I'm not going to be any help, but am interested in this as well. I've had multiple knee surgeries and am looking into options to help minimize and reduce my recurring swelling as I'm close to bone on bone in my right knee. Good luck!

I am not a physician nor have I had any of these treatments but i am a researcher who deals alot with osteoarthritis:

the knee joint is tricky to repair because there is a lack of blood ( vascularization ) in the area. tissue needs blood for it to heal, which explains the rationale for treatment 2).

You are right about 1)- it's not a permanent fix. But it is 'relatively' proven to work in most people, around 70% of the time it is pretty good. levels of relief may vary widely between subjects, though. read more here:
http://jbjs.org/content/86/3/538.


quoting them " We found that the patients who were older than sixty-five years of age and those with the most advanced radiographic stage of osteoarthritis (complete loss of joint space) were less likely to benefit from intra-articular injection of hyaluronic acid. Understanding the differences in hyaluronic acid efficacy among different patient populations is important when selecting patients for this therapy.....Despite the low rate of complications, injection of cross-linked hyaluronic acid may be associated with a painful acute local reaction, which should be considered a major adverse event49-52. However, the rate of painful acute local reactions to Synvisc injection in this meta-analysis (one of 139 knees) was lower than those in some other reports49-52, in which the rates have ranged between 2% and 8%"

2) and 3) are very much 'new' treatments, having surfaced within the last decade or so. we don't have long term results on them yet. I can't give you statistics or results because they are simply too new. They work wonders in the lab but their use in large scale application hasn't been fully explored yet. both are very much 'experimental'. the exact 'best' formulation of PRP and stem cells has yet to be determined. same for the PRP. here it would really depend on how good a doctor you have.

How high a success rate is your sports clinic claiming for the PRP procedure, and with what age groups? regenerative techniques (2 and 3) have higher changes of success for younger patients ( and sorry to say at 46 you're not that young anymore), so bear that in mind here. There 'may' be some complications in future we don't know about yet either- some doctors have hypothesized that growth factors in PRP might have a very small chance to cause cause fibrosis of the knee muscles. but as yet, no proof.

Can you afford the regenerative treatments? if you could personally I would try them out before synvisc. either way though, you're rather lucky because some rather promising products are coming out for knee menisucus patients- the Nusurface , CMI implant and the Actifit in particular. these are not FDA approved yet but are already being used in europe.
http://orteq.com/healthcare/actifit/
http://www.ivysportsmed.com/en/collagen-meniscus-implant
http://www.activeimplants.com/our-products/nusurfacer-meniscus-implant.html


good luck!

Thank you for those links...looks like some pretty cool treatments in the pipeline.

Let me ask about age and emerging therapies - at 55 and 41 years of running and going on 34 years of triathlons I am getting achy and creaky. Knees sometimes swell a bit after hard or long races, but I really do very well on a daily basis and my training, including IM training, is not limited. So, I am curious what your research might show for someone in my situation.

Thank you,

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David
* Ironman for Life! (Blog) * IM Everyday Hero Video * Daggett Shuler Law *
Disclaimer: I have personal and professional relationships with many athletes, vendors, and organizations in the triathlon world.

i had stem cell at age 65 for oa in left knee. as background i had major posterior horn meniscus removal in right knee at age 58. it was locking up and tear was major. as result i think, i favored that knee and put more stress on left knee and tried to keep running up for triathlons. as result i developed degenerative tears in left knee and major league oa. i could not bend the knee without pain. i could not run period. the amazing thing is the knee i had surgery on did not have oa as the doctor predicted. i can feel it on rainy cold days, but otherwise the one with surgery is apparently free of oa at this stage. back to the left knee with major league oa. when i went back to same excellent doctor (at emory and is the team knee and shoulder doc for ga tech) for a look at the arthritic left knee with tears, he said though i had minor tears he did not recommend surgery for removal. he said oa is the culprit for the pain. he said quit running and do yoga. i left dejected and researched stem cells at the regenexx website for next several months. it looked promising but the distance and cost was a drawback given probabilities. emory at that time did not do stem cell. they did do prp and synvisc but results were apparently not conclusive enough for them to make any promising recommendations. this was 2011.

fast forward to late 2013 and emory started doing stem cell. so in september 2013 i had the first phase done (drill into hip bone and harvest cells). 6 weeks later they did follow up just pure prp. it was not painful and done rather economically, $2500 at the time. no issurance coverage. the doc told me to give it time to take effect and truly work its majic if it was going to take hold. despite being an old duck, 65, if figured this is the last hope i have at running. so i gave it a lot of time to heal/rejuvenate and also made dietary changes to reduce inflammation and build collagen etc. I could tell within weeks it was beginning to work. a knee i could barely bend was now bendable and pain free. but i gave it time.

so i held off running (biking and swimming were mostly always fine before) for nearly 7 months. and built slowly. like run 2" walk 1". during the whole period i did do ellipital without pain. my long run now is only 4 miles, but i have been running pain free (some brief morning stiffness quickly disipated) and i have been very consistent with 3-4 short runs a week. it seemed in addition to slight stiffness i had to reacclimate the tendons & ligaments as the long layoff and reduced activity for nearly 5-6 years had an impact.

bottom line the stem cell treatment was the best money i ever spent. i opted for it as i am running out of time due to age. you have relative youth on your side. i have raced twice since starting back and i have won my age group at races in florida( rocketman classic and clearwater trirock). the advantage i had during the convalescence was more time on bike and swim. my run time at rocketman was slow given first race and nearly 31 mile bike. but run at trirock was sub 8 pace. the dietary changes i made to reduce inflammation have really improved my overall sense of health.

so bottom line: i highly recommend it, but do your own research. here are a couple of helps:

http://www.regenexx.com/


http://news.emory.edu/stories/2013/03/ortho_mautner_stem_cell_injections_osteo/index.html


hope not too winded for you.....best of luck

I had the three standard Synvisc injections late last year leading up to surgery on my left knee in December. Once inside the knee, my doc found damage worse than expected and performed a micro-fracture procedure on the 1.0 x 1.2cm full thickness defect in the trochlear grove area. (the defect was not well shown on the MRI imaging). The Synvisc was tried in part to see if I could avoid the surgery. Outside of the day or two of tenderness around the injection site, I couldn't feel ANY real difference in the knee whatsoever from the days before the injection series to the weeks after leading up to the surgery. Good Luck

Michael

I'm very interested in future research. I hear stem cell is coming to the US in 2015 or very soon after. My step dad did stem cells on horses as a vet and he said he had great outcomes. I'm intrigued to hear more about people that have had this done. Good to hear you had a good outcome! Thanks for the post
</htm

Thanks everyone.... There has been some wonderful links to additional research of these types of therapies provided here....

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Hook Em' Horns

I am 38 have also have an OA pothole in my knee following multiple knee surgeries as a youngster soccer player... I researched several treatments as you have and visited the doc. Ultimately I tried glucosamine supplements as a 1st step with little expectations and my knee has felt better than it has since I was 15. I also now run in Hoka's...

For what it's worth, my doc who was very in tune with all of the new research and off shore treatments told me (last year) that we are about 5 years from the day I can walk in the office and be cured fairly simply....

My advice - Consider baby steps.... the supplements have worked for me, maybe before you get the engine change re-built, try an oil change....

Good Luck!

GoJohnnyGo I have a co-worker who has the exact condition you have... He tried two (2) Synvisc injections and had zero improvement.... He then tried the PRP injections, to date he has had two (2), and he claims his knee is approximately 98% improved and is actually now stronger than his other knee.....

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Hook Em' Horns

did he elaborate? stem cell improvements or meniscus replacement materials for implants...just curious. maybe there will be 90-94 and 95-99 ages group categories soon.

I'm not trying to be crude here, but are they seriously giving you an injection ultimatum for treating "minor" OA?

You are only 46. Relatively young in terms of treatment options but old enough to EXPECT some degeneration especially given your activity choices.

You only report "flare ups" over the past year, which could happen to anyone for any number of reasons. You are still able to complete Ironman training/racing and pretty intense hiking annually.

I understand all of those treatments and have seen them used effectively and ineffectively. Given your situation, it doesn't seem warranted unless I'm misunderstanding how "minor" the OA is or they downplayed it to you.


My personal opinion with an over the phone diagnosis...they're blowing this out of proportion. You're 46, a long course triathlete and mountain hiker. I would expect some amount of degeneration in you just like I would expect it in anyone into their 5th decade of life and inactive or overweight.

You should get a second opinion and focus on strict muscular strengthening of your quads and pelvis before going to injections or PRP for "minor" OA. Just my opinion.

Why get a needle at all if you can do some intense strength training and achieve the same goal. Degenerative changes cannot be fixed, only slowed and mitigated.

OA and degenerative changes occur when you have abnormal stresses to the joint/articular surfaces. You have the changes due to some sort of abnormal stresses in your particular situation. Synvisc/PRP/stemcells/cortisone etc will only address the symptoms and does nothing to address fixing the cause of the abnormal stresses. If you stabilize your joint better you will be doing due diligence to limit the amount of continued degeneration. Get those quads and hips strengthened to the max and you'll kill two birds with one stone (address symptoms and control the process).

Again this is just assuming it is only minor changes which you have alluded to. Don't go crazy with this one. Best!

I did not take your post to be crude at all Yeeper! In fact I enjoy and encourage the contrasting opinions here as long as they are factual and constructive...

I should of added to my post that I was seeking some type of treatment or therapy that would enable me to remain active and keep me engaged in the activities that I love to participate in and ultimately avoid a knee replacement later on down the line....

Your post is informative and has sparked my curiosity as to exactly what type of muscular strengthening I can do for my quads and pelvis region to stabilize my knee joint?

I agree with your assessment that some abnormal stress is causing the reaction in my knee joint... Could this be something as simple as maybe running in the wrong pair of shoes?

Aside from getting evaluated at my local running shop(s), how can I get an accurate evaluation as whether or not there is something bio-mechinacally wrong with my running form that maybe contributing to this development of minor OA in my knee?

I appreciate your thoughts and opinions....

Thanks again!

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Hook Em' Horns

Unfortunately.. it is not so simple.

Yeeper is correct in saying that muscular strengthening 'could' reduce osteoarthritis.... but to be honest the science is very much unclear on this. We are very much unclear on what exactly predisposes one to osteoarthritis. The most important factor I can really say is obesity, as your weight really does play an important role here. but other biomechanical factors.... we don't know so much.

In theory, yes, there are some factors that would help-to understand that you will need to know abit more about knee anatomy and loading patterns at the knee. The knee is divided into two parts- the medial and lateral components ( medial being closer to the middle of your body, lateral on the outside). Due to the angle that the femur makes with the tibia, the loading pattern on the knee is somewhere around 60-70% of load on the medial compartment, with the remainder on the lateral compartment. This is one reason why we commonly see osteoarthritis on the medial side of the knee rather than the lateral side. we theorize that the larger hips of women (and their predisposition to bone-related diseases later in life) also likely causes a higher incidence of osteparthritis in women than men. ) In theory, reducing the load on the medial compartment by measures such decreasing knee adduction or limiting excessive pronation " should " reduce osteoarthritis of the knee, but this is an incredibly difficult thing to measure. Literature out there is quite fuzzy - we have no concrete evidence of this. Some researchers say knee adduction angles are lower in non-osteoarthritic patients versus osteoarthritic patients, but we don't know if this is a consequence or a causal factor. Gait analysis is pretty complex- changing one factor may change a host of other factors as well- for example, if you change that load pattern to a more equal distribution, might you see osteoarthritis occur in the lateral component? We see some limited evidence of this in patients who have undergone knee replacement , where surgeons typically try to cut and install the hardware such that you have a more 'level' joint. (then again, a patient with a repair will hardly have similar biomechanics as a normal patient, so this is sort of difficult to take at face value as well. ) How about causing osteoarthritis at the patella and femur interface? could that change? maybe. you decrease moments somewhere, it increases somewhere else. energy is energy, it has to go somewhere. What if you get hip or ankle osteoarthritis over knee, which are more difficult to treat? No one has come up with a foolproof physio treatment to manage knee OA- some groups have found it works, some found it made little difference.

http://www.sciencedirect.com/science/article/pii/S1063458407003974
http://jama.jamanetwork.com/article.aspx?articleid=412600
http://ard.bmj.com/content/62/12/1145.short
http://www.jrheum.org/content/30/6/1311.short
http://ard.bmj.com/content/64/6/906.short
http://www.bmj.com/content/325/7367/752.short

Shoes are the source of huge debate- and suffice to say you really won't find a conclusive answer to this. I'm not a shoe researcher, but the huge gamut of theories about shoe shape, design, running styles, minimalist running should tell you that no one really knows the answer. I will say that I am not a fan of minimalist running though. The group that says 'we were born to run' is probably right... but saying that everyone's body is perfectly adapted to running is hogwash. abnormal biomechanics can and do cause problems, and conventional shoe wisdom, with some caveats, has worked well for me. if you're biomechanically blessed, then it might work for you. if not, not so much. if you run alot, seeing a good podiatrist is important. If you have one who has a proper gait lab ( not the ones in running shops) even better.

In terms of supplements like glucosamine- they are rather pointless. save your money. Either you start taking it early- way before any joint problems start- or not at all. taking it when you start to get joint pain is pointless. And you need to be disciplined in taking them one pill of the typical aftermarket glucosamine supplements is supposedly ( from literature I've read) is not enough to cause an effect.

ultimately osteoarthritis is a biomechanical problem- we can't stop wear and tear on the joints, but we do suspect there are some ways we could limit it. Obesity and weight control is one, but not the only one. Why do some marathon runners, who run thousands of miles over their lifetime, never see OA, but some do? why do some healthy people see OA but some obese people don't? ( given similar activity levels). I do not think it is as simple a measure as strengthening some muscle groups.

By all means you can try strenghening, physio, taping, or non invasive measures. they may or may not work for you depending on a whole load of things. seeking a second opinion is of course fine as well. Without seeing some sort of scans its difficult to judge how bad your OA is. But if your doctor is good and you trust him well it's really your choice.

Hi All,

Unfortunately, this is also an interesting topic for me, since I was diagnosed with osteoarthritis in both my knees. And I'm only 40 years old.
I have a background in triathlon (one ironman finish, several 1/2 ironmans) but stopped about eight years ago (job, kids). Kept running (several 1/2 marathons) / cycling but less intensive and less often.

Currently, I'm only suffering from problems with the knee cap of my right knee. Option 1 has also been proposed to me and I soon give it a try. Just to reduce the mechanical problems I experience during sports.
Interesting to read that in the US options two and three are possible at all. In my country (the Netherlands) these options are still science fiction, but maybe possible with 5-10 years from now.

I have been strongly adviced to quit running (as I am also clearly suffering from osteofyts), although it depends a bit who you ask. But I think it makes sense to quit running. I moved now to rowing (and some cycling), and that works fine for me the moment. However, rowing might be not the best exercise to do also for the knees, but less problematic compared to running. Low-profle cycling and walking are adviced.

The perspective I have is that I need a replacement of the knee cap somewhere in the future, which I would really like to avoid. I hope I can slow down the whole degeneration process (option 1 doesn't contribute to that, but it doesn't harm) the coming years and hopefully there are better treatments possible (like option 2 and 3) within a couple of years.

Dutch. I am an elite cyclist with pretty bad knee problems, so much so that I had to stop cycling last summer. After 4 months I still did not improve so I had a single PRP injection and I can say that I have seen at least a 15% improvement. Difficult to quantify but I improved to the point I was able to get back on the bike everyday this past December/January while on holidays in Brazil. I also had a professional bike fit done but a bio-mechanics expert who doesn't just Depend on a computer to fit his clients.

I also considered a syn-visc type of treatment but I tried prp first. I have my second injection this week which is 2 months after my first treatment. Could you go to Germany to receive this?

Tim T

If you're symptomatic enough, which only you can decide, choose option 1. Easy, fast, cheap (relatively), low risk, not irreversible. Given it, had it.

Best,

John

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

John did you have any success with option 1? What were your symptoms?

Let's take this to a PM and not bore the others.

John

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

Here is an update: I ended up having the Synvisc Injection back in early December.... I have to say I am really impressed... The pain is gone and my knee is back to normal... I have resumed running and to date I have had no issues....

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Hook Em' Horns

I have had a "major " osteoarthitis diagnoses .... with little remaining cartilage remaining in my right knee.... just had synvisc injection done and am now back running ..10K yesterday..
Still painful but manageable
PS I am 49 years old

Jeff

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You can't fix stupid ..

Thank you all for your responses, also the person who started the this thread.

I will give option one a try. It is not a standard treatment in the Netherlands, but offered to me after a second opinion consult.
Would be very happy if the mechanical problems are reduced this way. But a return into running is a no-go for me.

@Tim: What do you mean by a 15% improvement? Of what?
I have had a dynamic bike fit done, a couple of years ago. This was done by the team doctor of the professional argos / shimano cycling team. At that time I was suffering with 'locking problems' of my right knee. I had to switch to a new bike after I had a serious (stupid) bike crash. Adjusting my position on the bike solved the knee problems at that time and running was also going fine.