Any recent stem cell experience for cartilage damage?

[mang0954]

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.

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/
How do you guys think about 3 PRP vs BMCA+fat+PRP?

[diesiel]

Did he mention anything about post-therapy rehab?  Don't you have to limit motion (especially shearing forces) in the knee to prevent wear on the kneecap? at least while the stem cells are doing their job  Something to ponder....


Also, he mentioned "symptom free", so he is not in fact claiming any regeneration?  Just reduced inflammation and hopefully slowing down the progression

[mang0954]

Did he mention anything about post-therapy rehab?  Don't you have to limit motion (especially shearing forces) in the knee to prevent wear on the kneecap? at least while the stem cells are doing their job  Something to ponder....


Also, he mentioned "symptom free", so he is not in fact claiming any regeneration?  Just reduced inflammation and hopefully slowing down the progression

Doctor implies that cartilage regeneration is minimum.

No doctor did not mentioned about limited motion on post-therapy. He said I can drive home myself (injection is on my right knee) and recommend starting physical therapy immediately after injection

[db1984]

If you're going the PRP and bone marrow concentrate route you should look into having your subchondral bone injected. There have been several studies in the last few years showing that injecting subchondral bone has a more potent effect than just injecting the joint. Ideally both the bone and joint space should be injected:

https://www.tandfonline.com/doi/abs/10.1517/14712598.2016.1157162
https://link.springer.com/article/10.1007/s10067-018-3985-6
https://journals.sagepub.com/doi/abs/10.1177/1947603518756462
https://link.springer.com/article/10.1007/s00264-020-04687-7
https://link.springer.com/article/10.1007%2Fs00264-020-04546-5
https://www.hindawi.com/journals/sci/2016/1247950/
https://link.springer.com/article/10.1007/s00264-018-3916-9

Subchondral bone is critical in OA. The idea is that by treating the subchondral bone the arthritis progression is slowed down significantly and with much greater pain relief. In OA there's also increased crosstalk between cartilage and bone, so injecting the bone can potentially treat the deep cartilage layers as well.

Next month I'm having an arthroscopy to remove some loose bodies from my knee, but after my knee has been drained I'll be having PRP injected into both the joint and the subchondral bone (trochlea), where I have a small cartilage defect but also a bone marrow lesion that was spotted on an MRI a few months ago.

[mang0954]

If you're going the PRP and bone marrow concentrate route you should look into having your subchondral bone injected. There have been several studies in the last few years showing that injecting subchondral bone has a more potent effect than just injecting the joint. Ideally both the bone and joint space should be injected:

https://www.tandfonline.com/doi/abs/10.1517/14712598.2016.1157162
https://link.springer.com/article/10.1007/s10067-018-3985-6
https://journals.sagepub.com/doi/abs/10.1177/1947603518756462
https://link.springer.com/article/10.1007/s00264-020-04687-7
https://link.springer.com/article/10.1007%2Fs00264-020-04546-5
https://www.hindawi.com/journals/sci/2016/1247950/
https://link.springer.com/article/10.1007/s00264-018-3916-9

Subchondral bone is critical in OA. The idea is that by treating the subchondral bone the arthritis progression is slowed down significantly and with much greater pain relief. In OA there's also increased crosstalk between cartilage and bone, so injecting the bone can potentially treat the deep cartilage layers as well.

Next month I'm having an arthroscopy to remove some loose bodies from my knee, but after my knee has been drained I'll be having PRP injected into both the joint and the subchondral bone (trochlea), where I have a small cartilage defect but also a bone marrow lesion that was spotted on an MRI a few months ago.

Hi db1984,

I hope your arthroscopy debriment operation goes well!
Thank you for your suggestion, this definetly helps, but I am not sure if doctors here who never combine subchondral bone and joint injection will be willing to inject in subchondral bone as well. I'll have to ask them.

And I was asking you in the culltured cell post if you can share the devices that you purchsed. I'll copy&paste the comment here below as my reply there is kind of off topic:

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, and mild swelling after using elliptical machine as well. So the difference is knee pointing to the side versus pointing to the front.

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


========================= Update 7/28/2020 =========================
Dr. Purite replied that no sub chondral injection as "articles indicate some deficienies in protocals with limited results/benefits"

[db1984]

Hi mang0954,

I just replied to your questions in the cultured cell thread. I agree that if a doctor doesn't normally do bone injection then they shouldn't do it. It's more complicated and requires fluoroscopic needle guidance. The data on bone injection looks pretty good though. I'm not sure how certain you are with pursuing treatment with Dr. Purita but I recommend giving Regenexx a call, at least for a consultation. They do subchondral injections all the time. I think if you're trying to maximize your outcome with bone marrow concentrate and PRP you should at least take a serious look at it.

[mang0954]

Hi db1984,

Thanks for your reply. I ordered another model of the same maker that you purchased:
https://www.amazon.com/dp/B0777SVFDZ/ref=emc_b_5_t?th=1
Bottom of the page has comparison of their different models

No I am not locked to any doctor, I'll ask 2 other PRP doctors in my local area if they do subchondral injections, I'll go for them for 3 PRP instead of Dr Purita if they do subchondral but I doubt it.

I was reading other posts in this board about Regenexx-c and I don't feel the result is convincing (they are good at markting though), and you yourself don't get much improvement in your cartiliage, no where near returning to sports. Considering the price of Regenexx-c is 4 times as much as Dr. Purita's and I am only 30-minute drive away from Dr. Purite package, I am hesitated to arrange international travels to grand cayman. If Regenexx-c is just to make me symptom free, then I know 2 tennis professional who received same day bone marrow or fat + PRP from doctors in Miami for their back/spine and got symptom free almost immediately. I feel that all stem cells doctors are eager to sell you the treatment including Dr. Purite, but if I throw a few grands to receve injectins locally and see no result, I won't be upset as I don't waste much time. Right now I am symptom free when I low bar squats a few sets of sub 300 lbs and single leg extention using 40 lbs weight on th machine. So unless regenexx-c has evidence that at least 50% of their knee patients get their hyaline cartilaige nearly 100% back, I'll rather wait for Dr. Adam Aanz till FDA approves the procedure. I'll read more about Regenexx-c though to find out more.
(https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=63739.30
Did you see Dr. Centeno's last comment in this post says "While the cultured procedure outperforms for hips and hand joints, for most knee patients, we now recommend the same day procedure"? Does this mean cultured stem cell is not superior than same day bone marrow?)

I did not inject aynthing in past 3 weeks, but my knee swellinig after exercise is much improved, I don't know if it is because PRP from mid of May or peptides that I injected last month. What I did in past few weeks is to apply Thai green herbal cream to my knee. I have a bottle of it at home as it is a miracle drug to heal burned skin, skin infection and insect bites, one day I happened to see the label on the bottle that it can be used to treat osteoarthritis so I gave it a try. The cream gives cool and burning sensation in skin causing a little swelling, but after 5-10 hours the swelling is gone and futher reduces the fulid in knee prior to using it. My understanding is that healthy swelling promote healing similar to PRP. On top of that I use infrared light knee warp in past few months as it promotes blood circulation. Similar to TENS and unltrasound, the research publication of infrared light is limited. I kind of believe that every little things matter a little bit like what you said.

Hi mang0954,

I just replied to your questions in the cultured cell thread. I agree that if a doctor doesn't normally do bone injection then they shouldn't do it. It's more complicated and requires fluoroscopic needle guidance. The data on bone injection looks pretty good though. I'm not sure how certain you are with pursuing treatment with Dr. Purita but I recommend giving Regenexx a call, at least for a consultation. They do subchondral injections all the time. I think if you're trying to maximize your outcome with bone marrow concentrate and PRP you should at least take a serious look at it.

[mang0954]

Hi db1984

I called Regenexx Cayman today. They said that Regenexx-C is not necessarily to grow cartiliage but to treat the whole join to strengthen it and that cartiliage growth is not the focus. So my understanding is that goal/result is the same as regular stem cell offered in the U.S., to change chemistry/lay down a new interface to make it asymptomatic.

As for cost, apart from the first treament price $19500 of Regenexx-C, each addtional injection costs $9000 (as long as you still have cell in their bank), with $9000 I can do two BMAC+fat+PRP locally. So if you instead spend that money to receive constant regular stem cell and PRP, you may get the same result, just like what MADL in this sub did. Regenexx Cayman on the phone did say that the advantage of C and why it is so costly is because it is able to treat multiple joins with only one bone marrow withdraw and if there are still cells left in the bank they can be used for future injection and that for single join single injection Regenexx-SD may work the same as Regenexx-C (They didn' mention higher cell number per injection on the phone).

[db1984]

mang0954,

I see where you're coming from and I've had countless conversations with Regenexx docs on the issue of cartilage repair vs joint health. This is something I've been thinking about for a long time. I've tried pretty much everything Regenexx offers... PRP, BMAC, A2M... And of course cultured cells. The Regenexx-C cultured cell injection blows everything else out of the water. The difference is like night and day. I went from getting basically zero relief from a Regenexx-SD to having amazing relief after a cultured cell injection that is just now starting to decline 3 years later.

I get it. Cultured cell injections are ridiculously expensive. My personal finances definitely feel it. But I consider it money well spent and I would gladly go through with it again. This is why I'm so gung ho about trying to figure out how to optimize the recovery. After spending many hours scrutinizing my before and after knee MRI's, I'm very confident the cultured cells improved my cartilage, but clearly it wasn't completely fixed.

I wouldn't blame you or anybody else for not wanting to spend that kind of money. It's borderline insane. But I'm telling you... If you went down to Regenexx Cayman you would be impressed. That is one hell of a knee injection!

If you want to stick to treatments in the US, just be smart about it and optimize as much as you possibly can. I'm doing that myself. Assuming I test negative for Covid-19 then next week I'll be getting arthroscopic loose body removal, combined with PRP injection throughout the joint, into the subchondral bone, and into some of my ligaments as well. That PRP will be concentrated 14x over baseline and completely undiluted since my knee will have been flushed out beforehand. Here's where I'm having it done:

http://nashvilleregenerative.com/

I consider this to be a highly optimized PRP treatment, about as good as it gets without stem cells, so I'm very curious to see how effective it will be. He's also adding in some ankle injections. All that for about $3k, so decently affordable.

Something else I would recommend is concentrated A2M. I had it injected at the Centeno-Schultz Clinic and it's a powerful anti-inflammatory. My knee just felt really good after the injection. I haven't had any more A2M injections since then but it made an impression on me and I'll likely try it again.

I've been following Dr. Adam Anz and his trial of Dr. Saw's technique in the US. That would be awesome if it was approved and covered by insurance. It's still a big surgery though and if it fails you're headed for either a massive allograft or arthroplasty. Nice thing about injections is they can be repeated, unlike surgery.

[mang0954]

Hi db1984

I did see that you mentioned night and day difference for you between Regenexx-C and Regenexx-SD, but besides you and rob8647932, I don't see anyone else here report concludsive positive result of Regenexx-C (exclude accounts that say good things about Regenexx-C on their 1st post). I have no doubt about what you have experienced but after seeing one of Dr. Centeno's comment about recommanding SD instead of X to knee join and talking to Regenexx Cayman general consultation line, I feel that even Regenexx Cayman themselves don't feel Regenexx-C is necessarily superior than same day stem cell for knee/cartilage (for majority of patients I guess, but obviously not your case). Besides, I believe in best advertising being word-of-mouth, creating multiple accounts here to advertise themselves and posting photo of Dr Adelson is their website to insult him really discredit Regenexx. Dr Adelson's price of $1500 for bmac+fat breaks the rule of stem cell world in the U.S., it is understandable that stem cell doctors in America who all get used to charge $5000 or upward is upset about Dr Adelson. I haven't signed up for Dr P*'s treatment yet is also because of same "best advertising being word-of-mouth" reason - his team hold frequent seminars to potential patients and provide free consultation to new patients. If something really works or your service is really good, you don't need advertising, that is what I learned from doing business with many different people in past few years. That is also what Dr Anz reminds me exactly - "Don't fall into their sales games, stem cells treatments are very money driven and are still in throw-spaghetti-against-the-wall stage, if they have such good success rate, get a FDA trail and publish their result offically rather than claiming success rate". He knows what Dr P* does and he knows from the beginning that my televisit with him is just to seek an objective opition/direction and would not do either PRP, stem cell or debritment with him because I am 10-hour drive away from him. so he should have no reason to offer me biased opinion to be in farovr of him .

I have no doubt that if I can only choose one single injection, Regenexx-C gives the best chance to heal. And I can very much afford Regenexx-C, but what I am asking myself is, instaed of spending $30k for 2 injections of Regenexx-C, what if I instead spend that money to receive 6 injections from Dr Purita, or 20 injections from Dr Adelson if I am willing to fly to Utah, will I get the same or ever better resualt than Regenexx-C? I also believe that there is reason why Dr Saw and Dr Broyles use multiple rounds of stem cell injection afrer drilling. It is the story of MADL, gb (https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=46074.0) and my acupuncture dcotor (who uses PRP on his knee on regular basis), as well as studies of a series of PRPs versus single PRP lead me to think how to spend these tens of thousands of dollars to get optimal result.

That being said, my plan is to do stem cell and PRP injections locally without travlling (for convenience, especailly during COVID-19 pandemic) on a regualr basis for at least next 6 months or so (unless my symptom gets worse). On top of that, I am going to add ipamorelin+cjc1295 for self-injection as an alternative to HGH as I have seen 10+ positive reports from people here and reddit who use HGH for their bad knee cartilage. Thank you for providing the information about Centeno-Schultz clinic and concentrated A2M. Travelling to Centeno-Schultz, Regenexx Cayman, Regenexx Nashville or Dr Adelson in Utah would be my next option after 6-month local treatment if no improvement. Grand Cayman shuts down travellers form U.S. indefinitely for now and Regenexx Cayman is closed till end of this year anyway.

I called my orthopedic doctor and 1 other PRP doctor to ask about subchondral bone injection, but none of them do it. My orthopedic doctor (works for a big hospital) said "they haven't credentialed the facitliy for that (subchondral bone injection)", so I doubt I can find any subchondral bone injection or concentrated A2M locally in south Florida.

I also called Dr Alimorad Farshchian's office in Miami, another experienced regenerative medicine doctor, they do fat, amniotic fluid and umbilical cord blood stem cells from donor.

mang0954,

I see where you're coming from and I've had countless conversations with Regenexx docs on the issue of cartilage repair vs joint health. This is something I've been thinking about for a long time. I've tried pretty much everything Regenexx offers... PRP, BMAC, A2M... And of course cultured cells. The Regenexx-C cultured cell injection blows everything else out of the water. The difference is like night and day. I went from getting basically zero relief from a Regenexx-SD to having amazing relief after a cultured cell injection that is just now starting to decline 3 years later.

I get it. Cultured cell injections are ridiculously expensive. My personal finances definitely feel it. But I consider it money well spent and I would gladly go through with it again. This is why I'm so gung ho about trying to figure out how to optimize the recovery. After spending many hours scrutinizing my before and after knee MRI's, I'm very confident the cultured cells improved my cartilage, but clearly it wasn't completely fixed.

I wouldn't blame you or anybody else for not wanting to spend that kind of money. It's borderline insane. But I'm telling you... If you went down to Regenexx Cayman you would be impressed. That is one hell of a knee injection!

If you want to stick to treatments in the US, just be smart about it and optimize as much as you possibly can. I'm doing that myself. Assuming I test negative for Covid-19 then next week I'll be getting arthroscopic loose body removal, combined with PRP injection throughout the joint, into the subchondral bone, and into some of my ligaments as well. That PRP will be concentrated 14x over baseline and completely undiluted since my knee will have been flushed out beforehand. Here's where I'm having it done:

http://nashvilleregenerative.com/

I consider this to be a highly optimized PRP treatment, about as good as it gets without stem cells, so I'm very curious to see how effective it will be. He's also adding in some ankle injections. All that for about $3k, so decently affordable.

Something else I would recommend is concentrated A2M. I had it injected at the Centeno-Schultz Clinic and it's a powerful anti-inflammatory. My knee just felt really good after the injection. I haven't had any more A2M injections since then but it made an impression on me and I'll likely try it again.

I've been following Dr. Adam Anz and his trial of Dr. Saw's technique in the US. That would be awesome if it was approved and covered by insurance. It's still a big surgery though and if it fails you're headed for either a massive allograft or arthroplasty. Nice thing about injections is they can be repeated, unlike surgery.

[mang0954]

Went to see Dr F in Miami for initial consultation and ended up receiving a PRP+Amniotic fluid injection as I felt good about the doctor and his assistant (a physical therapist) after a long conversation.

The assistant carefully examined x-ray and my knee physically, and concluded that cause of my patellofemoral joint injury is because I have degenerative tissue on my medial tibiofemoral component (less space between medial tibiofemoral joint, excessive weight distribution on medial tibia), causing my right leg not fully extend (very subtle that I cannot notice). Though I don't understand this relationship from compromised tibiofemoral joint to patellofemoral joint injury. He can tell that I have cartilage loss on my medial patella of right knee - when he inserted his fingers into/right behind medial patella of both legs at the same time he can feel less space in the medial patellofemoral joint of my right leg than that of left leg. This matches exactly what MRI report says about medial patella cartilage damage (He didn't see MRI and report).

Then Dr F came in after reviewing MRI images and said since I don't have pain so my osteoarthritis is in very early stage, I don't need the most powerful treatment fat aspirate or umbilical cord blood, just less costly amniotic fluid+PRP would work fine as amniotic fluid is very powerful in healing. In his opinion, fat>>bone marrow/processed umbilical cord blood (so called "dead cell")/amniotic fluid>PRP.

I asked Dr F about 3 PRP in a row, cultured cells and Dr P's PRP+bone+fat, he said they will all work and that lots of time it depends on what the patients believe in mentally. He said Dr P is a good doctor in stem cells and the price Dr P offered me is very reasonable but he doesn't think that I need such a powerful injection of PRP+bone+fat. He didn't push me to use his treatment but talked about lifestyle/activity modification and that laser, electrical stimulator, infrared light and high dosage glucosamine are beneficial. When I asked about repetitive injections, he said it definitely is better and there are Olympic athletes who come back like every 1.5 years for reinjection or receive an injection right before competition to boost the result because they have high physical demands, but he doesn't think I need that unless my symptom is not 100% resolved or I want to continue high impact exercise like running or heavy weight lifting.

After talking to the assistant again, he believed that if I receive one injection and not to run, bounce and load heavy weight while standing for 3 weeks, the medial tibiofemoral component should very much improve and will be able to be examined via x-ray in 3 weeks, and with a compromised joint I won't be able to add muscle around the knee no matter how I train my VMO (my right leg VMO is indeed getting smaller). I appreciated the patience and time they spent to talk to me so I decided to go for the injection.

While I was waiting for the PRP spin, I asked the assistant if he knows Dr C, he said Dr C is very biased and only believes what he believes - bone marrow and cell count which not necessarily mean better result, as there are many factors and right chemical combinations involved in healing but Dr C is not very open minded to try other things. I asked if he knows Dr P, he said yes of course he is very good. (but to me Dr P is very biased too when I visited him).

After injection, I asked Dr F about HGH, he said it really worked when he did intra-articular HGH injection for his patients until 2005 MLB banned it for anti-doping then it was getting controversial (he means side effect I guess). As mainstream is moving towards stem cells since 2010 so is him. He said peptides are very effective and that just doing IM injection of HGH myself or ipamorelin+cjc1295 should be very beneficial for healing.

To clarify, I don't mean to discredit Dr C or the C procedure, I believe each of Dr C, Dr P and Dr F all treat 10,000+ patients so far, they offer best (or most cost effective) treatment to each patient on a case to case basis based on the 10,000+ results they have collected (not necessarlliy the research results that other doctors published based on studies on tens or hundreds of patients). Dr P did say that fat+PRP should work for me but adding bone marrow on top of that would be best, and he was fairly sure that I don't need another PRP. He dropped expensive lipogems because of cost-effective reason and according to his assistant the protocol of injections had been ajdusted many times based on results/feedback. So theres is not a Yes/No answer to whether this or that doctor is correct or not, and I plan to receive repetitive injections and willing to try each of these doctors' treatment and am not going to commit to any single type of treatment unless there is further convincing result.

Also check Dr Neil Riordan in Panama who uses expanded umbilical cord blood stem cell from donor (live cell). Price starts $23,150 according to their website. There are clinics in Mexico advertise the same treatment too at much lower price, I see one of them advertise $2950 in their website
https://www.youtube.com/watch?v=OtL1fEEtLaA
https://www.cellmedicine.com/

[PuneKnee]

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)
=========================== Update on 7/20/2020 ===========================
-- 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

I've seen a lot of hour long presentation videos of Dr Saw Khay Yong and I clearly remember him mentioning that his method works for Patellofemoral cartilage damage which are harder to treat with ACI/MACI

[db1984]

Thought I would give a quick update. It's been 4 months since my left knee arthroscopy. As a reminder I have some partial thickness cartilage damage in my lateral trochlea, as well as a bone marrow lesion in the same area on my MRI from February of this year. Here's what I had done during the surgery (8/10/20):

-Arthroscopy to remove bone fragment from medial side of my femur
-NO debridement of the cartilage! We agreed to that prior to the surgery and he stuck to it.
-Intra-osseous PRP injection into the lateral trochlea (14x platelet concentration, leukocyte poor)
-Intra-articular PRP injection (same concentration). He drained my knee before the injection, so I had pure PRP in my knee after the surgery.
-MPFL PRP injection (7x PRP, leukocyte poor)

I had a follow-up PRP treatment on 9/25/20:

-Intra-articular PRP injection (14x again)
-MPFL PRP injection

During the recovery I've been using ultrasound stimulation on the damaged cartilage daily for the last 4 months. I've also been using E-Stim on my VMO to try and improve my patella tracking. I had a follow-up MRI on 11/19/20 and here's what the radiologist had to say about my trochlea in his report (in quotes):

"Patellofemoral articular cartilage: There is partial thickness cartilage loss and fissuring along the lateral aspect of the trochlea similar in distribution to the prior examination, however on close examination, the cartilage appears slightly thicker and more homogeneous in some areas, for example axial image 26 on the current study, compared to axial image 23 at the same level on the prior study). Previously seen moderate focal subchondral marrow edema in this region has substantially improved. Minimal fraying of the patellar cartilage, unchanged."

I looked at the MRI images myself and the improvement in the bone is the most obvious change, the bone marrow lesion in my trochlea is about 90% healed. I agree that the cartilage looks better but the change is subtle. Bone-Cartilage cross talk is well documented and pretty much established at this point, so I find that very believable.

Overall I'm very pleased with this result. It's not massive growth but it's very impressive considering it was just a couple rounds of PRP. I think the combination of bone injection and ultrasound stimulation made a big difference and really accelerated the effects of the PRP.

One thing I find strange is that I have a weird pattern of marrow edema in the back of my femur that I've never had before. It's not painful but I suspect it might have gotten a little beat up while my knee was still swollen and wobbly after the arthroscopy. The swelling has gone down and my knee is stable again so I think it should subside on it's own.

[silver_maple]

db1984, do you think your good recent results are due to the 14x PRP concentration? Most bed-side centrifuges get 4-5x concentration. Have you seen any research re optimal PRP concentration for knees (or particular parts of knees)? Would appreciate pointers.

On the leukocyte angle there is generally agreement poor is better.

Thanks!

[db1984]

silver_maple,

I think the 14x PRP concentration is definitely part of it, but also the intra-osseous injection and ultrasound stimulation. I took a closer look at my MRI's and did a before vs after comparison, there are definitely improvements in the cartilage like the radiologist said in his report. In addition to the cartilage thickening I had a full thickness fissure extending from the upper edge of the lesion that is now only partial thickness. Definitely a more consistent signal intensity as well. Of course the lesion hasn't fully healed. I'm getting a third PRP injection in a few days and will continue with the ultrasound.

As far as research on PRP concentration, the only thing I know about is a study Regenexx did on tendon cells. They showed that for cells from older patients (I think older means 30+) the cells proliferated faster the greater the platelet concentration was, but they didn't see that effect in cells for younger patients. You might do a search for it on Dr. Centeno's blog. I don't know about any dose escalation studies on platelet concentration for knee OA.