Stem cell injections for the knees

[mdf]

Which begs the question of whether it's ethical to do sham surgeries or how to ethically trick the brain in thinking it had sham surgery.

It's an established area of expertise...
https://en.wikipedia.org/wiki/Psychic_surgery

 

[CalG]

Psychic_surgery

It's all about healing

And the lion's share of that is "all in your mind". And I'm not talking about the thinking mind. Sometimes we need some "suggestions".

"Trust the force, Luke" ;-)

 

[AmyPJ]

Still following this thread. Fascinating and exciting! I opted out of meniscus repair surgery after I fractured my tibial plateau because the surgeon told me I'm better off having it in there the way it is than to take some out and not have it at all. He wanted me to see how it felt. Well, 2.5 years later, it's pretty good, I get pain once in awhile in that area, but who knows if it's the meniscus or arthritis.

With my poorly tracking patellas in both knees, and corresponding OA, I've always said I'll be needing knee replacement in my 50s. (Ack!) This gives me hope that I won't. (I'm currently 48.) I'll keep mountain biking like a maniac in the summer and skiing all winter. Both activities make my knees feel really good. I'll keep babying them with the hopes that this procedure becomes approved and covered by insurance.

 

[Ron]

sorry @AmyPJ but there is no clinical evidence that stems cells do much of anything (for now) and this comes from one of the top OS (Philippon) in the world who is doing extensive research on this. I had it done on my hip during surgery. He said there isn't anything concrete that shows it works but they do it for research purposes. There is some promise for certain uses but not much for knees and certainly not for Chondromalacia or @SBrown and I would have been signed up a long time ago. I have grade IV in my left knee and was told it would not work. Long-term, there will be uses for it and some claim it works for them but right now, there's nothing promising. Go see a CFMPT. they actually have some good success with correcting and treating Chondro.

There are some very promising trials going on right now though that involve harvesting cells, growing new cartilage and then placing it back into the knee as well as an artificial cartilage too.

 

[AmyPJ]

sorry @AmyPJ but there is no clinical evidence that stems cells do much of anything (for now) and this comes from one of the top OS (Philippon) in the world who is doing extensive research on this. I had it done on my hip during surgery. He said there isn't anything concrete that shows it works but they do it for research purposes. There is some promise for certain uses but not much for knees and certainly not for Chondromalacia or @SBrown and I would have been signed up a long time ago. I have grade IV in my left knee and was told it would not work. Long-term, there will be uses for it and some claim it works for them but right now, there's nothing promising. Go see a CFMPT. they actually have some good success with correcting and treating Chondro.

There are some very promising trials going on right now though that involve harvesting cells, growing new cartilage and then placing it back into the knee as well as an artificial cartilage too.

Well, hopefully SOMETHING more palatable that TKR in the next 10 years, how does that sound?
Until then, I'll keep biking because it works wonders for me.

 

[Ron]

seriously, go to a Functional Manual Therapist. I have a lot of experience with PT's This form of therapy is far more effective. It deals with re-alignment of the kenetic chain and retraining muscle function. its much more hands-on. FMT kept me going. My OS literally asked me how it was possible for me to have been as functional as I was while waiting for surgery. (I had to of course due to insurance and a 6 month wait for his schedule)

https://www.instituteofphysicalart.com/ipa-information/fmt.html About

http://www.instituteofphysicalart.com/ipa/world/view Finder

 

[AmyPJ]

seriously, go to a Functional Manual Therapist. I have a lot of experience with PT's This form of therapy is far more effective. It deals with re-alignment of the kenetic chain and retraining muscle function.

https://www.instituteofphysicalart.com/ipa-information/fmt.html About

http://www.instituteofphysicalart.com/ipa/world/view Finder

There's one near me. Cool. Will have to see if he accepts Tricare. I'm guessing probably not...

 

[Ron]

You can always go for an assessment and then see what the cash rate is and how many sessions might get you on track. Once you get things going, there's a lot you can learn to do on your own.

 

[RuleMiHa]

seriously, go to a Functional Manual Therapist. I have a lot of experience with PT's This form of therapy is far more effective. It deals with re-alignment of the kenetic chain and retraining muscle function. its much more hands-on. FMT kept me going. My OS literally asked me how it was possible for me to have been as functional as I was while waiting for surgery. (I had to of course due to insurance and a 6 month wait for his schedule)

https://www.instituteofphysicalart.com/ipa-information/fmt.html About

http://www.instituteofphysicalart.com/ipa/world/view Finder

THANK YOU!

I had 2 FMT appointments while visiting CA about 10 years ago which restored full mobility to my rotator cuffs (had been struggling with pain & restriction & tendinitis) after two visits. A few years ago I strarted to think about getting treatments to other areas (my rotator cuffs are still fine) & tried myofascial release but it just wasn't the same. I just didn't realize/couldn't remember what they were called.

So, yes, FMT's working on the appropriate areas are wonderful for restoring function, but it hurts like h***!

Hopefully there are some good ones in my area.

 

[Ron]

So, yes, FMT's working on the appropriate areas are wonderful for restoring function, but it hurts like h***!

SHHH, dont tell her it hurts It certainly can but it depends on what they are working on. I've had it done on shoulders, hand, forearm (tendinitis) Hips, SI joint (this works almost magically) and knees.

 

[RuleMiHa]

SHHH, dont tell her it hurts It certainly can but it depends on what they are working on. I've had it done on shoulders, hand, forearm (tendinitis) Hips, SI joint (this works almost magically) and knees.

I have never felt as limber and flexible (and good) as I did after leaving those FMT appts. But I sounded like a beached whale during both sessions. I was pretty sure my bellows of pain were scaring people away from the waiting room.

Despite what it sounds like I'd do it again in a heartbeat if I could because it saved me 100x the pain later on. Definitely one of the best things I've ever had done.

 

[Ron]

LOL, BREATHE

 

[PTskier]

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0175449

Eleven selected publications regarding knee OA* with 582 patients were included in the present meta-analysis. This analysis of MSC therapy in knee OA patients yielded encouraging results, with superiority in VAS, WOMAC and Lequesne scores; improvements in IKDC, Lysholm, and Tegner scores; and low rates of AEs*. Hence, these results suggest that MSC*** therapy has great potential as an efficacious treatment for patients with knee OA.

There is still a lot we do not know. Autologous bone marrow stem cell injections seem like they might work. In my case, not suitable for a joint replacement, allergic to strong anti inflammatories, cortisone and injectable hyaluronic acid preparations not effective, weight good (6', 175#), relatively fit, my only other option was to stop fun activities like hiking, biking, and skiing.

*OA = osteoarthritis

**AEs = adverse events

***"Mesenchymal stem cells, or MSCs, are multipotent stromal cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells which give rise to marrow adipose tissue)."
https://en.wikipedia.org/wiki/Mesenchymal_stem_cell

 

[Ron]

again, at some point it will be viable and some people have seen improvements. for chondro, there aren't many options. there is a patellar replacement surgery but that's sketchy so far.

 

[agreen]

Here is an update. Ive done approx. 25 stem cell injections so far starting in early August with follow up on approx. 20 patients greater than 2 weeks post injection. All but one patient are very happy with the results with most already reporting greater than 80% pain reduction. The one that is unhappy noted a 30% reduction stating his original pain was 10/10 (which I take with a grain of salt since he walked into the clinic and was not showing signs of extreme agony) and is now 7/10. We are using the cultivated amniotic fluid stem cells which are frozen and thawed just before injection and not the invasive procedure of taking the patients own bone marrow which is much more expensive.

Obviously this sample size is not huge and we haven't followed for a sufficient time so we cant get carried away just yet but I can definitely say without a doubt that the stem cell treatment is showing much more promise than the HA injections at the moment. And I have done well over 15K HA injections over the past 8 years so I have a good sample of those.

More anecdotal evidence. One of the doctors at the clinic was always limping due to chronic tendonitis in his foot. I injected him at two sites where the pain was maximal and after 6 weeks he has no pain. He said after a work day he would come home and was in severe pain especially when he fully plantar flexed his ankle. Each day, after work, he tests it by plantar flexing to see if he can recreate his pain. He says now he only feels a slight pulling sensation in that area and I watch him walking without any limp at all.

Obviously the current cost of this treatment is still prohibitive to many but I am hoping that with more studies and more time it will be covered by most insurance plans in the near future.

 

[PTskier]

3 month update for my bone marrow stem cell injections---

My knees feel fine. Very fine. I'm still limiting hard usage of them...I limit myself to 45° squats & lunges in the gym with moderate weights. I have not felt this good, without any anti inflammatories, in many years. I'm doing more gym work, biking at a high spin rate and moderate load an hour almost daily, and walking, including walking up or down hills and on a sloped beach feels good. As we're waiting for ski season I'll gradually increase the loading on my knees during exercise.

Dr. Wagner identified some tracking problems on my right knee, the most troublesome one. I know that I pronate, and that causes the knees to flex inward when bending thus putting unusual wear on the inner surface of the knee cap. My orthotics are several years old, as are my ski boot footbeds. Wagner says to get new orthotics (and presumably footbeds if they're posted) at least every seven years. The orthotics may break down, and the body changes. The manager of the local physical therapy clinic also fits orthotics, and she gave me the best evaluation I've ever had. She evaluated my feet, my ankles, my knees, my hips, and my gait. She greatly increased the posting angle of my old orthotics with temporary strips to see how they work, and they're working great! I'm now about 6° angled for my right heel, 3° for the right forefoot, and about 5° for the left heel. This is with the thick side of the wedge toward the inside to correct the pronation where the ankle rolls inward. I'll get new orthotics made to these specs, and I need to find someone to make footbeds that match. If the PT manager can make a full length orthotic, those should be good in the ski boots.


agreen, are the thawed amniotic fluid stem cells alive? I was told that the process to prevent infection and the freezing killed the amniotic stem cells. The still contain some growth factors so there is some medium term benefit to the recipient. Is this the case?

 

[agreen]

PTskier, you are absolutely right. It actually shouldn't be called stem cells but instead growth factor/cytokines which is very similar to PRP. This would, in theory, help the inflammation but not "re-grow" cartilage. So the question will be how long can the inflammation be suppressed? I'll keep everyone updated.

 

[Jerez]

So this is very similar to Regenokine. My DH had that done for his lower back issues. It was miraculous for about 3 months the first time and then for about 3 weeks the second time. He also followed a very strict anti-inflammatory diet per the Doc's advice after each one. I'm sorry to say it was not worth it in the long (or even medium) run and he ended up with surgery anyhow. (surgery was a terrific success and he is skiing again!) It is possible that if he'd had the surgery sooner, he might have avoided some minor nerve damage that appears now to be permanent.

Here is a YouTube link.
It is possible that these work better for knees, but until you've seen more than 6 months of relief, I wouldn't say the proverbial fat lady has yet sung.

 

[PTskier]

Just to be clear, Regenokine is very different from bone marrow stem cell injections. Regenokine involves drawing blood, heating it, centrifuging it, and injecting back part of this processed blood into the damaged area. It does not regenerate tissue.

Platelet rich plasma (PRP) is one's own blood that is centrifuged to get the platelets with the intent to reduce inflammation and promote healing.

The amniotic stem cell injections are also different. The stem cells are dead. "Growth factor/cytokines" appear to offer some short to medium term relief.

As I wrote above, "Mesenchymal stem cells, or MSCs, are multipotent stromal cells that can differentiate into a variety of cell types, including: osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells which give rise to marrow adipose tissue)." These are taken from one's bone marrow, possible combined with fat cells which also contain MSCs, possible combined with PRP, and injected into the damaged joint with the intention of regrowing the damaged tissue, cartilage in my case. I think they can also regrow ligament tissue. In the knee, that would be the ligaments within the knee capsule if that was where the injection was placed. I don't know if they can work on ligaments outside the capsule if the injection is placed there.

I asked Dr. Wagner about stem cells and spines. He does not do those. He said that there is a doctor in Portland, Oregon, who does, the success rate is lower than for big joints, and the cost is higher. I'm sure other doctors elsewhere also inject live stem cells into spines.

My knees are definitely getting better. I continue to do more with less discomfort, including more bike riding, more walking in hills, more work in the gym.

Amy wrote, "With my poorly tracking patellas in both knees, and corresponding OA...." Wagner spotted a tracking problem in my right (troublesome) knee. He suggested physical therapy. The manager of the PT clinic here fits patients for orthotics. She gave me the best evaluation I've had, better that a podiatrist who just focused on my feet. She evaluated my feet, ankles, knees, hips, and gait. The result was much more shimming of my old orthotics than I'd have imagined, and immediate comfort. I don't want to change what she initially tested, so I'll have new orthotics made to her pattern, and new ski boot footbeds also made to that pattern. In the past my knee pain always was worse on the inner half of my patella. Now, correctly aligned, that problem is gone.

 

[Jerez]

Right you are. I meant (and should have specified) that the dead cell version was like Regenokine, because the point of Regenokine is to stimulate the body's own cytokines, hence the name. Or at least that's what they said to us.
Sorry for the confusion.