Knee articular cartilage surgery and non-surgical repair

Prolotherapy Knee articular cartilage repair without surgery

Ross Hauser, MD

In this article we will present the non-surgical stem cell – comprehensive Prolotherapy alternative to various surgical techniques that are designed to repair or regrow the articular cartilage of the knee.

Knee articular cartilage surgery and non-surgical repair

In researching such surgical options as:

We often find one of the successes of the surgery outcome is that the patient did not need multiple surgeries. Let’s look at new research on these procedures.

Microfracture surgery for articular cartilage repair


Currently, there is no effective non-surgical treatment for articular cartilage injury

In November 2017 doctors from the Institute of Orthopaedics in China wrote in the medical journal Trials, “Spontaneous recovery from articular cartilage injury is difficult, and the ongoing progression of disease can eventually lead to osteoarthritis. Currently, there is no effective non-surgical treatment for articular cartilage injury.

Arthroscopic debridement and microfracture surgery are performed for fibrocartilage repair. But fibrocartilage is different from normal articular cartilage, and functional recovery is not satisfactory.”(1)

This research was not as enthusiastic as earlier 2017 studies where surgical researchers were happy to announce that cartilage repair or regeneration procedures (e.g., microfracture, Autologous Chondrocyte Implantation – ACI) typically result in a satisfactory outcome in selected patients.

This was detailed by doctors at the University of New Mexico who published research in which they suggest success in selective patients undergoing knee procedures including: chondroplasty, debridement, drilling, microfracture autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft, and that while these techniques may improve patient outcomes, NONE can reproduce normal hyaline cartilage.(2)

This is the problem, the cartilage repair is not as durable as the native cartilage. It is not a long-term solution.

In March 2017, Rush University Medical Center researchers suggested in the journal Sports medicine and arthroscopy review:

And in January 2017 research from Rush and Duke Universities about youth athletes:

Curious and troubling findings in patients who previous had Microfracture surgery and then went on to total knee replacement

Researchers writing in the medical journal Orthopedics found curious and troubling findings in patients who previous Microfracture surgery and then went on to total knee replacement. In comparing total knee replacement patients who had the Microfracture surgery and those who did not prior getting knee replacement, the doctors found that

Surgery creates more bone damage

Doctors at Saarland University Medical Center in Homburg, Germany publishing in the journal Scientific reports tested the hypothesis that early osteochondral repair following microfracture surgery is enhanced if bone marrow stem cell aspirate is added as an adjunct to the microfracture procedure.

The problem they were trying to solve was that the surgery creates more bone damage.

Interestingly, debridement down to the subchondral bone similarly led to a reduction of the bone volume both in the subchondral bone plate and subarticular spongiosa.(7)

Cartilage repair surgery an example of over complication with stem cells

Here in our opinion is another example of over complicating a simple procedure, the introduction of reparative stem cells into the knee.

So here is the understanding of it all:
1. Arthroscopic drilling
2. hyaluronic acid injections
3, stem cells therapy
and more injections six months later.

The study focused on the surgery and what made the surgery work better, and it wasn’t hyaluronic acid. It was the stem cells.

Why not try the repair with bone marrow aspirate stem cells without the surgery first?

In another study doctors writing in the medical journal Arthroscopy found that in 55 knees that underwent High Tibial Osteotomy (bone resurfacing or reshaping) and microfracture, those who received stem cells with hyaluronic acid had significantly better results than those who just received hyaluronic acid.(9)

Other research including our published findings

Here is a recent study that can suggest that trying the stem cell injections first may be a more realistic option for patients especially those concerned with microfracture knee surgery recovery time and rehab.

Abrasion Arthroplasty is a procedure that sounds exactly what is is – abrasions are created on the cartilage to create an injury with the hope that the body will repair not only the new injury but the deterioration of the joint as well. This is a surgical procedure. Studies have pointed out that this procedure may help alleviate symptoms of knee pain but it is not curative.(12)

Not only non-curative – may not work at all.

Doctors at RWTH Aachen University in Germany had a problem with Arthroscopic abrasion arthroplasty. They are not sure it worked at all. To test the theory that the surgery was helpful – they examined the effusion, the swelling fluids in the knee following the surgery.

What they found was the surgery indeed starting a healing process by stimulating STEM CELLS to repair the cartilage.

Now here is the amazing part. The doctors found that during the surgery, the doctors used constant suction to drain the surgical area. The researchers now “recommend not to use suction drainage as by this procedure a considerable amount of the regenerative potential of postoperative joint effusions might be extracted.”(13)

Treatment for articular cartilage is challenging because knee cartilage shows limited reparative and regeneration abilities following injury. Traditional non-operative (RICE therapy), various injection therapies and traditional arthroscopic techniques cannot restore the normal anatomy and function of cartilage in osteoarthritis.

Stem cell therapy for cartilage repair need not be a complicated procedure. In many instances bone marrow stem cells are drawn from a patient and injected into the patient’s knee with the hope of repairing cartilage and bone damage typical of a knee with severe osteoarthritis or damage from injury. The procedure is simple in concept: inject stem cells, heal knee. Please watch the video below.

Caring Medical and Rehabilitation Services Research

Please see our discussions in the medical journal Clinical medicine insights. Arthritis and musculoskeletal disorders where our team presented three difficult knee pain case histories treated with Bone Marrow Stem Cell Aspirate.

In this article we will present clinical research and case studies to support the use of Bone Marrow Aspirate for Knee Pain. Bone Marrow Aspirate therapy is often called bone marrow stem cell therapy or simply stem cell therapy.

Do you have a question about Knee articular cartilage surgery or becoming a patient? Get help and information from our Caring Medical staff

References for this article

1 Ma N, Wang H, Xu X, Wan Y, Liu Y, Wang M, Yu W, Dai Y, Peng J, Guo Q, Yu C. Autologous-cell-derived, tissue-engineered cartilage for repairing articular cartilage lesions in the knee: study protocol for a randomized controlled trial. Trials. 2017 Dec;18(1):519.  [Google Scholar]

2. Richter DL, Schenck RC Jr, Wascher DC, Treme G. Knee Articular Cartilage Repair and Restoration Techniques: A Review of the Literature. Sports Health. 2015 Oct 12. pii: 1941738115611350 [Google Scholar]

3. Scotti C, Gobbi A, Karnatzikos G Martin I, Shimomura K, Lane JG, Peretti GM, Nakamura N. Cartilage repair in the inflamed joint: considerations for biological augmentation towards tissue regeneration. Tissue Eng Part B Rev. 2015 Oct 15. [Google Scholar]

4. Frank RM, Cotter EJ, Nassar I, Cole B. Failure of Bone Marrow Stimulation Techniques. Sports Medicine and Arthroscopy Review. 2017 Mar 1;25(1):2-9. [Google Scholar]

5. Cvetanovich GL, Riboh JC, Tilton AK, Cole BJ. Autologous chondrocyte implantation improves knee-specific functional outcomes and health-related quality of life in adolescent patients. The American journal of sports medicine. 2017 Jan;45(1):70-6. [Google Scholar]

Ansari MH, Pareek A, Johnson NR, Abdel MP, Stuart MJ, Krych AJ. Clinical Outcome of Total Knee Arthroplasty After Prior Microfracture: A Matched Cohort Study. Orthopedics. 2017 May 1;40(3):e473-e478. [Google Scholar]

7 Gao L, Orth P, Müller-Brandt K, Goebel LKH, Cucchiarini M, Madry H. Early loss of subchondral bone following microfracture is counteracted by bone marrow aspirate in a translational model of osteochondral repair. Scientific Reports. 2017;7:45189. [Google Scholar]

8 Saw KY, Anz A, Siew-Yoke Jee C, Merican S, Ching-Soong Ng R, Ahmad RS, Ragavanaidu K. Articular Cartilage Regeneration With Autologous Peripheral Blood Stem Cells Versus Hyaluronic Acid: A Randomized Controlled Trial. Arthroscopy. 2013 Feb 4. [Google Scholar]

9 Wong KL, Lee KB, Tai BC, Law P, Lee EH, Hui JH. Injectable Cultured Bone Marrow-Derived Mesenchymal Stem Cells in Varus Knees With Cartilage Defects Undergoing High Tibial Osteotomy: A Prospective, Randomized Controlled Clinical Trial With 2 Years’ Follow-up. Arthroscopy. 2013 Dec;29(12):2020-8. [Google Scholar]

10 Gobbi A, Karnatzikos G, Scotti C, Mahajan V, Mazzucco L, Grigolo B. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up. Cartilage. 2011 Jul;2(3):286-99. [Google Scholar]

11 Hauser RA, Orlofsky A. Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Clin Med Insights Arthritis Musculoskelet Disord. 2013 Sep 4;6:65-72. [Google Scholar]

12 Johnson LL. Arthroscopic abrasion arthroplasty: a review. Clin Orthop Relat Res. 2001 Oct;(391 Suppl):S306-17. [Google Scholar]

13 Beckmann R, Lippross S, Hartz C, Tohidnezhad M, Ferreira MS, Neuss-Stein S, Seekamp A, Nebelung S, Kweider N, Rath B, Jahr H. Abrasion arthroplasty increases mesenchymal stem cell content of postoperative joint effusions. BMC Musculoskeletal Disorders. 2015;16. [Google Scholar]

 

 

 

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