpful. I came on looking for anyone who had had PRP done and saw your post right away. I donít seem to have as much information about my knee as you do. I have been told my cartilage is ďlike Swiss cheese.Ē Because is this, I am considering PRP.
I wanted to ask what sort of tests they performed to determine these options for you.

Thank you.

Offline mang0954

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Re: Any recent stem cell experience for cartilage regeneration?
« Reply #2 on: July 15, 2020, 03:17:37 AM »
Hi! Iím not going to be exactly helpful. I came on looking for anyone who had had PRP done and saw your post right away. I donít seem to have as much information about my knee as you do. I have been told my cartilage is ďlike Swiss cheese.Ē Because is this, I am considering PRP.
I wanted to ask what sort of tests they performed to determine these options for you.

Thank you.

PRP itself won't help much for most of people who have non-mild injuries. I did it and the knee swelled less on week 3-5 but after that swelling returns

Offline Brandon123

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Re: Any recent stem cell experience for cartilage damage?
« Reply #3 on: July 15, 2020, 12:08:40 PM »
Hi mang,

Thanks for all the interesting info!


3) No surgery is suitable for me including Dr. Saw's procedure (drilling+stem cell for cartilage regeneration) as Dr. Saw's drilling is in femur or tibia but NOT for patella cartilage (He said he met Dr. Saw several times and know his procedure)

Do you have any more information on why Dr. Purita didn't consider any surgery to be suitable in your case? Have you been in contact with any PF specialists? I wonder because it is fairly common for PF specialist to suggest some sort of tibial tubercle osteotomy (TTO) or realignment procedure in a case like yours. Based on the logic that alignment/anatomical issues are often the root cause for patellofemoral arthritis, and need to be addressed. At least that is what multiple docs have told me (I have similar damage, similar age). 
RK sharp pain while running, diagnosis chondromalacia patellae 6/09
RK arthroscopic chondroplasty 9/09
RK rehab, recovery, 90% normal, started running again -> back to square one 5/15
RK diagnosis patellofemoral arthritis + LK diagnosis chondromalacia patellae 8/15 -> conservative treatment

Offline mang0954

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Re: Any recent stem cell experience for cartilage damage?
« Reply #4 on: July 15, 2020, 09:00:11 PM »
Hi Brandon,
If I am not wrong, Dr. Purita is no longer performing surgery since he started focus on regenerative medicine. That is why he did not even mention about osteotomy.

On my follow up of PRP and HA injections with my doctor (a non-surgeon), he did mention about osteotomy like high tibial osteotomy as an option if I don't get better from physical therapy, but he said it is a big surgery and that very few doctors in our area (south Florida) that he can trust to do this surgery right.

I didn't read much about osteotomy, but how to know if cartilage damage is due to poor joint mechanical that needs osteotomy to fix or just overuse injury? I do heavy squats and deadlift once a week and run 5K (very fast pace) twice a week before the injury. Do you develop the problem because of strenuous activities or just from normal daily activities?



What is very confusing to me is that my MRI shows that my medial fact of patella has most severe damage but lateral fact of patella is perfect. I was reading lots of patella maltracking, they all talk about lateral tracking (lateral tilt) of patella due to weak VMO, tight outer quad muscle and IT band, putting stress on lateral patella, for example:

https://www.sportsmedcenter.com/patellar-chondromalacia

and ELPS (Excessive lateral pressure syndrome)
https://radiopaedia.org/articles/excessive-lateral-pressure-syndrome?lang=us


But I can't find any information online about cause of medial patella tilt and medial facet of patella damage, not even the terminology of "Excessive medial pressure syndrome" nor "EMPS". I thought I have a patella medial tilt, but my doctor told me that mine is lateral tilt (on my x-ray, the space between patella of femur in lateral side is slightly smaller than space of medial side). I asked 2 physical therapies why lateral tilt causes medial patella damage (supposed to cause lateral patella damage) but none of them is able to answer, instead I feel they throw me one-size-for-all exercises: strengthen VMO and all quad muscles, hams and gluteus medius.


After I saw your comment, I read a little bit more about osteotomy, it does say that "In osteoarthritis , cartilage breakdown in the knee often is much greater in the inner part of the knee joint"
https://www.cigna.com/individuals-families/health-wellness/hw/medical-topics/osteotomy-for-osteoarthritis-hw125548
But nurse of my doctor said she observed that 85% patients' cartilage damage is on lateral facet versus 15% on medial facet.

This maltracking thing is what I have been trying to figure out since my injury but I haven't been able to find an expert to help me..


Hi mang,

Thanks for all the interesting info!


3) No surgery is suitable for me including Dr. Saw's procedure (drilling+stem cell for cartilage regeneration) as Dr. Saw's drilling is in femur or tibia but NOT for patella cartilage (He said he met Dr. Saw several times and know his procedure)

Do you have any more information on why Dr. Purita didn't consider any surgery to be suitable in your case? Have you been in contact with any PF specialists? I wonder because it is fairly common for PF specialist to suggest some sort of tibial tubercle osteotomy (TTO) or realignment procedure in a case like yours. Based on the logic that alignment/anatomical issues are often the root cause for patellofemoral arthritis, and need to be addressed. At least that is what multiple docs have told me (I have similar damage, similar age).
« Last Edit: July 15, 2020, 09:12:22 PM by mang0954 »

Offline SuspectDevice

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Re: Any recent stem cell experience for cartilage damage?
« Reply #5 on: July 16, 2020, 10:41:01 PM »
My reading suggests most diagnoses of patella mal-tracking are bunkum.  The patella might be slightly out of 'perfect alignment' but it does not cause problems.

I've lived with patella chondromalacia since my teens (I'm now 56).  It has caused intermittent pain, but did not stop me being very active sporting-wise.  My orthopedic surgeon (who trimmed my torn medial meniscus) once said he was surprised I could do as much triathlon as I did, because one area of my patella was very worn.

I've since backed off at least 50% on my sport (due to PFPS mostly) and the chondromalacia problem has lessened.  I still get pain, but not as bad as at its worst, and I can manage it.

There is a lot of evidence that chrondro can just heal itself with careful gentle exercise. My experience is this is true - though I keep doing more than gentle exercise (e.g. hard cycling, gym work, now added a little running) which probably stops mine from healing more.  But I've learned to listen to the symptoms & know when to back off.

I had PRP (x3) for my PFPS and it did nothing.

Microfracture was suggested to me (drill small holes in the back of the patella), but my OS basically suggested avoiding any more knee surgery at all costs - which in hindsight was excellent advice, as I've coped quite well with my issues over the past decade.

I would say strengthening key support muscles other than the quads (e.g. glutes/hammies/hips/core/lower back with deadlifts, Belgium squats, kettle bell swings etc.) has helped take pressure off my knee joints and allowed me to continue a decent level of training in aerobic pursuits.

Take away message - don't go for a quick fix, see if you can learn to manage it with conservative methods.
« Last Edit: July 16, 2020, 10:42:37 PM by SuspectDevice »
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline mang0954

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Re: Any recent stem cell experience for cartilage damage?
« Reply #6 on: July 17, 2020, 05:20:09 AM »
Hi SuspectDevice ,

Thank you very much for your write! I'll take your advice not to surgery at all possible.

I don't have pain when I do moderate exercise but the problem is that right knee swells very easily.

5 month ago prior to injury, my right leg quad especially VMO is obviously bigger than that of my left leg because I am right handed (I should have done more single leg exercise to avoid imbalance). I do physical therapy in past 5 months and the exercise most of the time is on right leg only (all VMO exercise are on right leg only), but right now right leg quad is obviously smaller than left leg, and right leg VMO is almost disappeared whereas left leg VMO maintains decent size. I am really worried about it.


My reading suggests most diagnoses of patella mal-tracking are bunkum.  The patella might be slightly out of 'perfect alignment' but it does not cause problems.

I've lived with patella chondromalacia since my teens (I'm now 56).  It has caused intermittent pain, but did not stop me being very active sporting-wise.  My orthopedic surgeon (who trimmed my torn medial meniscus) once said he was surprised I could do as much triathlon as I did, because one area of my patella was very worn.

I've since backed off at least 50% on my sport (due to PFPS mostly) and the chondromalacia problem has lessened.  I still get pain, but not as bad as at its worst, and I can manage it.

There is a lot of evidence that chrondro can just heal itself with careful gentle exercise. My experience is this is true - though I keep doing more than gentle exercise (e.g. hard cycling, gym work, now added a little running) which probably stops mine from healing more.  But I've learned to listen to the symptoms & know when to back off.

I had PRP (x3) for my PFPS and it did nothing.

Microfracture was suggested to me (drill small holes in the back of the patella), but my OS basically suggested avoiding any more knee surgery at all costs - which in hindsight was excellent advice, as I've coped quite well with my issues over the past decade.

I would say strengthening key support muscles other than the quads (e.g. glutes/hammies/hips/core/lower back with deadlifts, Belgium squats, kettle bell swings etc.) has helped take pressure off my knee joints and allowed me to continue a decent level of training in aerobic pursuits.

Take away message - don't go for a quick fix, see if you can learn to manage it with conservative methods.
« Last Edit: July 17, 2020, 07:47:46 AM by mang0954 »

Offline Dave33

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Re: Any recent stem cell experience for cartilage damage?
« Reply #7 on: July 18, 2020, 11:08:58 PM »
My reading suggests most diagnoses of patella mal-tracking are bunkum.  The patella might be slightly out of 'perfect alignment' but it does not cause problems.

This.

Personally, I see PRP as basically a half step above snake oil, and that's largely because of the way it's being "marketed" as a non invasive cureall, particularly in the USA. HA injections in the patella are pretty much worthless, and don't even fare too well against placebo in the tibial/femoral application. You'll find no shortage of doctors that will give you lots of treatment options, but all of them are pretty low percentage. I've been through all of them, and as I've mentioned in other posts, the pain of each surgery/treatment was very secondary to the mental stress of disappointment and frustration after each failed to produce any substantial benefit.

The best thing you can do for substantial medial/distal patella wear is find activities which don't bother it too much, and do those - an osteotomy might unload it a little, but it will still likely hurt. Perhaps over time it'll improve a bit if you stay out of red zone. Ultimately, you can make the decision as whether you can live with it, or get it resurfaced when you hit around 45+, which is what I did, with no regrets.




Offline mang0954

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Re: Any recent stem cell experience for cartilage damage?
« Reply #8 on: July 20, 2020, 07:56:43 PM »
Just finished a meeting with Dr Adam Anz, the doctor who brought Dr. Saw's procedure to U.S. and just finished a 5-year clinical trials in U.S. He said result of cartilage regeneration is very good, and he expects FDA to approve it so he can perform the procedure in U.S. again. Here is the summary

-- 70% of patients in his trail (or Dr Saw's procedure) are for patellofemoral join issue, thus Dr Purita's statement of Dr. Saw's procedure is only for tibiofemoral joint is wrong

-- If I need this procedure now, I can go to Malaysia, not sure how long we have to wait in U.S., may be a few years

-- The peripheral stem cell (higher cell count) used in the trail and by Dr. Saw is not available U.S.

-- They tested or someone just published (I didn't catch it very well) bone marrow v.s. PRP and fat aspirate v.s. PRP, it turns out that neither bone marrow nor fat aspirate has any difference than PRP alone, it is just doctors that want to make money including cytokines. He commends doing 3 PRP injections in 3 consecutive weeks which has study to prove better result over single injection.
May be this https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029538/

-- He said there is no publication to prove that debridement leads to early osteoarthritis. He recommends me to do 3 PRP and debridement. Any existing cartilage restoration surgery or osteotomy are all big operations and should be last option. If Dr. Saw's procedure is approved here, he would choose this procedure over any other procedures for my injury.

And has anyone done 3 PRP in 3 weeks? I only found one study that is for patellar tendinopathy not for cartilage
https://pubmed.ncbi.nlm.nih.gov/24519184/




or get it resurfaced when you hit around 45+, which is what I did
Hi Dave33, Why you said wait till 45+ to get resurfaced?


« Last Edit: July 22, 2020, 04:18:53 AM by mang0954 »















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