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Author Topic: Stem Cell Cartilage Repair (Shetty) Patella - 2 Years post-surgery  (Read 364 times)

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Offline Leeds, UK

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I thought I should contribute my experience, to give something back to this forum because it was helpful to me when I was in bad way in 2017. In fact, I think it was a post here that first informed me of Prof Shetty, leading me to research his stem cell treatment (and a similar one by an Italian surgeon Gobbi).

My story: I'm 48. In 2016 I started to get fit again after a very stressful and difficult period of life when I lost my way, gained weight etc. I lost 18kg, bought a water rower, stopped drinking... And then i noticed crepitus in my knee, a loss of dexterity, loss of quads volume and a small swelling besides my lower lateral right patella. Long story short: MRI revealed Grade 4 lesion in lateral facet of that patella. I was distraught and dismayed. I'd done a lot of reading by then and I was well organised to stablise my damaged cartilage using the approach of Doug Kelsey:
But Grade 4: too late for that. The lesion was estimated to be approx 1cm2

I read up on the MACI of Prof Shetty (Kent) - using keyhole surgery, microfracture, HA scaffold and stems cells from iliac crest. Data from early published trials looked very promising (as did Gobbi's trials, really amazing). Went to see Prof Shetty. By then my quads had gone. He noted severe maltracking (lateral shift) and patella tilt. He operated. Did MPLF reffing and lateral release to correct positional issues and the stem cell + microfracture. When I came round he said the cartilage was worse than the MRI had suggested (not unusual): 6cm2 - most of the load-bearing portion of the kneecap...

I did not do well in first 6 months. Fear of overloading it, very poor NHS physio in my area, loss of quads and loss of ability to activate them (neurological). I think I may have looked like a treatment failure in those early months. The ligament repairs played a part in this bad start probably (loads of swelling and no rehab protocol to manage these surgeries specifically). I narrowly avoided having another procedure to break up scar tissue but manage to get range of motion back by working hard and getting some help from a brilliant sport masseur in my area weeks 10-12 post surgery.

I do not know what the quality of the cartilage is. Strangely, I when I phoned at the 6 month period to ask about my review and MRI I discovered I had been discharged. But this has been my experience in the 1.5 years following that:

- I have continued to work on my rehab, using resistance bands etc and, most helpful of all, the Total Trainer advocated by Doug Kelsey that allowed me to do controlled squats every day to stimulate and strengthen the cartilage. It allowed me to control the % of body weight going through my knee (gradient settings). I got mine second hand on Ebay for 120 and it's the best 120 I've ever spent. It helped me build up a sense of safety and to rehab in a graded way without overloading the joint, damaging newly growing tissue. I learned it takes up to 2 years for the new tissue to mature so I took a 2-3 year view (cos I was late in getting going with my rehab because of missteps and setbacks)

It is now 2 years and 3 months since surgery. My quads and dexterity is still not back to 2015 levels and I am still working at it. But I have no pain and NO CREPITUS. If you put your hand on my kneecap as I squat now you would feel nothing. It used to be extremely rough, creaky and full of vibrations.

Just wanted to post this positive story. I don't know why there is so little about this procedure around. I am very grateful to Prof Shetty because I think he did an amazing job. But I think it could have failed if I hadn't supported the healing process all the way, restricting impact activities, building strength and using the approach advocated by Doug Kelsey, who I also owe a massive debt of gratitude.

Unfortunately, I learned that UK physio (NHS in particular, but also some UK-trained private physio) is in a very bad way. So much so that I considered writing to the HCPC (UK professional regulator). If you have this procedure in the UK you may find this aspect of the process a real challenge.

I was not a straightforward case as I had hoped I would be before embarking on this surgery journey. But it's been incredibly valuable and I wanted to post this in case you are someone struggling with similar problems to mine. And I'd like to add, the chondromalacia in my left patella in now way improved, probably as a result of hours of work on the Total trainer, under the recommendations of Doug Kelsey.

Offline Brandon123

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Re: Stem Cell Cartilage Repair (Shetty) Patella - 2 Years post-surgery
« Reply #1 on: May 06, 2021, 04:50:56 PM »
Thanks for sharing! Always great to hear success stories!

Please keep us updated on how things progress in the future :)
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 KingwoodKate

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Re: Stem Cell Cartilage Repair (Shetty) Patella - 2 Years post-surgery
« Reply #2 on: May 11, 2021, 10:15:28 PM »
 It's great to hear a good news story....I'm pretty bummed right now. 

I had an ACL replacement surgery 3 years ago after years of struggling with instability and pain.  3 weeks ago I had a nasty fall on my mountain bike where my knee bent sideways medially and then POP, POP...POP.  MRI results in and I just learned I have a Grade 4 chondromalacia of the femoral trochlear cartilage in addition to a full thickness ACL allograft tears at both ends, tibial tunnel widened and eroded, fractures, edema and pain pain pain. 

I'm 51 and was trying to get back in shape after the COVID 15 pounds when this happened.  I have heard of the Total Gym but, hadn't looked into it.  Once I figure out what's next for me....either a 2 staged surgery and then potential Total Knee Replacement in 5-7 years or to just replace the knee now instead of multiple surgeries.

Keep up the good work sir!  Enjoy your progress!
ACL Reconstruction 5/2019
4/2021 ACL Full Thickness Tear, Flap Tear Medial Meniscus, Grade V Chondromalacia of femoral trochlear cartilage

Offline Leeds, UK

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Re: Stem Cell Cartilage Repair (Shetty) Patella - 2 Years post-surgery
« Reply #3 on: May 17, 2021, 09:12:52 PM »
I'm sorry to hear that. That's a complex set of difficulties and I'm sorry I cannot offer any advice. I suspect you're in the process if coming to terms with this - psychologically - and sorting through your options. I know the procedure I had can work with people with very nasty cartilage damage, including on the femoral trochlear (potentially, with no guarantees). But its important to establish stability either in advance or at the same time (like my surgeon did). Whether this can be an option for you, I cannot say because it is outside of my knowledge.

As far as recovering from knee surgeries, I do recommend the Total Trainer or similar, to rebuild strength and establish regular movement and loading without overloading. I think a lot of physical therapists in the US use it. And for cartilage recovery, I think it is a WAY  underestimated/ overlooked aid. Enabling active care-taking of cartilage.

Good luck with working out your next stage.