This Graph Below Shows how PRP can work over a long period of time. I believe that this might be a reflection of how people can begin gaining not only ligament and disc strength but also as they move forward their function returns and the muscles begin to get stronger. In our office we aim to get to the far end of this graph faster than two years out. Things like Honey Matrix, CRP, adding Adipose Stem Cells, Ozone, proper rehabilitation, exercise with oxygen therapy as well as Chiropractic considerations all ad an advantage to receiving PRP at Gecko Joint and Spine. The use of High Definition Ultrasound to visualize your injury and guide the injection of the the PRP make sure our doctors are treating the appropriate tissues. Our athletes as well as many other patients whom often travel from out of state report significant benefit as well as a rapid recovery from spine and joint injury. You will be amazed at why some MD’s still use steroids with these results. Platelet Rich Plasma of the Knee vs. CorticoSteroids of the Knee. Graph showing them comparison over 104 weeks. We are in Sarasota Florida, Tampa, orlando, florida. We are a non surgical, non drug clinic that uses regenerative injections to rebuild cartilage in the knee for meniscus and osteoarthritis of the knee.
I was wondering if I would be a candidate for PRP. I have arthritis in my right knee and a lateral meniscus tear. Last year in March, I had arthroscopic surgery on the right knee due to a lateral & medial meniscus tears. At that time they repaired the tears and scraped the arthritis. Though I did not feel 100% back to normal, I was feeling better throughtout the enitre summer, swimming almost every day, and I did feel as though I was gaining my strength back. I started experiencing stiffness and knee pain about a month ago that was so bad I could barely walk. My co-workers commented ,asking me what happened? At that time I made an appointment to see the orthopedic doctor. An MRI shows another lateral meniscus tear and they also said I have arthritis. I am 54 years old, not overweight and in good health other than my knee pain.
Unfortunately arthoscopic surgery almost always causes early arthritis. It is always best to get PRP on a meniscus tear as PRP acts like a glue to reattach the torn pieces of meniscus back together. Now that you have a missing area of meniscus or your “repair site” you will always have a bit of instability there. The best we can do with this is to create as much stability in this area as possible by strengthening the collateral ligaments and getting the meniscus material around the site to grow as much as we can through PRP or even stem cell therapy using bone marrow or adipose. If your arthritis is significantly affected the hyalin cartilage (the cartilage at the end of the bone which is different than the meniscus which is fibrocartilage) the stem cells have been shown in studies to work better of that. The PRP does work well for the fibrocartilage FYI! Our results have been very good with these cases. Once we can asses your case we would be better able to guide you as to the best game plan.
Magnetic pulse treatment for knee osteoarthritis: a randomised, double-blind, placebo-controlled study.
Rheumatology Department, King’s College Hospital (Dulwich), London, UK.
We assessed the efficacy and tolerability of low-frequency pulsed electromagnetic fields (PEMF) therapy in patients with clinically symptomatic knee osteoarthritis (OA) in a randomised, placebo-controlled, double-blind study of six weeks’ duration. Patients with radiographic evidence and symptoms of OA (incompletely relieved by conventional treatments), according to the criteria of the American College of Rheumatology, were recruited from a single tertiary referral centre. 75 patients fulfilling the above criteria were randomised to receive active PEMF treatment by unipolar magnetic devices (Medicur) manufactured by Snowden Healthcare (Nottingham, UK) or placebo. Six patients failed to attend after the screening and were excluded from analysis. The primary outcome measure was reduction in overall pain assessed on a four-point Likert scale ranging from nil to severe. Secondary outcome measures included the WOMAC Osteoarthritis Index (Likert scale) and the EuroQol (Euro-Quality of Life, EQ-5D). Baseline assessments showed that the treatment groups were equally matched. Although there were no significant differences between active and sham treatment groups in respect of any outcome measure after treatment, paired analysis of the follow-up observations on each patient showed significant improvements in the actively treated group in the WOMAC global score (p = 0.018), WOMAC pain score (p = 0.065), WOMAC disability score (p = 0.019) and EuroQol score (p = 0.001) at study end compared to baseline. In contrast, there were no improvements in any variable in the placebo-treated group. There were no clinically relevant adverse effects attributable to active treatment. These results suggest that the Medicur unipolar magnetic devices are beneficial in reducing pain and disability in patients with knee OA resistant to conventional treatment in the absence of significant side-effects. Further studies using different types of magnetic devices, treatment protocols and patient populations are warranted to confirm the general efficacy of PEMF therapy in OA and other conditions.
J Rheumatol. 1994 Oct;21(10):1903-11.
The effect of pulsed electromagnetic fields in the treatment of osteoarthritis of the knee and cervical spine. Report of randomized, double blind, placebo controlled trials.
Trock DH, Bollet AJ, Markoll R.
Department of Medicine, Danbury Hospital, CT.
We conducted a randomized, double blind clinical trial to determine the effectiveness of pulsed electromagnetic fields (PEMF) in the treatment of osteoarthritis (OA) of the knee and cervical spine.
A controlled trial of 18 half-hour active or placebo treatments was conducted in 86 patients with OA of the knee and 81 patients with OA of the cervical spine, in which pain was evaluated using a 10 cm visual analog scale, activities of daily living using a series of questions (answered by the patient as never, sometimes, most of the time, or always), pain on passive motion (recorded as none, slight, moderate, or severe), and joint tenderness (recorded using a modified Ritchie scale). Global evaluations of improvement were made by the patient and examining physician. Evaluations were made at baseline, midway, end of treatment, and one month after completion of treatment.
Matched pair t tests showed extremely significant changes from baseline for the treated patients in both knee and cervical spine studies at the end of treatment and the one month followup observations, whereas the changes in the placebo patients showed lesser degrees of significance at the end of treatment, and had lost significance for most variables at the one month followup. Means of the treated group of patients with OA of the knee showed greater improvement from baseline values than the placebo group by the end of treatment and at the one month followup observation. Using the 2-tailed t test, at the end of treatment the differences in the means of the 2 groups reached statistical significance for pain, pain on motion, and both the patient overall assessment and the physician global assessment. The means of the treated patients with OA of the cervical spine showed greater improvement from baseline than the placebo group for most variables at the end of treatment and one month followup observations; these differences reached statistical significance at one or more observation points for pain, pain on motion, and tenderness.
PEMF has therapeutic benefit in painful OA of the knee or cervical spine.
By Dr. John Lieurance
My first experience with PRP was in 2006. I had been utilizing prolotherpy in my office for 12 years. I had a snow boarding injury for about ten years and the MRI showed something called a cleavage tear in the medial meniscus. I couldn’t bend my knee all the way without it poping and swelling up. It was a chronic problem and prolotherpy wasn’t working. The first week that we started offering pur patients PRP at Gecko Joint and Spine I wanted to have my knee injected with PRP. I was amazed! I could go on and one about how well it did but instead listen to our patients tell you they’re story. The first few video’s are on PRP and then check out the video’s on using bone marrrow and adipose stem cells. We are one of the few places to offer a combination of bone marrow and adipose stem cells together we call marrapose. Gecko uses PRP or platelet rich plasma and stem cells to strengthen the ligaments, repair the meniscus, and improve cartilage in the knee joint. The injections used growth factors to bring stem cells into the area for repair.
Gecko Joint and Spine is one of the first clinics to offer the combination of bone marrow and adipose derived stem cells in a combination treatment for osteoarthritis to rebuild cartilage. Why is this important? As we age our bone marrow produces less stem cells however there are stem types of stem cells that both favor differentiation into cartilage as well as helping to create new blood supply called neovascularization. By combining these factors all together you are receiving the best science and the new age of stem cell orthopedic has to offer. Besides it being extremely difficult to find a clinic that will offer you both of these cuting edge therapies together when you do find one the expense might suprise you. Gecko Joint and Spine has decided to keep our costs reasonable, so much so you might be able to receive this treatment for 2 or 3 joints at the same time. SInce our first cases we have seen remarkable recovery from pain and dysfunction associated with cartilage loss in the hip, ankle,knee, and shoulder using MarroPose.
The following post will look at studies showing Statins improve knee pain and arthritis and study that shows it can make it worse.
Recent research suggests that cholesterol-lowering drugs may help knee osteoarthritis.
“Osteoarthritis is the most frequent chronic joint disease causing pain and disability. Besides biomechanical mechanisms, the pathogenesis of osteoarthritis may involve inflammation, vascular alterations and dysregulation of lipid metabolism. As statins are able to modulate many of these processes, this study examines whether statin use is associated with a decreased incidence and/or progression of osteoarthritis.
Participants [2,921] in a prospective population-based cohort study aged 55 years and older were included. X-Rays of the knee/hip were obtained at baseline and after on average 6.5 years for osteoarthritis. Any increase in score was defined as overall progression [incidence and progression].
Statin use is associated with more than a 50% reduction in overall progression of osteoarthritis of the knee, but not of the hip.”1
Here is the study showing Statin made Knee pain worse.
“Recently published research suggests that statins may have beneficial structural effects in persons with knee osteoarthritis (OA). The potential effects of statins on patient-reported knee pain and function have not been examined. We studied a large prospective community-based cohort of persons with knee OA to determine if statin usage was associated with changes in knee structure, pain and function trajectories.
Data were obtained from the Osteoarthritis Initiative using a subset of 2207 persons with radiographically suspected or confirmed knee OA. The changes in Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Physical Function scores, pain intensity and Kellgren-Lawrence radiographic grade over 4 years were examined. [The same applied in the above study.]
Data from persons were coded based on whether they were incident users of statins over the 4-year period. Outcome trajectories and probability of statin use were examined over the 4-year study period using parallel processing growth curve modeling. The analysis adjusted for potential confounders and determined if statin use predicted outcome trajectories.
Statin use was not associated with improvements in knee pain, function or structural progression trajectories. The only significant finding indicated that increased duration of statin use was associated with worsening in WOMAC Physical Function scores over the study period. Statin use was not associated with improvements in knee pain, function or structural progression over the 4-year study period.”2
Common sense would suggest that statin drugs do NOT help knee pain and arthritis. Using regenerative injection treatments such as PRP, Prolotherapy using dextrose and Stem Cell Transplant make much more sense to build up the cartilage that was lost and to strengthen the ligaments that have been damaged to stabilize the joint.
1. Stricker BH, Bierma-Zeinstra SM. Statin use is associated with reduced incidence and progression of knee osteoarthritis in the Rotterdam study. Ann Rheum Dis. 2012 May;71(5):642-7. Epub 2011 Oct 11.
2. Riddle DL, Moxley G, Dumenci L. Ann Rheum Dis. 2012 Nov 21. [Epub ahead of print]
Associations between Statin use and changes in pain, function and structural progression: a longitudinal study of persons with knee osteoarthritis.
The meniscus is important part for stabilization of the knee. There are actually two menisci per knee, located on the outer edges that provide stability, cushion and shock absorption. Some of the most common knee injuries involve a tear in one or both of the menisci. In younger people a meniscus tear usually results from a sharp twisting motion during sports or other physical activities. In older people the meniscus may tear as a result of degeneration in the cartilage of the meniscus. In both groups there is , generally, a common cause of this with the collateral ligament that holds the meniscus in place becoming stretched or torn. This allows the meniscus to move out of the position that keeps it from too much pressure and torque. Either way a barbaric yet traditional treatment for a torn meniscus at your local orthopedic’s office involves arthroscopic knee surgery to shave or remove the meniscus material that is damaged. I say this is Barbaric because we already mentioned, the meniscus plays an essential role in knee stability. So removing parts or all of it is an old system of care. Studies show that decreasing the stability in the knee can lead to instability in other ligaments and cartilage of the knee which leads to premature arthritis is patients who have received these needless surgery’s. Let’s take a look at what happens during arthroscopic surgery for a torn meniscus:
Torn Meniscus Before Surgery
You can see the torn meniscus before surgery. Despite being torn there is a good amount of cartilage that makes up the meniscus and provides support and stability to the knee.
Torn Meniscus During Arthroscopic Surgery
During arthroscopic surgery a large probe enters into the knee space to remove parts of the meniscus. Although arthroscopic surgery is “minimally invasive”, for a space this small it involves quite a bit of invasion.
Meniscus After Surgery
Finally, after the arthroscopic surgery, the meniscus space is “clean” but lacking in cartilage, support, stability, and protection. This missing meniscus leaves the knee susceptible to further degeneration and pain for the patient.
A more cutting edge option is to undergo a true minimally invasive therapy that regenerates cartilage instead of removing it: Platelet Rich Plasma and or Stem Cell Injections. The problem with meniscal injuries is that the meniscus receives a very poor blood supply and therefore does not have access to the healing factors of the body. These new options works to create a graft of new tissue to the torn meniscus and usher in all of the healing factors naturally present within a person’s body. It involves comprehensive injections under ultrasound guidance.
If you are faced with a torn meniscus, ask yourself what treatment is best. Please contact us with any questions on your specific case; we would love to help you get on the path to healing.
One-Step Cartilage Repair with Bone Marrow Aspirate Concentrated Cells and Collagen Matrix in Full-Thickness Knee Cartilage Lesions
Comment: The following article is regarding knee regeneration. We treat many knee’s with these methods, however we use the adipose tissue to collect the stem cells. We feel it it better.
Yours in Health,
Wellington Chen, MD.
Results at 2-Year Follow-up
- Alberto Gobbi1⇓
- Georgios Karnatzikos1
- Celeste Scotti2
- Vivek Mahajan1
- Laura Mazzucco3
- Brunella Grigolo4
1Orthopaedic Arthroscopic Surgery International, Bioresearch Foundation, Milan, Italy
2Residency Program in Orthopaedics and Traumatology, University of Milan, Milan, Italy
3Centro Trasfusionale e Laboratorio Biotecnologie, Ospedale SS Antonioe Biagio, Alessandria, Italy
4Laboratorio di Immunoreumatologia e Rigenerazione Tissutale, Istituto Ortopedico Rizzoli , Bologna, Italy
- Alberto Gobbi, MD, Orthopaedic Arthroscopic Surgery International, Via Amadeo 24, 20133, Milan, Italy Email: firstname.lastname@example.org
Objective: The purpose of our study was to determine the effectiveness of cartilage repair utilizing 1-step surgery with bone marrow aspirate concentrate (BMAC) and a collagen I/III matrix (Chondro-Gide, Geistlich, Wolhusen, Switzerland). Materials and Methods: We prospectively followed up for 2 years 15 patients (mean age, 48 years) who were operated for grade IV cartilage lesions of the knee. Six of the patients had multiple chondral lesions; the average size of the lesions was 9.2 cm2. All patients underwent a mini-arthrotomy and concomitant transplantation with BMAC covered with the collagen matrix. Coexisting pathologies were treated before or during the same surgery. X-rays and MRI were collected preoperatively and at 1 and 2 years’ follow-up. Visual analog scale (VAS), International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Marx, SF-36 (physical/mental), and Tegner scores were collected preoperatively and at 6, 12, and 24 months’ follow-up. Four patients gave their consent for second-look arthroscopy and 3 of them for a concomitant biopsy. Results: Patients showed significant improvement in all scores at final follow-up (P < 0.005). Patients presenting single lesions and patients with small lesions showed higher improvement. MRI showed coverage of the lesion with hyaline-like tissue in all patients in accordance with clinical results. Hyaline-like histological findings were also reported for all the specimens analyzed. No adverse reactions or postoperative complications were noted. Conclusion: This study showed that 1-step surgery with BMAC and collagen I/III matrix could be a viable technique in the treatment of grade IV knee chondral lesions.
PRP therapy a viable joint treatment?
December 6, 2011
PRP therapy may be a way of fixing a muscle, tendon, or joint-related injury without surgery — and it’s really catching on.
The thing is, there’s no firm evidence that this experimental treatment actually works.
CBS News medical correspondent Dr. Jon LaPook explains that the term PRP stands for “platelet-rich plasma” therapy. Platelets are a part of your blood that’s responsible for clotting and healing.
“It’s that healing power that first attracted professional athletes to it about five years ago,” LaPook said. “Now, ordinary folks are requesting the treatment, and some swear by it.”
After enduring years of chronic foot pain, Linda Leonard is thrilled to be back on horseback. While riding 15 years ago, her horse stumbled, prompting her to jump off. Leonard landed hard, shattering her ankle.
Leonard said of her injury, “The angle, weight, momentum, just blew (my ankle) apart into 40 places. And I thought. ‘I’m in real trouble.’ And I had to crawl out on my elbows, and I was laying on the side of the road.”
After multiple surgeries, arthritis set in.
“People who live with pain every day — it’s exhausting,” Leonard said. “It got to a point where I thought, ‘Is this going to be my life? This is not even the essence of me; it’s not me.”‘
Leonard spent years searching for relief. Then, in 2009, she heard about an experimental, non-surgical solution that claims to stimulate powerful healing. Leonard sought out Steven Sampson, an osteopath who offers PRP.
“What we do is we isolate the body’s natural healing properties, called platelets,” Sampson, of the Orthohealing Center, said. “We’ve learned that platelets release growth factors that stimulate repair.”
The procedure is simple. A small amount of the patient’s blood is spun in a centrifuge to separate and concentrate the platelets. Then they’re injected into the injury. The cost varies from about $500 to $2,000, but is rarely covered by insurance because it’s still experimental.
Sampson said, “We’ve had success from head to toe, from neck, back, hip, knee.”
But thus far, studies have not produced convincing evidence that PRP is a magic bullet for tendon and muscle injuries.
Dr. Peter McCann, chairman of orthopedic surgery at Beth Israel Medical Center in New York City, said, “The PRP is equivalent to cortisone injections. There are a few studies that show slight improvement, but it’s really not improvement that patients would appreciate.”
That didn’t stop former National Basketball Association star Maurice Taylor from trying it. He claims it eliminated pain in both of his knees.
“I’m very surprised because it’s a quick treatment,” Taylor said. “I’m surprised that a treatment that takes so little time has such big results.”
McCann, who is also editor in chief of The American Journal of Orthopedics, says further studies are warranted
“The jury’s still out,” McCann said. “We need more studies to figure out if we can select out those patients who could really benefit because it does have great potential.”
Taylor said, “I was off the court and away from training for two days, then the third day, I was playing basketball.”
Taylor now plays for a team in China, and Leonard remains free of crippling pain.
“Maybe it won’t work on everybody, but it worked on me,” Leonard said. “It’s given me my life back.”
PRP has not yet been approved by the Food and Drug Administration, LaPook added on “The Early Show.” The agency told CBS News that licensed medical practitioners can use it, but they cannot claim the treatment will actually correct any problem.
“Patients are coming in and asking for it, right?” LaPook said. “It’s the classic clash between belief and evidence-based medicine. Last year, the International Olympic Committee commissioned a report saying, ‘Let’s look at the entire world literature and see (whether it works).’ They found that it was safe so far, although there are no long-term studies, but in terms of it being effective, the jury is still out.”
The results, LaPook said, are anecdotal up to now. “You know who was not in today’s piece?” LaPook asked. “My friend, Richard, who had an injection in each Achilles tendon for $2,500 each, and it totally didn’t work.”
” … I think there’s a very important study that people need to go back to,” LaPook continued. “About 10 years ago, everybody knew that, if you had arthritis of the knee, you do an arthroscopy, you clean things out, you smooth things out and you get better. So people said, ‘I get better with this.’ Well, so they said, ‘Let’s do a brave study,’ and it was brave, 180 people, they divided them into three groups. One had the actual arthroscopy and they washed it out. Another had the debris cleaning procedures. The other had a placebo — they did a couple of cuts and they did nothing. There was no difference between the three groups. And interestingly enough, all three groups got better. So what is the contribution of the placebo effect? Placebo is very powerful. And until you do these controlled studies, you know, you really don’t know for sure.”
When asked how this all plays out, LaPook said, “I think it goes to informed patient consent, informed decision-making, which is that the doctor says in the privacy of that office, what really goes on when you look at that patient in the eye, are you saying, ‘I’m telling you, this works. In my hand, it works.’ But are you saying the honest truth, which is, look, the jury is still out.”