Knee Osteoarthritis And PRP Knee Injections heal injured knees by changing the diseased knee joint environment

to a repairing knee environment by waking up native stem cells in the knee.
 

The basics behind how PRP works for knee osteoarthritis is summarized in research from doctors at the University of California. In their study in the publication Tissue engineering. Part B, Reviews, the doctors suggest that PRP injections cause positive, beneficial, and healing cellular changes in the joint environment. These changes help move the knee from degenerative knee disease to a healing and regenerating knee joint. Healing includes: regeneration of articular cartilage, increasing the volume of natural knee lubricants, and waking up the stem cells present in the knee to assist in the transformation to healing environment.

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In the present study, the researchers wrote: PRP modulates the repair and regeneration of damaged articular cartilage in the joints and delays the degeneration of cartilage by stimulation of mesenchymal stem cell migration, proliferation, and differentiation into articular chondrocytes (the cells of cartilage).

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• What this last sentence means is that stem cells in the knees, responsible for repair on many levels, migrate because PRP call them to the site of the injury, proliferate – make more of themselves, differentiate – change themselves into cartilage.  In addition PRP reduces the pain by decreasing inflammation of the synovial membrane where pain receptors are localized. Synovial membrane is a protective layer of connective tissue that is also responsible for creating synovial fluid that lubricates the joints.
   

Is PRP a knee lubricant like gel shots?​

• As amazing as the above research is – it is another in the progression of studies. Previously in 2015, the same University of California Davis researchers speculated that PRP provided the lubrication needed to protect the cartilage. The study researchers summarized that intra-articular injections of PRP have the potential to relieve the symptoms of osteoarthritis in the knee and that there is an influence on superficial zone protein (SZP) which is a boundary lubricant in articular cartilage and plays an important role in reducing friction and wear and therefore is critical in cartilage regeneration.

 

You may be recommended a damaging cortisone injection

Over the years we have seen many patients who have received corticosteroid (cortisone) injections for joint pain. Unfortunately for many, excessive cortisone treatments lead to a worsening of  chronic pain.

• Corticosteroid damaged knee cartilage and provided no significant pain relief after two years.

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In 2017, doctors from Tufts Medical Center in Boston, asked “What are the effects of intra-articular injection of 40 mg of triamcinolone acetonide (corticosteroid injection) given every 3 months on progression of cartilage loss and knee pain in patients with osteoarthritis?”

Writing in the Journal of the American Medical Association, (JAMA) they published their answer:

“Among patients with symptomatic knee osteoarthritis, 2 years of intra-articular triamcinolone, compared with intra-articular saline, resulted in significantly greater cartilage volume loss and no significant difference in knee pain. These findings do not support this treatment for patients with symptomatic knee osteoarthritis.

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WILL PRP TREATMENT HELP ME AVOID SURGERY?

With any treatment option the outcome and sustained results are highly dependent on the extent of the injury. For example in the case of mild arthritis, PRP could potentially prevent the development of further degeneration. However, in advanced arthritic degeneration the goal of the treatment is to minimize pain and improve function. PRP (potentially if used in tandem with the use of stem cells) could avoid surgery such as joint replacements and potentially spinal fusion.

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HOW IS PRP CREATED?

Creation of PRP is simple, painless, and conveniently done at an office visit. The entire process of drawing blood to solution preparation only takes approximately 25-30 minutes. A small amount of blood is drawn from the patient, just like a routine blood test. Once the blood is drawn it is then placed into a centrifuge. The centrifuge is a machine that spins the blood at high speeds in order to separate the blood into red blood cells and concentrated platelets. Once the blood is separated the red blood cells are discarded, and we are left with concentrated platelet rich plasma (PRP) which is ready to be used in the treatment process.

Generally speaking PRP injections are not painful; however the discomfort level depends on the part of the body being treated. Injections into the joint are of minimal discomfort. There is sometimes a small amount of pain after the procedure; however this does not last more than a few days and can be minimized with over the counter Tylenol. It is critical to avoid anti-inflammatory medications such as Aleve, Motrin, Celebrex, Naprosyn, and Mobic. These drugs may impede the healing process.

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WHEN CAN I EXPECT TO FEEL BETTER?

The benefit to PRP therapy is that unlike other treatments it has a sustained outcome and is categorized as a permanent fix. The timeframe for experiencing results is dependent upon the area of injury and the extent of the injury. On average, most patients start to see signs of improvement in the form of reduced pain or increased function within four to six weeks. Continuing a well-designed course of physical therapy and avoidance of aggressive physical activity or overloading the injected tissues is advised in the weeks that follow the injections. This is done to allow the tissues to heal best.

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Platelet Rich Plasma versus Stem Cells

How does PRP compare to a stem cell treatment?  First, one must be very clear about what is needed to ‘fix’ a given problem, and this is where some of the common diagnostic misconceptions in the medical community come into play.   For instance, in a knee that has significant loss of cartilage (bone on bone), are the symptoms actually due to ‘bone ends rubbing together’, and to an inflammation (arthritis), or are the symptoms in knees where cartilage loss is noted primarily coming from the ligaments and tendons around the knee, and is the cartilage loss due to mechanical abrasion due to ‘loose ligaments’?  

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A pure Stem Cell treatment ONLY grows new tissue, like cartilage.  It DOES NOT add new collagen to ligaments and tendons, which is the way that pain and joint instability are successfully treated and resolved.  Research studies have clearly shown that addressing ‘bone on bone’ knees by simply treating the cartilage surface and trying to grow new cartilage, does not give as good, or as enduring, symptom relief as treating the ligament and tendon structures in conjunction with treating the joint surface.  Some doctors are  personally convinced that a significant percent of the symptoms in such knees, and other joints, are in fact coming from stretch-induced small fiber nerve damage in the damaged ligaments and tendons, NOT from the cartilage loss, and our treatment strategy targets both issues.  They are also convinced that the loss of cartilage is in fact due to ‘loose’ ligaments, which are in turn caused by a lack of collagen molecules in these ligaments (unhealed damage).  So, stem cell treatments address only one of the two major causes of joint pain in ‘bone on bone’ joints, and probably the more minor of the two causes, while PRP addresses both causes.  The excellent results obtained by basing our treatment strategy on thoroughly treating both causes of pain in patients in whom total joint replacement has been recommended, lends supports this idea.

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While stem cell treatments do produce good clinical results in patients with ‘large joint’ cartilage loss (knee, hip, shoulder), there are two concerns about using this treatment strategy:  First, THE COST.  If equivalent, much less better, results can be obtained by using a treatment strategy that is a fraction of the cost, why not fully explore the much less expensive option?  Secondly, in a situation where cartilage has been lost, and the primary effort is to provide a nice, shiny new layer of cartilage, one must also ask what is likely to happen to this new, expensive layer of cartilage going forward?

 

I would gently suggest that in all likelihood, the same thing will happen to this new layer that happened to the original cartilage.  Unless the ligament laxity that caused the initial cartilage loss is successfully addressed, results will likely not be long-lived.   Many doctors would simply point out that they have not seen a single patient with significant cartilage loss who does not also have demonstrable ligament laxity of the anterior cruciate ligament, and likely other ligaments.  It is emphasized that most Orthopedic surgeons and other physicians who offer stem cell treatment, and PRP treatment, are apparently not aware of the role of the ligaments in causing either pain or cartilage loss (they assign the cause of the damage and the pain to an inflammatory process called ‘arthritis’…which has largely been discounted by recent research), and their treatment strategy—simply inserting either stem cells or PRP in the joint capsule, in conjunction with treatment with anti- inflammatory medication—reflects the belief that all of the symptoms are arising from a combination of cartilage loss and joint inflammation.

 

This treatment strategy would be likely to produce results with far less than 100% relief of symptoms—which research studies clearly confirm—and the results that are produced will probably diminish over time— which research studies also confirm.

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Again, simply putting stem cells into the knee capsule will have no effect on ligament length, strength, or symptom production, and to the extent that this ligament mechanism for symptoms remains unrecognized by the practitioner, the patient’s actual pain sources will remain untreated.

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PRP and Dextrose Prolotherapy does an excellent job of treating a very high percentage of these patients, would reasonably be ‘first line’ therapy, with stem cell treatment, or total joint replacement, reserved for the small percentage of these patients—less than 5%—that do not respond adequately to these ‘first line’ options.